腺性膀胱炎侵犯输尿管口的微创治疗

Mini-invasive treatment of cystitis glandularis with affected ureteric meatus

目的探讨伴输尿管口侵犯的腺性膀胱炎的微创治疗方法。方法18例腺性膀胱炎侵犯单侧输尿管开口12例，双侧6例。（1）可能诱因的治疗：膀胱结石3例、膀胱颈部狭窄7例、尿道外口狭窄2例、前列腺增生3例先行给予相应手术或药物治疗；均给予敏感抗生素治疗；（2）能辨认输尿管开口者5例，置双“J”管后行经尿道等离子电切；（3）不能辨认输尿管开口者共13例。肾功能正常者10例，先行病变黏膜下注射丝裂霉素，能辨认输尿管口者，置双“J”管后电切；不能辨认者先行经尿道电切，术中发现输尿管口者则留置双“J”管，不能置双“J”管者，术后肾绞痛、肾积水加重，再次膀胱镜下置管；肾功能异常者，先行输尿管切开后置双“J”管或输尿管再植术，肾功能恢复后行经尿道电切术；（4）术后膀胱灌注化疗、抗感染及对症治疗。结果1例伴发膀胱腺癌者行膀胱切除术，余17例共6例复发，再次电切术后未复发；肾积水均消失或明显减轻；主要并发症为尿路感染6例、血尿3例、膀胱输尿管返流2例。结论侵犯输尿管口的腺性膀胱炎，确保输尿管引流通畅可避免膀胱全切或部分切除，去除诱因、抗感染、黏膜下注射、术前利尿能提高输尿管置管成功率，经尿道等离子电切仍是有效的治疗方法。

Objective To investigate the minimal invasive management of cystitis glandularis with invasion of the ureteric meatus. Methods The clinical data of 18 cases were reviewed. Among the 18 cystitis glandularis patients, 12 cases were invasion of bilateral ureteric meatus and 6 of unilateral ureteric mneatus. Operation or drug treatment was performed on the diseases that can cause cystitis glandularis such as bladder stone, bladder neck stegnosis, external urethral meatus stegnosis and benign prostate hyperplasia. Sensitive antibiotic was administrated in all eases. After placing ureter catheter, transurethral plasma electro-resection was carried out in five patients whose ureteric meatus could be identified. In addition, of thirteen patients with ureteral orifice unable to be identified, there were ten cases with normal renal function, mitomycin was injected under affected membrana mucosa, and then the patient with ureteral orifice identified underwent transurethral plasma electro-resection after placing ureter catheter. On the other hand, the patient whose ureteral orifice still could not be recognized undertaken transurethral electro-resection at first, during which the ureter catheter was put once ureteral orifice had been detected, otherwise, the ureter catheter should be placed through cystoscope if nephritic colic emerged and hydronephrosis aggravated after operation. In those patients with kidney dysfunction,the ureter catheter was put by ureter discission or ureter replantation at first, the transurethral electro-resection could not be executed until the renal function recovered. Following all these procedure above, bladder instillation of drugs regularly, anti-infection and symptomatic treatment were administrated. Results One patient combined with bladder adenoearcinoma received eystectomy, of the other patients, six cases recurred and underwent electrotomy again resulting in no relapse. All nephrohydrops vanished or relieved obviously, nevertheless, urinary tract infection, haematuria and bladder-ureter backstreaming as the cardinal complication developed in some cases. Conclusion In the management of cystitis glandularis encroaching ureteric meatus, total or partial cystectomy can be avoided if ureter draining freely can be ensured, motivation removal, antiinfection,injection of drug under mucosa and preoperative diuresis conduce to the achievement of ureter catheter placing, transurethral plasma electro-resection is still effective methods in treating these cystitis glandularis.