经尿道肿瘤剜除术治疗黏膜下型膀胱平滑肌瘤初探

Initial experience of transurethral enucleation of submucosal bladder leiomyoma

目的探讨经尿道肿瘤剜除术治疗黏膜下型膀胱平滑肌瘤的疗效及安全性。方法同顺性分析6例黏膜下型膀胱平滑肌瘤患者的临床资料。男2例，女4例。年龄32～78岁，平均59岁。表现为排尿梗阻3例，排尿刺激症状1例，肉眼血尿1例及尢临床症状、体检发现1例。病程1周～4年，平均23个月。B超检查均发现膀胱内占位性病变，肿瘤平均最大直径3．0（2．0～3．5）cm。CT检查示肿瘤形态完整，增强后较均匀轻度强化。4例1VU检查发现膀胱充盈缺损。6例膀胱镜检金均提示膀胱黏膜下占位，黏膜表面光滑。6例均行膀胱镜下穿刺活检病理检查，诊断为膀胱平滑肌瘤，后行经尿道膀胱肿瘤剜除术（2例位于侧壁、体积较小肿瘤以激光剜除，4例体积较大肿瘤以电切镜剜除）。肿瘤基底部活检后，电灼肿瘤基底及创缘。结果6例手术均顺利完成，无膀胱穿孔等并发症。术后患者均排尿通畅，排尿刺激症状明显缓解，血尿消失。术后中位随访时间58（4～158）个月，未见肿瘤复发或转移。结论病理检查是确诊黏膜下型膀胱平滑肌瘤的主要手段。经尿道肿瘤剜除术治疗黏膜下型膀胱平滑肌瘤安全有效。

Objective To evaluate the clinical efficaey and safety of transurethral enucleation of submueosal bladder leiomyoma. Methods Analyze retrospectively the clinical data of 6 patients （2 male, 4 female） of submueosal bladder leiomyoma. The mean age was 59 years （range 32 - 78）. The clinical manifestations included dysuresia in 3 cases, irritative bladder in 1 case, gross hematuria in 1 caes, and no clinical symptoms in l case. The mean course was 23 months （range 1 week -4 years）. All the bladder tumors were indicated by uftrasonography, CT scan and cystoseopy, while 4 cases of bladder filling defects were showed by intravenous urogram. Before the transurethral enucleation of the bladder tumor, a deep needle biopsy and pathological examination were carried out to confirm the diagnosis of bladder leiomyoma. For the relatively small lateral leiomyomas, holium laser enucleation was carried out, while for the big ones, resectoscope enucleation was used to remove the mass. Biopsys were performed after complete removal of the tumor. Results Transurethral enueleation of 6 cases of submucosal bladder tumors were successful without any postoperative complication. All patients regained normal urination, and lower urinary tract irritation was relieved obviously and hematuria disappeared. No tumor recurrence or metastasis was found during the follow-up of 4 to 158 months. Conclusions Cystoscopy and transurethral biopsy are the most important methods for the diagnosis of submucosal bladder leiomyoma. The transurethral enucleation is a feasible and safe surgical technique for such patients with excellent results.