“超声膀胱软镜”可辅助用于膀胱占位性病变的术前诊断

"Flexible ultrasonic cystoscopy" can help to diagnose space-occupying lesions of the bladder before operation:an initial experience

目的采用超声支气管镜作为"超声膀胱软镜"(超声内镜)用于膀胱占位性病变术前诊断,探讨其可行性及临床价值。方法采用超声支气管镜(Olympus BF-UC260F-OL8)对22例B超提示膀胱占位的患者行膀胱超声内镜检查,超声内镜初步诊断后改用传统膀胱镜行膀胱镜镜检,对可行活检的19例患者行病变活检术。根据镜检结果进行针对性手术治疗。比较超声内镜、传统膀胱镜检查术中的疼痛视觉评分(visual analogue scale,VAS);分析超声内镜检查结果与传统膀胱镜检查及手术后病理的符合率。结果顺利完成22例超声内镜检查,操作时间4～10 min,平均(6.4±1.2)min,长于传统膀胱镜检时间(5.1±1.8)min,差异具有统计学意义(P<0.01);但超声内镜检查VAS为(1.4±0.5)分,低于传统膀胱镜检的(4.3±1.3)分,差异具有统计学意义(P<0.01)。超声内镜下膀胱壁黏膜层、肌层、浆膜层层次清晰,诊断非肌层浸润性膀胱癌15例;肌层浸润性膀胱癌3例;左输尿管末段实性占位1例,结合宫颈腺癌术史考虑为局部复发;1例为脐尿管囊肿伴钙化;1例为膀胱肌层平滑肌瘤;1例为腺性膀胱炎。超声内镜诊断与术后病理诊断基本吻合。结论 "超声膀胱软镜"操作可行,能显示膀胱各层结构及输尿管末端和膀胱外病变,具有痛苦小、无盲区的优点,但在镜头活动度、工作通道设计等方面仍有不足,进一步改进后可用于膀胱占位性病变的术前诊断。

Objective To evaluate the feasibility of using ＂ flexible ultrasonic cystoseopy＂ （ultrasound-guided bronchoscopy as substitute） in diagnosing space-occupying lesions of the bladder. Methods Totally 22 patients diagnosed as having ＂space-occupying lesions of the bladder＂ by routine transabdominal ultrasound were examined by a novel cystoseopy, namely, the ＂flexible ultrasonic cystoscopy＂ （ultrasound guided bronchoscopy）. Then all the patients received routine rigid cystoscopic examination, and 19 patients also underwent biopsy. Pertinent surgical procedures were performed according to the cystoscopic results. The visual analogue scales（VASs） were compared between ultrasonic cystoscopy and routine cystoscopy. The findings of the ultrasonic cystoscopy were compared with those of routine rigid cystoscopy and postoperative pathological findings. Results The operation time taken by ＂flexible ultrasonic cystoscopy＂ examination was 4-10 rain in the 22 patients, with a mean of （6.4±1.2） rain, significantly longer than that by routine rigid cystoscopy（[5.1±1.8] rain, P〈0.01）. The VAS of ＂flexible ultrasonic cystoscopy＂ was significantly lower than that of routine rigid eystoscopy（ 1.4±0.5 vs 4.3±1.3,P〈0.01）. Flexible ultrasonic cystoseopy clearly displayed the 3 layers of the bladder wall= mucosa/submucosa, muscle, and adventitia. Fifteen cases were diagnosed as having non-muscle-invasive bladder cancer, 3 having muscle-invasive bladder cancer, and 1 having cervical adenocarcinoma metastasis to the end of left ureter and prolapsing into the bladder; the rest 3 patients had benign lesions of bladder, including 1 with uraehal cyst combined with calcification, 1 with leiomyoma of bladder muscle layer, and 1 with cystitis glandularis. The outcomes of preoperative ＂flexible ultrasonic eystoscopy＂ were largely consistent with the postoperative pathological findings. Conclusion ＂Flexible ultrasonic cystoscopy＂ is feasible in clinical practice; it can display the 3 layers of bladder wall and indentify the lesions at the end of urethral tract and outside of the bladder. It has the advantage of minimal pain, without blind area. The range of motion of camera lens and working passage design still need to be improved.