膀胱原位癌误诊分析并文献复习  

Misdiagnosis of Carcinoma in Situ of the Urinary Bladder and Literature Review

作　　者：敖金文 黄欣[2] AO Jinwen;HUANG Xin(Department of Urology,Wuxi Branch of Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine,Wuxi,Jiangsu 214142,China;Department of Urology,Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine,Shanghai 200025,China)

机构地区：[1]上海交通大学医学院附属瑞金医院无锡分院泌尿外科,江苏无锡214142 [2]上海交通大学医学院附属瑞金医院泌尿外科,上海200025

出　　处：《临床误诊误治》2024年第8期20-23,共4页Clinical Misdiagnosis & Mistherapy

摘　　要：目的探讨膀胱原位癌的误诊原因及预防措施。方法回顾性分析2019年10月—2022年10月收治曾误诊的膀胱原位癌4例的临床资料。结果本组2例表现为尿频、尿急6月余,加剧1周,伴少量血尿;1例表现为排尿困难2月余;1例表现为排尿困难3年余,行前列腺电切术后出现尿路刺激症状10月余。初期诊断为慢性膀胱炎2例,尿道感染和前列腺炎各1例。误诊时间(10.34±2.26)周。按误诊疾病治疗后皆症状反复,后结合疾病特点和尿脱落细胞学、膀胱镜及病理检查等最终确诊为膀胱原位癌。3例行膀胱内注射卡介苗结合膀胱肿瘤电切术治疗症状改善,随访1~3年无复发;1例拒绝治疗和随访。结论膀胱原位癌无典型临床表现,易与泌尿系统感染性疾病相混淆,临床医师需加强对该病认识,提高对其鉴别诊断能力,并及时完善相关医技检查,以减少或避免其误诊误治。Objective To investigate the causes of misdiagnosis of carcinoma in situ(CIS)of the urinary bladder and its preventive measures.Methods The clinical data of 4 patients with CIS of the urinary bladder who had been misdiagnosed in our hospital from October 2019 to October 2022 were retrospectively analyzed.Results In this group,2 patients showed repeated frequency and urgency of urination for more than 6 months,which was aggravated for 1 week,accompanied by a small amount of hematuria.One patient presented with dysuria for more than 2 months,and one patient presented with dysuria for more than 3 years and urinary tract irritation for more than 10 months after electroprostatectomy.The initial diagnosis was chronic cystitis in 2 patients,urethral infection and prostatitis in 1 patient.The duration of misdiagnosis was(10.34±2.26)weeks.According to the misdiagnosed diseases,the symptoms were repeated after treatment,and then combined with the characteristics of the disease and urine cytology,cystoscopy and pathological examination,the final diagnosis was CIS of the urinary bladder.Three patients receiving intravesical injection of BCG vaccine combined with electroresection of bladder tumor reported significant improvement in symptoms.They were followed up for 1-3 years,and no recurrence was reported.One patient declined treatment and follow-up.Conclusion CIS of the urinary bladder has no typical clinical manifestations and is more likely to be confused with infectious diseases of the urinary system.Clinicians need to strengthen their understanding of this disease,improve their ability of differential diagnosis,and perform relevant medical examination in time to reduce or avoid misdiagnosis and mistreatment.

关 键 词：膀胱肿瘤 原位癌 误诊 膀胱炎 尿道感染 前列腺炎 诊断 鉴别诊断 

分 类 号：R737.14[医药卫生—肿瘤]