腺性膀胱炎的临床特点与CT表现分型的研究

Clinical characteristics and CT classifications of cystitis glandularis

目的探讨腺性膀胱炎的临床合并症与CT表现分型。方法 23例经病理确诊为腺性膀胱炎患者,分析术前多层螺旋CT结果,并与膀胱镜或术中所见的临床分型对照。结果 23例患者症状比例由高到低依次为尿路刺激症状、肉眼血尿、下腹痛。18例患者有合并症,比例由高到低依次为尿路感染(30.4%)、泌尿系统结石和/或梗阻(30.4%)、膀胱结石(13.0%)。CT表现大致分为弥漫增厚型、结节样增厚型和片样增厚型,病灶强化程度等或稍高于正常膀胱壁。弥漫增厚型病变常累及双侧输尿管入口。弥漫增厚型病变中临床分型以滤泡水肿样型为主;而结节样增厚型病变中临床分型以乳头状瘤样型为主。结论腺性膀胱炎临床表现缺乏特异性,当临床上存在各种慢性刺激因素时,综合分析CT的分型表现特征,有助于提高术前诊断的准确性。CT分型为结节样增厚型病变者临床分型以乳头状瘤样型为主,应警惕癌前病变。

Objective To investigate the clinical complications and CT classification of cystitis glandularis. Methods We selected 23 patients with cystitis glandularis diagnosed by pathology. The preoperative results of Multi-Detector-Row Computed Tomography （MDCT） were analyzed and correlated with results of clinical classifications under cystoscope or observation during the operation. Results The most frequent symptoms of the 23 patients were urethral irritation followed by gross hematuria and lower abdominal pain. There were 18 patients with complications. The most frequent complications were urinary tract infection （30. 4% ） followed by urinary tract calculi and/or obstruction （30. 4% ） and bladder calculi （ 13.4% ）. The CT features can be classified as diffused thickening, nodular thickening and limited thickening of the bladder wall. The extent of enhancement was close to or slightly above the normal bladder wall. Lesion of diffused thickening usually involved the bilateral opening of ureters. Lesion of nodular thickening had higher rate of papillary types in clinical classification. Conclusion Chronic stimulation factors and detailed classified CT features could facilitate the pre-operative accurate diagnosis of cystitis glandularis.