儿童膀胱良性肿瘤的诊治分析

Diagnosis and treatment of bladder benign neoplasm in children

目的 探讨儿童膀胱良性肿瘤的的诊治特点 方法 回顾性分析我院2006年10月至2016年5月收治的15例膀胱良性肿瘤患儿的临床资料。男10例，女5例。年龄1.1～13.8岁，平均8.7岁。临床表现为肉眼血尿9例，尿频、尿急、尿痛3例，排尿困难1例，腹痛2例，排尿后腹痛、头痛1例。超声检查示膀胱内实性占位，等回声或不均质低回声。增强CT检查示膀胱内规则或不规则实性占位，部分肿瘤强化明显。15例患儿均行保留膀胱的开放性膀胱肿瘤切除术，术中见肿瘤位于三角区2例，膀胱前后壁及侧壁9例，输尿管口4例。15例肿瘤均为单发，呈菜花状或乳头状生长，肿瘤最大径1.2～6.0 cm，平均3.1 cm。总结儿童膀胱良性肿瘤的临床特点、病理类型、治疗方法。 结果 15例患儿的病理诊断为尿路上皮乳头状瘤5例，镜下见肿瘤表面被覆移行上皮，呈乳头样生长；内翻性乳头状瘤1例，镜下见肿瘤表面被覆正常尿路上皮，向下内翻生长；炎性肌纤维母细胞瘤（inflammatory myofibroblastic tumor，IMT）7例，镜下可见大量梭形细胞排列；血管瘤1例，镜下可见大小不等的血管；副神经节瘤1例，镜下可见巢片状肿瘤细胞。15例术后均获随访，随访时间6～36个月，平均27个月，复查超声均未见肿瘤复发或转移。结论 小儿膀胱良性肿瘤临床少见，以肉眼血尿为主要表现，少见排尿困难，多发生在膀胱三角区以外部位，病理类型较多，治疗以手术完整切除为主，尽可能保留膀胱，预后良好。

Objective To summarize the experience about the diagnosis and treatment of bladder benign neoplasm in children.Methods A retrospective study was conducted for a total of 15 patients with bladder benign neoplasm from October 2006 to May 2016.There were 10 males and 5 females with a mean age of 8.7 years （ranging 1.1-13.8 years） .The clinical manifestations of 15 patients included hematuria in 9 patients, frequent micturition with urgent and painful in 3 patients, dysuria in 1 patient, abdominal pain in 2 patients and headache during voiding in 1 patient. Ultrasound showed solid masses in the bladder with iso-echoic or nonhomogeneously hypoechoic. CT scanning showed regular or irregular mass with some enhancement in the bladder. All cases received tumor complete resection by opening operation and bladders were preserved. Among the 15 cases, neoplasms located in the anterior, posterior and lateral wall of bladder in 9 cases, ureteral orifice in 4 cases and trigone of bladder in 2 cases. The size of tumors ranged from 1.2 to 6.0 cm （mean 3.1cm）. The tumors were unifocal and seemed like papillary or cauliflower. The literatures of benign neoplasm of bladder were reviewed, which focused on the clinic characters, pathological classification and therapeutic method. Results Pathologic type included papilloma in 5 patients, inverted papilloma in 1 patient, inflammatory myofibroblastic tumor in 7 patients, hemangioma in 1 patient, pheochromocytoma in 1 patient. Fifteen patients were followed up for 6 to 36 months, mean 26.7 months.All patients recovered well without relapse or metastasis Conclusions Bladder benign neoplasm in children is rare with many kinds of pathological classification .The major clinical manifestation is gross hematuria while dysuria is unusual. Tumors are fewer in trigone of bladder. The best treatment is to resect the tumor completely with bladder preservation if possible.