膀胱平滑肌瘤临床分析

Clinical Analysis of Bladder Leiomyoma

目的提高对膀胱平滑肌瘤诊断及治疗的认识。方法回顾性分析1996年～2008年收治13例膀胱平滑肌瘤患者,其中男2例,女11例,平均年龄46岁。临床表现为排尿困难4例,膀胱刺激症状3例,血尿3例,下腹部不适2例,无症状1例。13例均行B型超声和CT检查。11例首次B型超声检查发现膀胱内低回声肿块,3例合并单侧肾积水。CT示类软组织密度影,平均CT值为45.5Hu。4例行MRI示高信号肿块(T2WI)。7例行IVP检查提示膀胱内充盈缺损。3例尿脱落细胞检查均为阴性。均行膀胱镜检,确定肿瘤2例,提示占位性病变10例。13例均行手术治疗,其中肿物切除术9例,膀胱部分切除术3例,经尿道电切1例。结果术后病理证实13例均为膀胱平滑肌瘤,肿瘤平均最大直径为6.5cm。肿物大多表面光滑,切面质韧、灰白色。镜下观察:肿瘤细胞分化良好,无异型性,偶见病理性核分裂相。术后随访6月～6年,预后良好,未发现肿瘤复发和转移。结论膀胱平滑肌瘤是一种少见的良性肿瘤,诊断依靠影像学检查,确诊依赖膀胱镜检查及病理活检,以手术治疗为主,预后良好。

Objective To improve the recognition on the diagnosis and treatment of the leiomyoma of the bladder. Methods The data of 13 patients with bladder leiomyoma（2 male and 11 female） from 1996 to 2008 were analyzed retrospectively. Clinical manifestation included 4 cases with dysuria,3 cases with irritative bladder, 3 cases with hematuria,2 cases with hypogastric malaise and 1 case without symptom. B- ultrasonography and CT were available in all 13 cases. Low-echo mass inside bladder was found in 11 cases at the first ultrasonographic examimation and 3 of suffered monolateral hydronephrosis. Soft tissue density shadow was measured by CT and the average CT value was 45.5Hu. High signal mass was on T2-weighted images were recorded by MRI in 4 cases. IVP showed filling defect inside bladder in 7 cases. Three cases were negative in the urinary cytologic examinations. Cystoscopy confirmed 2 tumors and 10 occupying lesions. All cases were performed by operation, tumor enucleation was performed in 9 cases, partial cystectomy in 3 cases and transurethral recection in i case. Results Postoperative pathological observation confirmed that the diagnosis of bladder leiomyoma, the mean largest diameter of the tumor was 6. 5cm. Most of the surfaces in the tumors were smooth with tenacious and grayish-white sections. It was observed by microscope that the tumor cell differentiated well with rare caryocinesia phase while without heteromorphisrn. Recurrence and metastases have not be found and the prognosis has well been in all 13 cases postoperatively during follow-up from 6 months to 6 years. Conclusion Leiomyoma of the bladder is benign neoplasm rarely occurred in clinic, whose diagnosis depends on medical imaging. The definitive diagnosis is based on cystoscopy and pathological biopsy. Surgery is the main treatment way and the prognosis is usually well.