膀胱平滑肌瘤的诊断和治疗

Diagnosis and treatment of bladder leiomyoma （report of 6 cases）

目的 探讨膀胱平滑肌瘤的病因、诊治方法和预后。方法 回顾性分析1984年至2005年收治6例膀胱平滑肌瘤患者资料。患者男1例，女5例，平均年龄36岁。临床表现为排尿障碍4例、血尿1例、膀胱刺激症状1例。病程1～16个月。除1例血尿患者外，其余5例均非首诊。6例B超检查，首次发现病变3例。5例行CT检查，均发现肿块且有不同程度强化。6例膀胱镜检，发现肿瘤2例，提示占位病变3例。肿瘤直径1．5-5．0cm。6例均采用手术治疗。结果 6例患者术后排尿通畅，血尿消失，排尿刺激症状明显缓解。1例术后出现伤口漏尿，经保守治疗治愈，余未发生其他并发症。6例随访9个月～8年，未见肿瘤复发或转移。结论 膀胱平滑肌瘤是一种少见的良性肿瘤，临床症状不典型，排尿障碍和血尿是最常见的表现，诊断主要依靠B超、CT和膀胱镜检查，初诊时误诊率较高。外科手术治疗预后良好。

Objective To discuss the cause, diagnosis, treatment and prognosis of bladder leiomyoma. Methods The clinical data of 6 patients with bladder leiomyoma from 1984 to 2005 were retrospectively analyzed. Clinical manifestation including dysuresia in 4 cases, hematuria in l case and irritative bladder in 1 case. Only 1 patient with hematuria was correctly diagnosed in the first visit. Three cases were missed in the first ultrasonographic exam. Cystoscopy confirmed 2 tumors and found 3 suspected lesions. Enhanced tumors were clearly showed on CT scan in all the 5 cases. Partial cystectomy was performed in 1 case, tumor enucleaton in 4 cases and transurethral resection in 1 case. Results The patients got normal urination and hematuria disappeared. The complication included 1 patient with urine leakage. No recurrence was found in the 9 month to 8 year period of follow-up. Conclusions Bladder leiomyoma is an unusual benign tumor without specific symptom. Dysuria and hematuria could be the manifestation. Ultrasonography, cystoscopy and CT scan could be main techniques for diagnosis. The disease can be treated by resection and prognosis is fine.