膀胱平滑肌瘤8例临床分析
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摘要
目的:对膀胱良性肿瘤中平滑肌瘤的诊疗进行回顾性研究,从而更好地理解和掌握其诊疗方式。方法:回顾性分析2010年12月～2017年10月我院收治的8例膀胱平滑肌瘤患者的临床资料。其中男4例,女4例,年龄25～57岁,平均38岁。临床表现为腰痛1例,无任何临床症状体检时发现7例。病程3d～4个月,平均病程27d。8例患者术前B超检查均发现膀胱内占位性病变,其中2例患者可于肿瘤内探及血流信号,CT检查发现7例患者肿瘤有不同程度强化,1例患者未见明显强化,1例行IVU检查提示膀胱壁充盈缺损,CTU检查6例患者发现膀胱壁充盈缺损,8例患者行膀胱镜检查均发现膀胱壁占位。对8例患者分别采用经尿道膀胱肿瘤电切术(TURBt)、腹腔镜下膀胱部分切除术和机器人辅助腹腔镜下膀胱部分切除术治疗。结果:1例患者术后腰痛消失,未出现手术并发症。术后随访3个月～5年,平均随访时间2年,未见肿瘤复发或恶变转移。结论:膀胱平滑肌瘤在膀胱肿瘤中较为罕见,其预后良好,诊断主要依靠影像学和膀胱镜检查,在影像学表现上与膀胱尿路上皮癌鉴别困难,膀胱镜及病理可予以鉴别。确诊需依据病理,手术治疗效果较好。
Objective:To retrospectively analyze the diagnosis and treatment of bladder leiomyoma cases,so as to improve the diagnosis and treatment.Method:The clinical data of 8 patients with bladder leiomyoma from 2010 to 2017 were analyzed retrospectively.The mean age was 38(range,25-57)years old.Clinical manifestation included lumbago in 1 case and 7 cases were found in medical examination without any clinical symptoms.The course of disease ranged from 3 days to 4 months with an average of 27 days.Intravesical occupation lesions were found in 8 cases by B-ultrasonography before operation,of which 2 cases could detect blood flow signal in tumor.CT found that 7 cases had different degrees of enhancement of tumor,1 case had no obvious enhancement.IVU examination found bladder filling defect in 1 case and CT examination found bladder wall filling defect in 6 cases.Cystoscopy showed submucosal occupation of bladder in 8 cases.These 8 patients underwent transurethral resection of bladder tumor(TURBt),laparoscopic partial cystectomy and robotic assisted laparoscopic partial cystectomy.Result:Lumbago disappeared after sugery in 1 case,and no postoperative complications occurred.Recurrence or metastases could not be found during the follow-up period from 3 months to 5 years(mean,2 years).Conclusion:Bladder leiomyoma is rare in bladder tumors,and its prognosis is good.The diagnosis depends mainly on imaging and cystoscopy.The imaging findings can be difficult to distinguish from bladder urothelial carcinoma.Cystoscopy and pathology can be identified.The diagnosis needs to be based on pathology,and the surgical treatment is effective.
Objective:To retrospectively analyze the diagnosis and treatment of bladder leiomyoma cases,so as to improve the diagnosis and treatment.Method:The clinical data of 8 patients with bladder leiomyoma from 2010 to 2017 were analyzed retrospectively.The mean age was 38(range,25-57)years old.Clinical manifestation included lumbago in 1 case and 7 cases were found in medical examination without any clinical symptoms.The course of disease ranged from 3 days to 4 months with an average of 27 days.Intravesical occupation lesions were found in 8 cases by B-ultrasonography before operation,of which 2 cases could detect blood flow signal in tumor.CT found that 7 cases had different degrees of enhancement of tumor,1 case had no obvious enhancement.IVU examination found bladder filling defect in 1 case and CT examination found bladder wall filling defect in 6 cases.Cystoscopy showed submucosal occupation of bladder in 8 cases.These 8 patients underwent transurethral resection of bladder tumor(TURBt),laparoscopic partial cystectomy and robotic assisted laparoscopic partial cystectomy.Result:Lumbago disappeared after sugery in 1 case,and no postoperative complications occurred.Recurrence or metastases could not be found during the follow-up period from 3 months to 5 years(mean,2 years).Conclusion:Bladder leiomyoma is rare in bladder tumors,and its prognosis is good.The diagnosis depends mainly on imaging and cystoscopy.The imaging findings can be difficult to distinguish from bladder urothelial carcinoma.Cystoscopy and pathology can be identified.The diagnosis needs to be based on pathology,and the surgical treatment is effective.
引文
1 Chen H,Niu Z B,Yang Y.Bladder leiomyoma in a 6-year-old boy[J].Urology,2012,79(2):434-436.
2 Moyano Calvo J L,Maqueda Marín Mde L,Dávalos Casanova G,et al.Bladder leiomyoma in a 17-year-old male patient[J].Arch Esp Urol,2005,58(9):954-956.
3 Bulun S E.Uterine fibroids[J].N Engl J Med,2013,369(14):1344-1355.
4 Bulun S E,Moravek M B,Yin P,et al.Uterine leiomyoma stem cells:linking progesterone to growth[J].Semin Reprod Med,2015,33(5):357-365.
5 Strang A,Lisson S W,Petrou S P.Ureteral endometriosis and coexistent urethral leiomyoma in a postmenopausal woman[J].Int Braz J Urol,2004,30(6):496-498.
6 Bai S W,Jung H J,Jeon M J,et al.Leiomyomas of the female urethra and bladder:a report of five cases and review of the literature[J].Int Urogynecol J Pelvic Floor Dysfunct,2007,18(8):913-917.
7 Alvarado-Cabrero I,Candanedo-González F,Sosa-Romero A.Leiomyoma of the urethra in a Mexican woman:a rare neoplasm associated with the expression of estrogen receptors by immunohistochemistry[J].Arch Med Res,2001,32(1):88-90.
8 Kaviani A,Razi A,Mokhtarpour H,et al.Epitheliod leiomyoma of the bladder:an unusual case of irritative and obstructive voiding symptoms[J].Case Rep Urol,2012,2012:759150.
9沙建军,潘家骅,王兆亮,等.经尿道肿瘤剜除术治疗黏膜下型膀胱平滑肌瘤初探[J].中华泌尿外科杂志,2011,32(9):636-638.
10 Lee T K,Miyamoto H,Osunkoya A O,et al.Smooth muscle neoplasms of the urinary bladder:a clinicopathologic study of 51cases[J].2010,34(4):502-502.
11杨栋,潘峰,梁华庚,等.膀胱平滑肌瘤误诊为子宫肌瘤1例并文献复习[J].临床泌尿外科杂志,2012,27(5):337-338.
12 Park J W,Jeong B C,Seo S I,et al.Leiomyoma of the Urinary Bladder:A Series of Nine Cases and Review of the Literature[J].Urology,2010,76(6):1425-1429.
13 Hernandez D J,Chan D Y.Bladder leiomyomata and pelvic pain[J].Urology,2007,70(4):807-808.
14 Xin J,Lai H P,Lin S K,et al.Bladder leiomyoma presenting as dyspareunia[J].Medicine(Baltimore),2016,95(28):e3971.
15 Wu S.Imaging findings of atypical leiomyoma of the urinary bladder simulating bladder cancer:a case report and literature review[J].Med Ultrason,2013,15(2):161-163.
16秦燕,周顺科,刘军,等.膀胱平滑肌瘤的非典型CT表现及病理学特点对照分析[J].中华泌尿外科杂志,2015,36(12):895-898.
17 Wong-You-Cheong J J,Woodward P J,Manning M A,et al.From the archives of the AFIP:Inflammatory and nonneoplastic bladder masses:radiologic-pathologic correlation[J].Radiographics,2006,26(6):1847-1868.
18马振,彭昌伟,白铁男,等.经尿道剜除术治疗膀胱平滑肌瘤的疗效观察[J].临床泌尿外科杂志,2013,28(9):654-656.
19 Nerli R B,Reddy M,Koura A C,et al.Cystoscopy-assisted laparoscopic partial cystectomy[J].J Endourol,2008,22(1):83-86.
2 Moyano Calvo J L,Maqueda Marín Mde L,Dávalos Casanova G,et al.Bladder leiomyoma in a 17-year-old male patient[J].Arch Esp Urol,2005,58(9):954-956.
3 Bulun S E.Uterine fibroids[J].N Engl J Med,2013,369(14):1344-1355.
4 Bulun S E,Moravek M B,Yin P,et al.Uterine leiomyoma stem cells:linking progesterone to growth[J].Semin Reprod Med,2015,33(5):357-365.
5 Strang A,Lisson S W,Petrou S P.Ureteral endometriosis and coexistent urethral leiomyoma in a postmenopausal woman[J].Int Braz J Urol,2004,30(6):496-498.
6 Bai S W,Jung H J,Jeon M J,et al.Leiomyomas of the female urethra and bladder:a report of five cases and review of the literature[J].Int Urogynecol J Pelvic Floor Dysfunct,2007,18(8):913-917.
7 Alvarado-Cabrero I,Candanedo-González F,Sosa-Romero A.Leiomyoma of the urethra in a Mexican woman:a rare neoplasm associated with the expression of estrogen receptors by immunohistochemistry[J].Arch Med Res,2001,32(1):88-90.
8 Kaviani A,Razi A,Mokhtarpour H,et al.Epitheliod leiomyoma of the bladder:an unusual case of irritative and obstructive voiding symptoms[J].Case Rep Urol,2012,2012:759150.
9沙建军,潘家骅,王兆亮,等.经尿道肿瘤剜除术治疗黏膜下型膀胱平滑肌瘤初探[J].中华泌尿外科杂志,2011,32(9):636-638.
10 Lee T K,Miyamoto H,Osunkoya A O,et al.Smooth muscle neoplasms of the urinary bladder:a clinicopathologic study of 51cases[J].2010,34(4):502-502.
11杨栋,潘峰,梁华庚,等.膀胱平滑肌瘤误诊为子宫肌瘤1例并文献复习[J].临床泌尿外科杂志,2012,27(5):337-338.
12 Park J W,Jeong B C,Seo S I,et al.Leiomyoma of the Urinary Bladder:A Series of Nine Cases and Review of the Literature[J].Urology,2010,76(6):1425-1429.
13 Hernandez D J,Chan D Y.Bladder leiomyomata and pelvic pain[J].Urology,2007,70(4):807-808.
14 Xin J,Lai H P,Lin S K,et al.Bladder leiomyoma presenting as dyspareunia[J].Medicine(Baltimore),2016,95(28):e3971.
15 Wu S.Imaging findings of atypical leiomyoma of the urinary bladder simulating bladder cancer:a case report and literature review[J].Med Ultrason,2013,15(2):161-163.
16秦燕,周顺科,刘军,等.膀胱平滑肌瘤的非典型CT表现及病理学特点对照分析[J].中华泌尿外科杂志,2015,36(12):895-898.
17 Wong-You-Cheong J J,Woodward P J,Manning M A,et al.From the archives of the AFIP:Inflammatory and nonneoplastic bladder masses:radiologic-pathologic correlation[J].Radiographics,2006,26(6):1847-1868.
18马振,彭昌伟,白铁男,等.经尿道剜除术治疗膀胱平滑肌瘤的疗效观察[J].临床泌尿外科杂志,2013,28(9):654-656.
19 Nerli R B,Reddy M,Koura A C,et al.Cystoscopy-assisted laparoscopic partial cystectomy[J].J Endourol,2008,22(1):83-86.
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