腺性膀胱炎治疗方案选择

Selection of glandular cystitis treatment

目的探讨腺性膀胱炎的治疗方案。方法对216例经膀胱镜及病理学检查确诊的腺性膀胱炎,按类型不同分为A组（慢性炎症型及黏膜无显著改变型）40例及B组（乳头状型及滤泡样或绒毛膜样水肿型）176例,分别予保守治疗及经尿道电切并术后即刻吡柔比星膀胱灌注。结果随访209例,随访6-72个月,中位随访时间28个月。A组28例治愈,6例好转,6例无效改电切及吡柔比星膀胱灌注,仅1例有效。B组治愈91例,好转37例,无效28例,复发13例,其中1例3年内复发4次,行膀胱部分切除后治愈,无一例发生恶变。结论早期腺性膀胱炎保守治疗疗效满意,而乳头状型、滤泡样或绒毛膜样水肿型腺性膀胱炎以及广泛肠上皮化生型宜采用经尿道电切,术后可予单剂吡柔比星即刻膀胱灌注化疗,无须维持膀胱灌注化疗。

Objective To approach the treatment of cystitis glandularis. Methods Two hundred and sixteen cases of cystitis glandularis diagnosed by cystoscopic and pathological examination were divided into group A of 40 cases with chronic inflammation and of no significant change in the mucosa pattern and group B of 176 cases of papilloma-like pattern or with follicle or chorion-like oedema pattern. Group A were treated by antibiotics while group B were treated by transurethral resection and bladder irrigation of pirarubicin immediately after operation. Results Follow-ups of 209 patients were carried out from 6 months to 72 months （median 28 months ）. In group A, 28 cases fully recovered, 6 cases improved and 6 cases remained ineffective which were subsequently treated by transurethrai resection and bladder instillation, with only one case improving. In group B, 91 cases fully recovered, 37 cases improved, 28 cases remained ineffective, and 13 cases recurred. One case recurred four times in three years, and was cured after being treated with partial cystectomy. No single case ever developed cancer. Conclusion Cystitis glandularis in initial stage can be effectively treated by anti-infective therapy and transurethral plasmakinetic resection is effective for the treatment of other cystitis glandularis （ papilloma-like pattern, follicle or chorion-like oedema pattern, and extensive intestinal metaplasia pattern）. Bladder pirarubicin irrigation immediately after operation is sufficient for the treatment.