尿路上皮内翻性乳头状瘤62例临床分析

The clinical analysis of 62 cases of the urothelial inverted papilloma

目的探讨尿路上皮内翻性乳头状瘤的临床表现、生物学行为及临床诊治方案。方法回顾性分析1990年1月至2008年8月62例尿路上皮内翻性乳头状瘤患者的临床资料。男性51例，女性11例，平均年龄56．4岁。单发56例，多发6例。肉眼血尿为最常见的首发临床表现。发病部位在输尿管5例，4例行肿瘤局部切除术，1例行左肾及输尿管全长切除术；发生于输尿管合并膀胱1例，行膀胱全切术；发生于膀胱52例，44例行经尿道膀胱肿瘤切除术，6例行膀胱部分切除术，2例行膀胱全切术；发生于尿道4例，1例行经尿道肿瘤切除术，3例行尿道肿瘤切除术。结果62例患者术后病理均证实为内翻性乳头状瘤，其中伴发尿路上皮癌7例。49例随访3个月～12年。2例分别于术后7和79个月复发，3例分别在术后18个月、2年和6年发现尿路上皮癌。结论尿路上皮内翻性乳头状瘤为良性肿瘤，需与尿路上皮恶性肿瘤相鉴别。手术是其主要治疗方式，术后应定期复查膀胱镜及随访。

Objective To investigate the clinical manifestation, biological behavior, diagnosis and treatment of the urothelial inverted papilloma. Methods Sixty-two cases of urothelial inverted papilloma were analyzed retrospectively from January 1990 to August 2008. Of the 62 patients, 51 were men and 11 were women. The average age at presentation was 56. 4 years old. Fifty-six cases were solitary tumors and 6 were multiple. The most common compliant was macroscopic hematuria. The tumor located at the ureter in 5 cases. Of these cases, 4 were treated by local excision, 1 by nephroureterectomy. One case of multiple ureteral inverted papilloma with coexistent bladder inverted papilloma was treated by total eystectomy. The tumor located at the bladder in 52 cases, with 44 treated by transurethral resection of bladder tumor, 6 by partial cystectomy, 2 by total cystectomy. Four cases had the tumor located at the urethra, with 1 treated by transurethral resection of tumor, 3 by tumorectomy. Results The postoperative pathological diagnosis of all the 62 cases was inverted papilloma, synchronous urothelial carcinoma in 7. Follow-up data were available in 49 cases. Two cases had a recurrence at 7 months and 79 months, respectively. Three case of subsequent transitional cell carcinoma developed 18 months, 2 years and 6 years later, respectively. Conclusions Inverted urothelial papilloma is a kind of benign tumor. It should be differentiated from malignant urothelial tumors. Surgical operation is the main treatment choice. Cystoscopic surveillance and followup are necessary after the operation regularly.