膀胱白斑不同病变部位超微病理及其临床意义

The ultrastructural pathological change and clinical significance of vesical leukoplakia lesions at different areas

目的探讨膀胱白斑不同病变部位超微病理及其临床意义。方法随机抽取膀胱自斑病变中部标本80例次，白斑边缘处、白斑边缘外1．0cm处、2．0cm处及2．5cm处标本共89例次，用双盲法进行电子显微镜检查，并与非膀胱白斑患者的正常膀胱黏膜比较。结果膀胱镜下所见白斑旁区均已存在早期病变。从白斑边缘外2cm处到白斑中央，膀胱黏膜由移行上皮逐渐变为尿路上皮与鳞状上皮交错、鳞状上皮化生、鳞状上皮化生伴不全角化或角化。基膜由平直变弯曲，呈现出4型（5种）典型表现。病变中部的80例，0Ⅰ型5例，0Ⅱ型8例，Ⅰ型12例，Ⅱ型42例，Ⅲ型13例。结论以病变中部为准，可将膀胱白斑的超微结构表现分为4型，即0型（0Ⅰ型、0Ⅱ型）、Ⅰ型、Ⅱ型、Ⅲ型。该分型能较好地说明膀胱白斑的发生、发展过程，对膀胱白斑的诊断及治疗方法的选择有参考价值。

Objective To investigate the ultrastructural pathological change and clinical significance of vesical leukoplakia lesions at different areas. Methods We randomly selected 80 cases/times of the mucosa in central area of vesical leukoplakia, and 89 cases/times of the mucosa located respectively in marginal area of vesical leukoplakia and 1.0,2.0,2.5 cm away from the marginal area of vesical leukoplakia. The mucosa in all cases was examined using the electron microscope by double blind method to study the ultrastructural characteristics in different areas of vesical leukoplakia lesions, and then compared with the uhrastructure of normal bladder mucosa from non-vesical leukoplakia. Results There were early pathological changes in para-leaukoplasia areas that found by cystoscope. From 2 cm away from the marginal area of vesical leukoplakia to center of the lesions, the covering epithelia were altered gradually from transitional epithelia to interphase of transitional and squamous epithelia, squamous metaplasia, keratinizing squamous metaplasia. The basement membrane of the epithelia was transformed gradually from flat to curved. Four types of, including 5 kinds, typical uhrastructural features in lesion areas could be seen. There were 5 cases of tpye 0 Ⅰ ,8 cases of type 0 Ⅱ , 12 cases of type Ⅰ ,42 cases of type Ⅱ , and 13 cases of type Ⅲ in 80 central areas of vesical leukoplakia. Conclusion According to the uhrastructural changes,lesion of vesical leukoplakia could be divided into 4 types, namely type 0 （ type 0 Ⅰ , type 0 Ⅱ）, tpye Ⅰ type Ⅱ and typeⅢ. This classification could help us to better understand the process of occurrence and development of vesical leukoplakia, and it has also important value in the diagnosis of vesical leukoplakia and the selection of therapeutic methods for this disease.