经尿道局部电切术治疗早期腺性膀胱炎疗效观察

Transurethral electronresection in the treatment of cystitis glandularis of initial stage-retrospective study of 18 cases

目的 探讨经尿道局部病灶电切术治疗早期腺性膀胱炎的疗效。方法 早期腺性膀胱炎 18例 ,膀胱镜下为位于三角区或膀胱颈的单个小滤泡 ,小颗粒状黏膜凹凸不平和充血。存在下尿路感染征象 14例 ,其中 4例有下尿路梗阻表现。活检病理报告囊腺性膀胱炎伴鳞状上皮化生14例 ,腺性膀胱炎 4例。 18例在硬膜外麻醉下行经尿道局部病灶电切电灼术 ,伴后尿道息肉者同时行电灼治疗。定期复查膀胱镜 ,以患者主观症状改善情况和膀胱镜活检病变复发情况作为疗效判断标准。结果 术后随访 5～ 3 4个月 ,自觉症状消失 2例 ,无改变 10例 ,加重 6例 ,膀胱镜活检病变复发 10例。结论 早期腺性膀胱炎单纯行局部电切电灼术不仅不能改善症状 ,部分患者症状反而加重 ,病变复发率高。建议治疗上应同时针对下尿路感染、梗阻及下尿路动力学异常进行处理。

Objective To elucidate the efficacy of transurethral electronresection in the treatment of cystitis glandularis of initial stage (CG IS).Methods Eighteen cases of CG IS were retrospectively studied after transurethral electronresection of the local lesions of the bladder membrane.The lesions under cystoscopy were single or some clearing follicles in most cases,sometimes hyperemia of cystic mucosa or uneven granulae occurred in trigone or vesical neck.Of the 18 cases of CG IS,14 cases had lower urinary tract infection,of which 4 cases were complicated with symptoms of lower urinary obstruction.Symptom changes and recurrence of the lesions after treatment were used as criterion of the therapy.Results All 18 cases were followed up for 5 34 months with a mean of 20 months.The patient's symptoms disappeared in 2 cases,showed no change in 10 cases,and worsened in 6 cases.Pathological biopsy showed recurrence of the lesions in 10 cases.Conclusions Simple transurethral electronresection of the local lesions of CG IS had no effect on symptom improvement of the patients,moreover the symptoms might be worsened.The lesions showed high recurrent rate after the therapy.It is suggested that the accompanied lower urinary tract infection,obstruction and urodynamic disorders should be treated at the same time.