發(fā)布時(shí)間：2018-04-27 13:08

  本文選題：膀胱內(nèi)翻性乳頭狀瘤 + 膀胱灌注��； 參考：《青海大學(xué)》2017年碩士論文

【摘要】：目的:1.通過(guò)將臨床中診斷為膀胱內(nèi)翻性乳頭狀瘤的一般病例資料進(jìn)行搜集整理,回顧性分析探討總結(jié),揭示此病相關(guān)臨床特征及發(fā)生率。2.將收集的病例分組,觀察經(jīng)尿道膀胱腫瘤電切術(shù)聯(lián)合表柔比星膀胱灌注和單純經(jīng)尿道膀胱腫瘤電切術(shù)在膀胱內(nèi)翻性乳頭狀瘤中的療效差別,探索優(yōu)化的治療方案,減少?gòu)?fù)發(fā)惡變率,減少后期不適癥狀的發(fā)生率。方法:1.搜集青海大學(xué)附屬醫(yī)院、青海省人民醫(yī)院、西寧市第一人民醫(yī)院、青海省中醫(yī)院泌尿外科2011.03-2016.11期間內(nèi)所有被確診膀胱內(nèi)翻性乳頭狀瘤的病人,對(duì)收集的所有病例進(jìn)行一般情況、發(fā)病部位、臨床表現(xiàn)等多個(gè)方面進(jìn)行臨床特征研究分析歸納總結(jié),揭示其發(fā)生情況特點(diǎn)。2.將收集的病例分為兩組,經(jīng)尿道膀胱腫瘤電切術(shù)聯(lián)合表柔比星膀胱灌注的定為A組,只行經(jīng)尿道膀胱腫瘤電切術(shù)的定為B組,在術(shù)后按期進(jìn)行尿脫落細(xì)胞學(xué)、泌尿系彩超或膀胱鏡檢查、病理活檢相關(guān)檢查,記錄檢查結(jié)果,比較兩組患者的復(fù)發(fā)及惡變的情況,計(jì)算復(fù)發(fā)及惡變率;計(jì)算后期不適癥狀的實(shí)際發(fā)生情況。結(jié)果:1.總共收集64例患者,其中:男性53例,女性11例;50歲以內(nèi)的23例,50歲及以上的41例;臨床表現(xiàn)為間斷性無(wú)痛肉眼血尿有31例,臨床表現(xiàn)為尿頻尿急尿痛有17例,臨床表現(xiàn)為排尿困難的有6例,臨床表現(xiàn)為下腹部腰背部酸脹不適感的有2例,無(wú)明顯臨床癥狀的有8例;尿常規(guī)檢驗(yàn)結(jié)果:白細(xì)胞+~++++共有23例,紅細(xì)胞+-~++++共有41例;1例多發(fā),膀胱內(nèi)可見(jiàn)3處大小不等的病灶,大小為10mm×13mm,14mm×21mm,25mm×36mm。63例單發(fā),5例在膀胱左側(cè)壁,8例膀胱在右側(cè)壁,6例在底部,34例在頸部,11例在三角區(qū);腫瘤直徑在10mm以內(nèi)的有21例,10mm-30mm的有39例,大于30mm的有4例;26例腫瘤外觀呈基底部較寬的乳頭或息肉狀,38例腫瘤外觀呈蒂較細(xì)的珊瑚樣或海藻狀。2.A組總例數(shù)34例,復(fù)發(fā)2例,惡變1例,復(fù)發(fā)率為5.88%,惡變率為2.94%;B組總例數(shù)30例,復(fù)發(fā)3例,惡變2例,復(fù)發(fā)率為10.00%,惡變率為6.67%。兩組復(fù)發(fā)率及惡變率比較P0.05,差別均沒(méi)有統(tǒng)計(jì)學(xué)意義。結(jié)論:1.IPB常發(fā)生于男性,女性少見(jiàn),男女比例為5:1,常發(fā)病年齡在中年水平。2.IPB起病原因不清楚,與長(zhǎng)期反復(fù)的膀胱炎性刺激、各種原因?qū)е碌南履蚵饭Ｗ�、HPV(人類乳頭瘤病毒)感染、化學(xué)性致癌物質(zhì)因素以及吸煙等因素有密切聯(lián)系。3.IPB以無(wú)痛性肉眼血尿?yàn)樽疃嘁?jiàn),其次為尿頻尿急尿痛、排尿困難或下腹部不適感癥狀,也有無(wú)明顯臨床癥狀的患者。4.膀胱IP比較常見(jiàn)的好發(fā)位置位于三角區(qū)、頸部以及雙側(cè)輸尿管口附近區(qū)域,前列腺尿道部比較少見(jiàn),膀胱頂部位置極少見(jiàn)。5.IPB的檢查方式以膀胱鏡檢查和病理活檢為主。6.IPB常常單發(fā),多發(fā)情況較少出現(xiàn),腫瘤多在3cm之內(nèi)。7.IPB預(yù)后相對(duì)較好,復(fù)發(fā)和惡變率較低。8.A、B組復(fù)發(fā)率及惡變率對(duì)比,差別均沒(méi)有統(tǒng)計(jì)學(xué)意義。
[Abstract]:Purpose 1. The clinical data of the patients diagnosed as inverted papilloma of the bladder were collected and analyzed retrospectively to reveal the clinical characteristics and incidence of the disease. The patients were divided into two groups to observe the effect of transurethral resection of bladder neoplasms combined with epirubicin instillation and simple transurethral resection of bladder tumors in patients with inverted papilloma of the bladder. The rate of recurrence and malignancy was reduced, and the incidence of late discomfort was reduced. Method 1: 1. To collect all the patients in the affiliated Hospital of Qinghai University, the people's Hospital of Qinghai Province, the first people's Hospital of Xining City, and the Department of Urology of Qinghai Provincial Hospital of Chinese Medicine during the period 2011.03-2016.11, all the patients who were diagnosed as turning inverted papilloma of the bladder, and the general information of all the cases collected, The location of the disease, clinical manifestations and other aspects of clinical characteristics were analyzed and summarized, revealing its occurrence characteristics. 2. 2. The patients were divided into two groups: group A with transurethral resection of bladder tumor and intravesical instillation of epirubicin, and group B with transurethral resection of bladder tumor. Urine exfoliative cytology was performed after operation. Urological ultrasound or cystoscopy, pathological biopsy related examination, record the results, compare the recurrence and malignancy of the two groups, calculate the recurrence and malignancy rate, calculate the actual occurrence of the late discomfort symptoms. The result is 1: 1. A total of 64 patients were collected, including 53 males and 11 females aged less than 50 years in 23 patients aged 50 or above, 31 patients with intermittent painless gross hematuria, and 17 patients with acute urinal pain with frequency of urination. The clinical manifestations were dysuria in 6 cases, acid distention in the lower abdomen and back in 2 cases, and no obvious clinical symptoms in 8 cases. There were 41 cases with multiple lesions in RBC-~, and 3 lesions of varying size were found in bladder. The size of the lesions was 10mm 脳 13mm ~ 14mm 脳 21mm ~ 25mm 脳 36mm.63 (5 cases). In the left wall of bladder, 8 cases were located in the right wall of bladder, 6 cases were located in the right wall, 34 cases were located in the neck and 11 cases were located in the triangle area. There were 39 cases with tumor diameter less than 10 mm ~ 30 mm in 10mm, 4 cases with tumor larger than 30mm, and 26 cases with large papilla or polyp at base. 38 cases had coral-like or seaweed shaped appearance with thin pedicle in 38 cases, and 2 cases recurred in group A, the tumor diameter was less than 10 mm ~ (30 mm), and 4 cases (n = 26) were larger than 30mm, and the appearance of tumor was coral-like or trehalous in appearance. In group B, there were 30 cases of malignant change, 3 cases of recurrence, 2 cases of malignant change, 10.00% of recurrence and 6.67% of malignant change. There was no significant difference in recurrence rate and malignant change rate between the two groups (P 0.05). Conclusions: 1. IPB often occurs in males and females, the ratio of male to female is 5: 1. The onset age of IPB is not clear. 2. The causes of IPB are unclear, which are associated with chronic repeated cystitis and various causes of lower urinary tract obstruction (human papillomavirus) infection. The factors of chemical carcinogen and smoking were closely related. 3. Painless naked hematuria was the most common factor of IPB, followed by frequent urination pain, dysuria or lower abdominal discomfort, and patients with no obvious clinical symptoms. The common location of bladder IP is located in the triangle area, neck and the area near the bilateral ureteral orifice, but the prostate urethra is rare. At the top of bladder, cystoscopy and pathological biopsy were the main methods of IPB examination. 6. IPB often appeared singly, and the multiple cases were rare. The prognosis of IPB was relatively good in 3cm .7.IPB. The recurrence rate and malignant change rate were lower. 8. There was no significant difference in recurrence rate and malignant change rate.
【學(xué)位授予單位】：青海大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R737.14

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