以LUTS为首发症状膀胱肿瘤病理与影像特点

Pathological and Imaging Characteristics of Bladder Tumor with LUTS as the First Symptom

摘要: 目的：分析以下尿路症状(LUTS)为首发症状的膀胱癌患者的病理类型以及影像学特点，更好的总结相应治疗经验。方法：回顾性分析我院近2年来因LUTS为首发症状入院的576例患者的临床资料，包括病史，临床表现，病理级别，及术后治疗方案，其中行经尿道膀胱镜下异常粘膜随机电切活检术后，病理证实为膀胱恶性肿瘤的有312例患者。结果：312例患者皆因LUTS为首发症状入院，高级别浸润性尿路上皮癌123例，高级别乳头状尿路上皮癌57例，低级别尿路上皮癌129例，鳞癌2例，腺癌1例，膀胱均在超声下显示膀胱壁欠光滑，异常增厚或见低回声结节，CT下均示膀胱壁异常增厚或见结节影，在普通的膀胱镜下表现为类似膀胱炎的淡红色改变及单发或多发肿物，且行异常粘膜随机电切活检，病理示肿瘤恶性程度概率高，低级别尿路上皮癌及高级别乳头状尿路上皮癌可辅以膀胱肿瘤电切术(TURBt)及术后膀胱灌注化疗药物治疗，高级别浸润性尿路上皮癌、鳞癌及腺癌需行根治性手术并辅以新辅助化疗及术后放化疗。结论：以LUTS为首发症状膀胱肿瘤患者影像学具有一定特征，且病理类型相对恶性程度较高，需要行异常粘膜电切活检，并积极治疗。

Abstract: Objective: To analyze the pathological types and imaging characteristics of bladder cancer patients with the following urinary tract symptoms (LUTS) as the first symptom, so as to better summarize the corresponding treatment experience. Methods: The clinical data of 576 patients admitted to our hospital with LUTS as the first symptom in the past two years were analyzed retrospectively, in-cluding medical history, clinical manifestation, pathological grade, and postoperative treatment plan. Among them, 312 patients were pathologically confirmed as bladder malignant tumor after transurethral cystoscopic random resection biopsy of abnormal mucosa. Results: 312 patients were all admitted because of LUTS as the first symptom, 123 cases of high-grade invasive urothelial car-cinoma, 57 cases of high-grade papillary urothelial carcinoma, 129 cases of low-grade urothelial carcinoma, 2 cases of squamous cell carcinoma, 1 case of adenocarcinoma, all of which showed that the bladder wall was not smooth, abnormally thickened or hypoechoic nodules under ultrasound, and the bladder wall was abnormally thickened or nodular shadow under CT. Under common cys-toscope, it shows light red changes similar to cystitis and single or multiple tumors, and carries out random electroresection biopsy of abnormal mucosa. Pathological findings show that the probabil-ity of malignancy of the tumor is high. Low grade urinary tract epithelial carcinoma and high grade papillary urinary tract epithelial carcinoma can be supplemented by bladder tumor resection (TURBt) and postoperative bladder infusion chemotherapy drug treatment, high grade invasive urinary tract epithelial carcinoma Squamous cell carcinoma and adenocarcinoma need radical sur-gery, neoadjuvant chemotherapy and postoperative radiotherapy and chemotherapy. Conclusion: The patients with bladder tumor with LUTS as the first symptom have certain characteristics in imaging, and the pathological type is relatively malignant, so it is necessary to perform abnormal mucosal resection biopsy and active treatment.