膀胱黏膜红斑样病灶的特征和活检病理结果分析  

Biopsy pathological analysis of bladder mucosal red patch

作　　者：王鑫[1] 王志洋 陈慧玉 沈洪伟 张顺[1] 张青[1] 邓永明[1] 张士伟[1] 郭宏骞[1] WANG Xin;WANG Zhiyang;CHEN Huiyu;SHEN Hongwei;ZHANG Shun;ZHANG Qing;DENG Yongming;ZHANG Shiwei;GUO Hongqian(Department of Urology,Nanjing Drum Tower Hospital,Affiliated Hospital of Medical School,Nanjing University,Nanjing 210008,China)

机构地区：[1]南京大学医学院附属鼓楼医院泌尿外科,江苏南京210008

出　　处：《现代泌尿外科杂志》2024年第8期685-690,共6页Journal of Modern Urology

摘　　要：目的分析经膀胱镜检查发现的膀胱黏膜红斑样病灶(RPL)的特征及病理良恶性概率,探讨RPL活检的意义。方法回顾性分析2019年1月—2023年6月南京大学医学院附属鼓楼医院泌尿外科膀胱镜检查中发现RPL患者的性别、年龄、膀胱镜检查原因、是否有疤痕、并发症以及活检病理结果等资料,按照病理结果将患者分成良性组和恶性组,分析其临床和RPL特征。结果共收集521例患者资料,其中病理结果良性416(79.8%)例,恶性105例(20.2%),恶性组患者平均年龄更高,差异有统计学意义[(66.8±12.2)岁vs.(62.8±12.9)岁,P=0.005]。膀胱镜检查原因为膀胱癌/肾盂输尿管癌术后随访、血尿待查和下尿路症状患者RPL的恶性检出率分别为23.7%(92/389)、19.6%(9/46)、4.7%(4/86)。医师根据膀胱镜下直接观察的结果和经验判断对RPL高度怀疑恶性、轻度怀疑恶性、良性概率大的3组患者的病理恶性检出率分别为56.9%(37/65)、37.0%(30/81)、10.1%(38/375)。结论RPL活检在膀胱癌/肾盂输尿管癌患者的术后随访中具有重要意义,尤其是男性高龄患者且病灶位于疤痕或疤痕旁时。Objective To analyze the characteristics and malignancy of red-patch like lesion(RPL)during cystoscopy,and to explore the significance of RPL biopsy.Methods Clinical data of patients who had RPL detected in our hospital during Jan.2019 and Jun.2023 were retrospectively analyzed,including gender,age,cause of examination,presence of scars,complications and biopsy pathology.The patients were divided into the benign and malignant groups,and their clinical and RPL characteristics were analyzed.Results A total of 521 cases of RPL were enrolled including 416(79.8%)benign cases,and 105(20.2%)malignant cases.The averae age of the malignant group was higher than the benign group s[(66.8±12.2)years vs.(62.8±12.9)years,P=0.005].The malignant detection rate of RPL in postoperative follow-up patients,those with hematuria and those with lower urinary tract symptoms was 23.7%(92/389),19.6%(9/46),4.7%(4/86),respectively.According to direct observation and experience,the detection rate of pathological malignancy in the three groups of patients with high suspicion of RPL malignancy,mild suspicion of RPL malignancy and high probability of benign was 56.9%(37/65),37.0%(30/81)and 10.1%(38/375),respectively.Conclusion Once RPL is detected during cystoscopy,active biopsy should be performed.For elderly male patients undergoing postoperative follow-up,RPL biopsy is particularly important,especially when the lesion is located on or near the scar surface.

关 键 词：膀胱癌 红斑 活检 病理 膀胱镜 

分 类 号：R737.1[医药卫生—肿瘤]