膀胱疼痛综合征相关症状的鉴别诊断及临床意义

Differential Diagnosis plays a significant role in the diagnosis of bladder painful syndrome

目的探讨鉴别诊断在女性膀胱疼痛综合征/间质性膀胱炎诊断中的重要意义。方法回顾2005年至2011年间42例转诊到广州医科大学附属广州市第一人民医院的膀胱疼痛综合征/间质性膀胱炎(IC)女性患者的临床资料。患者平均年龄49(26～69)岁,IC病程14(6～24)个月。通过详细分析病史及辅助检查(如尿动力学检查、尿道膀胱镜检、排尿期膀胱尿道造影、尿流率、剩余尿量测定、磁共振等)来探讨这些IC病例是否存在其他泌尿系疾病,以及这些新发现的其他疾病经治疗后IC症状的改善情况。结果尿动力学检查发现10例(24%)存在膀胱出口梗阻;排尿期膀胱尿道造影联合尿流率和剩余尿量发现16例(38%)存在远端尿道狭窄;核磁共振发现5例(12%)存在尿道憩室;尿道膀胱镜检发现21例(50%)膀胱三角区严重黏膜充血、滤泡增生明显,部分黏膜下可见弥漫脓包形成,5例(12%)存在尿道外口狭窄。42例患者根据新发现的病变进行相应的治疗,如膀胱出口梗阻或尿道外口狭窄接受尿道扩张、尿道松解术或者尿道外口成形术;膀胱炎接受经尿道膀胱黏膜电灼术;尿道憩室接受尿道憩室切除术等。42个患者中,26例(62%)的症状明显改善或完全消失,16例(38%)症状无改善。平均随访时间18(6～36)个月。结论膀胱疼痛综合征/间质性膀胱炎因与泌尿系统其他疾病的症状相似而容易被混淆。只有做好缜密的鉴别诊断才能避免误诊。

Objective To explore the significance of detailed differential diagnosis in the diagnosis of bladder painful syn- drome/interstitial cystitis （PBS/IC）. Methods Data of 42 female patients with PBS/IC transferred to our hospital during 2005 and 2011 were retrospectively analyzed. The mean age of these patients was 49 （26～69） years, with 14 （6～24） months IC course. Detailed history was analyzed, and auxiliary examinations, such as urodynamic study, cystoscopy, voidng cystoure- thrography （VCUG）, maximal urine flow rate （Qmax）, post-void urine residue （PVR）, and MRI, were used to identify com- plicated urologic conditions. Results Urodynamic study indicated bladder outlet obstruction in 10 patients （24%） ; VCUG in combination with Qmax and PVR showed distal urethral stricture in 16 cases （38%） ; MRI documented urethral diverticula in 5 cases （12 %）; cystoscopy demonstrated trigonal severe infections with mucosal congestion and pus pocket formation in 21 pa- tients （50 %）, and meatal stenosis in 5 patients （12%）. All 42 patients with an established IC diagnosis were found to have oth- er urologic conditions and were treated accordingly with urethral dilation, urethrolysis, urethral meatoplasty, transurethral ful- guration of the bladder mucosa, urethral diverticulectomy, and so on. During the follow-up of 18 （6～36） months, 26 patients （62 %） had symptoms greatly improved or relieved after the identifiable disorders were corrected. The other 16 patients （38 %） did not respond to treatment. Conclusions Other urologic conditionsmay be ignored as they have similar symptoms as PBS/ IC, which shows that detailed differential diagnosis is important in the diagnosis of IC.