膀胱非上皮肿瘤的诊断、治疗(附30例报告)

Diagnosis and treatment of non-epithelial tissue tumor in bladder(Report of 30 cases)

目的 总结膀胱非上皮肿瘤的诊治经验.方法 回顾性分析1998～2013年收治的30例膀胱非上皮肿瘤临床资料.男11例,女19例.年龄6～77岁,主要临床表现为：尿频、排尿困难、肉眼血尿、盆腔肿块、排尿晕厥等.结果 3例行经尿道膀胱肿瘤电切术,21例行膀胱部分切除术,2例行全膀胱切除术,无法手术4例,恶性肿瘤术后辅助化疗或放疗.随访10个月～15年,良性肿瘤均无复发,恶性肿瘤中恶性嗜铬细胞瘤1例、淋巴瘤3例随访1～2年至今仍存活,神经内分泌癌1例、癌肉瘤2例、小细胞恶性肿瘤1例、平滑肌肉瘤1例,随访2～6个月内复发、死亡.结论 膀胱非尿路上皮肿瘤临床少见,B超引导下深部活检可提高诊断率,良性肿瘤预后较好,可行膀胱部分切除术,应完整切除,恶性肿瘤应争取全膀胱切除,结合病理特点辅助化疗或放疗,可提高疗效.

Objective To summarize the experience in the diagnosis and treatment of non-epithelial tissue tumor in bladder. Methods The clinical data of 30 patients with non-epithelial tissue tumor in bladder from 1998-2013 in our hospital were retrospectively analyed. 11 males and 19 females, aged between 6-77 years. Urinary frequency, dysuria, gross hernaturia, pelvic mass and fainting during voiding were systoms of non- epithelial tissue tumor in bladder. Results 3 cases were treated with transurethral bladder tumor resect（TUR- BT）, 21 cases were treated with partial cystectomy, 2 cases underwent radical cystectomy, and 4 patient＇ s tumor were unresectable. Adjuvant radiotherapy and chemotherapy were performed in malignant tumor patients. Follow-up time was 3 months to 15 years. No recurrence was found in benign tumor patients. 3 patients with bladder malignant lympboma and 1 with malignant pheochromocytoma survived for 1 to 2 years now. 5 patients with bladder malignant tumors died in 2 to 6 months after diagnosis. Conclusion Non-epithelial tissue tumor in bladder is rare with complicated pathologic types. Deep-site biopsy can improve the diagnostic rate. Partial cystectomy is the main therapy for benign tumors, and it＇ s prognosis is good. Radical cystectomy is the main therapy for maligant tumors, and combined with chemotherapy and radiotherapy could improve the efficacy of operation according to the pathological features.