膀胱异位骨化症的临床分析

Clinical analysis of heterotopic ossification of bladder

目的提高对膀胱异位骨化症的认识。方法通过一例膀胱异位骨化症患者的临床资料，结合相关文献讨论其发生机制、临床特点以及诊治措施。结果本例患者术前诊断为膀胱肿瘤，行经尿道膀胱肿瘤电切术，术中可见膀胱右输尿管开口外上方可见一结节状骨性肿物，直径约3．5cm，蒂较细，基底部毛糙，未见明显出血，余黏膜正常，因肿物质硬，以碎石钳咬碎肿物逐步取出。术后病理回报：（膀胱肿瘤）检材于变性的纤维组织中可见较多钙盐沉积及骨小梁形成。术后未行其他辅助治疗，随访2年，无肉眼血尿，自行排尿通畅，一般身体状况良好。结论膀胱异位骨化症罕见，国内尚未见报道。在相关诱导因素持续作用下，在合适的局部微环境中，组织内应答细胞可被诱导成骨。本病术前诊断困难，须与膀胱癌肉瘤及骨肉瘤相鉴别，主要靠膀胱镜检查及术后病理检查确定诊断，治疗以手术为主，适应证与膀胱肿瘤相近。

Objective To improve the understanding of heterotopic ossification （HO） of blad- der. Methods The pathogenic mechanism, clinical features, diagnosis and treatment measures of the disease were reviewed and discussed with relevant literatures by analyzing the clinical data of a patient with bladder ossification. Results This patient was preoperatively diagnosed as bladder tumor, and a operation of transurethral resection of bladder tumor was performed. A nodular mass of bone - like, su- perior to the right ureteral orifice was found on the right lateral wall of the bladder during operation, with 3.5 cm in diameter. The pedicle of the tumor was thin, and the base was rough. Surrounding mu- cosa of the neoplasm was normal and no bleeding. We had to remove the tumor gradually by using a gravel pliers in that it was too hard. Postoperative pathology report revealed the main tumor as benign bladder neoplasm, which trabecular bone formation was founded in the fibrosis tissue. This patient was not treated with intravesical instillation. She was followed up for 2 years, no gross hematuria and dysu- ria, the general physical condition was good. Conclusions HO of bladder is rare. HO originates from osteoprogenitor stem cells lying dormant within the affected soft tissues. With the proper stimulus, the stem cells differentiate into osteoblasts and begin the process of osteoid formation, eventually leading to mature heterotopic bone formation. The diagnosis of this disease is difficult, and must be distinguished from osteosarcoma and carcinosarcoma. The determined diagnosis depends on cystoscopy and his- topathological examination. The main treatment regimen is surgical resection, and the indication is similar to bladder tumor.