表现为男性间质性膀胱炎的膀胱癌4例诊治分析并文献回顾  

Diagnosis and treatment of bladder cancer manifesting as interstitial cystitis: report of four cases and literature review

作　　者：杨洋[1] 张中元[1] 吴士良[1] Yang Yang;Zhang Zhongyuan;Wu Shiliang(Department of Urology,Peking University First Hospital,Beijing 100034,China)

机构地区：[1]北京大学第一医院泌尿外科

出　　处：《中华临床医师杂志（电子版）》2019年第11期860-863,共4页Chinese Journal of Clinicians(Electronic Edition)

摘　　要：目的探讨表现为男性间质性膀胱炎/膀胱疼痛综合征(IC/BPS)的膀胱癌4例患者的特点及诊治经过,以期提高对男性表现为IC/BPS的膀胱癌的诊治效率。方法收集2015年1月至2018年1月就诊于北京大学第一医院泌尿外科行膀胱水扩张随机活检的男性间质性膀胱炎患者,对住院期间相关临床资料及门诊随访资料进行分析。结果 4例术后病理确认为膀胱癌患者纳入本研究,年龄分别为53、46、71、67岁。其中1例患者曾接受前列腺钬激光剜除术。4例患者病理分别为乳头状移行细胞癌、高级别尿路上皮癌、高级别尿路上皮癌、乳头状移行细胞癌。术前自由排尿最大尿量分别为155 ml、18 ml、75 ml、93 ml,水扩张后膀胱容量为400 ml、95 ml、140 ml、250 ml。膀胱水扩张均具有黏膜苍白、广泛点状出血及局部纤维素样渗出表现,其中2例具有局部黏膜发红增厚、滤泡样改变。4例患者最终均接受了膀胱全切尿流改道术,术后疼痛症状均缓解,随访均无复发。结论男性IC/BPS需要警惕膀胱癌的存在,推荐多位点、重复的随机活检,可能提高膀胱癌的确诊率。Objectives To explore the characteristics, diagnosis, and treatment of four cases of bladder cancer presenting as interstitial cystitis/bladder pain syndrome(IC/BPS) to improve the diagnosis and treatment efficiency of bladder cancer in men with IC/BPS. Methods Male patients with interstitial cystitis who were admitted to the Department of Urology of Peking University First Hospital for random biopsy and water dilatation from January 2015 to January 2018 were reviewed. Relevant clinical data and follow-up data were collected. Main symptoms, duration of symptoms, microscopic manifestations of water dilatation, postoperative pathology, reoperation method, and follow-up information were summarized. Results Four cases were confirmed as bladder cancer by pathology and were included in this study. The patients were aged 53, 46, 71, and 67, respectively. One of the patients had previously undergone holmium laser enucleation of the prostate. The pathologies were papillary transitional cell carcinoma, high-grade urothelial carcinoma, high-grade urothelial carcinoma, and papillary transitional cell carcinoma, respectively. The maximum preoperative free urine volume was 155, 18, 75, and 93 ml, respectively, and the bladder capacity after water dilatation was 400, 95, 140, and 250 ml, respectively. The bladder showed a pale mucosa, extensive punctate hemorrhage, and local fibrinous exudation during water dilation. Cases 1 and 4 showed redness and thickening of local mucosa and follicular changes. All the 4 patients finally received total bladder resection, and the pain symptoms were relieved in all. No recurrence was detected. Conclusion Men with IC/BPS need to be alert to the presence of bladder cancer, and multiple, repeated random biopsies are recommended, which may improve the diagnosis rate of bladder cancer.

关 键 词：间质性膀胱炎 膀胱癌 男性 

分 类 号：R737.14[医药卫生—肿瘤]