膀胱乙状结肠瘘误诊原因分析及防范措施  

Analysis of Causes of Misdiagnosis of Vesicosigmoid Fistula and Preventive Measures

作　　者：刘伟 周正兴 李清华 许国胜 孙松 陈红兵 LIU Wei;ZHOU Zhengxing;LI Qinghua;XU Guosheng;SUN Song;CHEN Hongbing(Department of Urology,the Third Affiliated Hospital of Anhui Medical University/the First People's Hospital of Hefei City,Hefei 230001,China)

机构地区：[1]安徽医科大学第三附属医院合肥市第一人民医院泌尿外科,合肥230001

出　　处：《临床误诊误治》2025年第9期21-27,共7页Clinical Misdiagnosis & Mistherapy

基　　金：合肥市卫生健康委员会项目(Hwk2024zd010)。

摘　　要：目的 分析膀胱乙状结肠瘘的临床特点、诊断和鉴别诊断措施、误诊原因和防范措施。方法 回顾性分析2022年3月至2023年4月收治的曾误诊为膀胱癌的膀胱乙状结肠瘘2例的临床资料。结果 2例分别因发现直肠肿物3 d、间歇性肉眼血尿9 d入院。2例均误诊为膀胱癌,皆行经尿道膀胱诊断性电切术,术后病理提示为膀胱肉芽肿性炎、腺性膀胱炎。术后经导尿管逆行向膀胱内注入造影剂后CT平扫发现瘘口位置,明确诊断为膀胱乙状结肠瘘。误诊时间1~2周。确诊后1例行开放性乙状结肠部分切除+膀胱乙状结肠瘘修补术;1例行腹腔镜下乙状结肠部分切除+膀胱结肠瘘修补术+膀胱部分切除术。术后均恢复良好,随访未见异常。结论 膀胱乙状结肠瘘临床罕见,部分患者由于缺乏特异性症状,临床医师认识不足、影像学检查受限等原因,极易被漏诊、误诊,临床医生应高度警惕膀胱乙状结肠瘘,以免延误治疗。Objective To analyze the clinical characteristics,diagnosis,differential diagnosis,causes of misdiagnosis and preventive measures of vesicosigmoid fistula.Methods From March 2022 to April 2023,the clinical data of 2 patients with vesicosigmoid fistula misdiagnosed as bladder cancer were retrospectively analyzed.Results Two patients were admitted due to rectal mass for 3 d and intermittent gross hematuria for 9 d,respectively.Both patients were misdiagnosed as bladder cancer and underwent transurethral resection of the bladder.The postoperative pathology showed bladder granulomatous inflammation and cystitis glandularis.The diagnosis of vesicosigmoid fistula was confirmed following the location of the fistula identified by CT plain scan after retrograde injection of contrast agent into the bladder through a urinary catheter.The misdiagnosis lasted 1 to 2 weeks.One patient underwent open partial resection of sigmoid colon and vesicosigmoid fistula repair.One patient underwent laparoscopic partial resection of sigmoid colon + vesicocolonic fistula repair + partial cystectomy.All patients recovered well after operation and no abnormality was found during follow-up.Conclusion Vesicosigmoid fistula is rare in clinical practice.Several patients are more likely to experience missed diagnosis and misdiagnosis due to lack of specific symptoms,insufficient understanding of clinicians,and limited imaging examination.Clinicians should be highly alert to vesicosigmoid fistula to avoid delay in treatment.

关 键 词：膀胱乙状结肠瘘 误诊 膀胱癌 膀胱肉芽肿性炎 腺性膀胱炎 乙状结肠憩室 膀胱乙状结肠瘘修补术 

分 类 号：R694[医药卫生—泌尿科学]