膀胱内翻性乳头状瘤的影像学特点及治疗分析  

Imaging Characeristics and Treament of Inverted Papilloma of the Bladder

作　　者：杨奕[1] 顾家为 崔新浩[1] 周慧芳[1] 郭彦超[1] YANG Yi GU Jia-wei CUI Xin-hao et al(Shijingshan Teaching Hospital of Capital Medical University, Beijing Shijingshan Hospital, Beijing 100043, China)

机构地区：[1]首都医科大学石景山教学医院 北京市石景山医院,北京100043

出　　处：《中外医学研究》2017年第19期3-5,共3页CHINESE AND FOREIGN MEDICAL RESEARCH

摘　　要：目的:探讨膀胱内翻性乳头状瘤(IPB)的临床表现,影像学特点及其治疗方法。方法:回顾性分析笔者所在医院经手术病理证实的9例膀胱内翻性乳头状瘤的B超、CT的特点,膀胱镜下表现,临床表现、治疗及预后。结果:全部患者术前均行泌尿系B超及CT增强检查,B超发现膀胱内实质性占位病变7例,均为单发病灶,病灶根据声像学表现4例为结节型,2例为条带型,1例为不规则型,63.6%病灶内部无血流信号;CT发现膀胱占位7例,肿块均为单发,其中4例呈乳头状、有蒂,3例呈菜花状,具有广基底,有3例增强扫描病例呈中度-高度均匀强化,延时扫描表现为边界清楚的低密度充盈缺损,肿块局限于膀胱腔内,未见明显囊变坏死,膀胱外膜层光滑,与膀胱周围结构分界清楚,盆腔内未见明显异常肿大淋巴结。膀胱镜检查发现肿瘤大小0.5~3.5 cm,5例位于三角区,2例位于膀胱颈部,2例位于侧壁,有蒂6例,无蒂3例。全部患者均同期行经尿道膀胱肿瘤电切术,1例合并良性前列腺增生者同时行经尿道前列腺激光汽化切除术,1例合并右侧输尿管结石同时行输尿管镜激光碎石。4例术后予羟基喜树碱40 mg/次行膀胱规律灌注1年,全部患者随访3个月~10年未见复发。结论:B超上IBP病灶纵径明显大于横径,呈带状伸入膀胱内,病灶内部多无血流信号或仅见少量血流信号是IPB最具特征性的声像表现;CT上IBP大多数表现为单发实性肿块,肿块局限于膀胱腔内,有蒂或宽基底与膀胱壁相连,膀胱外膜层光滑,病灶边缘与膀胱周围结构分界清楚,增强扫描肿瘤呈中-高度强化;治疗上IPB大多瘤体较小、有蒂,呈非浸润性生长,不侵犯肌层,故TURBT是其治疗的"金标准"。该病预后良好,但需定期随访。Objective： To explore the color Doppler ultrasonography and CT imagilogical characteristics, the clinical features and prognosis, to establish some key points in the clinical and surgical management of inverted papilloma of the bladder （IPB）.Method： The Uhrasonographic, CT images and clinical features of 9 patients with pathologically proved IPB were retrospectively analyzed.Result： 7 of 9 patients were found bladder tumor after underwent transabdominal ultrasonography and CT before operation.The maximum diameter of tumors was 0.5~3.5 cm, The tumors were papillary（n=7） or cauliflower-shaped（n=3）.Color Doppler flow imaging（CDFl）showed that there were no blood flow signals in 63.6% cases.On CT, the typical appearance oflPB were single solid masses with pedicle basement and smooth bladder extine, and moderate to high enhancement was observed after injection of eonti＇ast medium in 3 cases.All cases received transurethral bladder tumor resection and Pathology was defined as inverted papilloma of the bladder.4 cases received the intravesical chemotherapy and postoperative follow-up time was 3 months-10 years, among which no recurrence was seen.Conclusion： The Uhrasonography and CT findings of IPB reveal some IPB＇s characteristics, which are of certain value in the initial diagnosis. The final diagnosis should be relied on eystoscopy and postoperative pathological examination.Transurethral bladder tumor resection（TUR-BT）is the main method of treatment, and the intravesical chemotherapy and follow-up are necessary.

关 键 词：膀胱内翻性乳头状瘤 超声 体层摄影术 诊断 治疗 

分 类 号：R737.14[医药卫生—肿瘤]