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膀胱结石为泌尿外科常见病和多发病,膀胱肿瘤是我国泌尿外科最常见肿瘤之一。但临床上膀胱结石合并膀胱癌的病例则较少见。本文分析膀胱结石合并膀胱肿瘤4例诊治情况。患者表现为尿频、尿急、尿痛及偶发血尿等临床症状,病程3天~2年。均首先于外院就诊,诊断为膀胱结石,漏诊膀胱肿瘤,其中1例漏诊长达6个月。入我院后行泌尿系超声、膀胱镜检查、肿瘤活检及CT检查,经病理检查证实为低级别尿路上皮癌3例、高级别尿路上皮癌1例。膀胱结石合并低级别尿路上皮癌3例,行经尿道膀胱结石液电碎石术及绿激光膀胱肿瘤汽化切除术,均一次碎石成功,膀胱肿瘤切除干净,术中无膀胱穿孔,无大出血及水中毒症状。留置导尿管5~7天,术后无发热,复查泌尿系X线平片未见膀胱结石残留。术后常规行吡柔比星膀胱灌注治疗,经随访均未出现尿道狭窄及大出血等并发症。膀胱结石合并高级别尿路上皮癌1例,行常规膀胱全切、回肠膀胱术,随访至今,未见肿瘤局部复发及转移。结合本组4例诊治情况,临床上遇有膀胱结石患者,应仔细询问、分析病史,尤其对于合并慢性感染且膀胱结石较大、病程较长、年龄偏大患者,应给予高度重视,如影像学检查结果可疑,应立即行膀胱镜检查,避免漏诊,并取肿物及可疑部位组织进行病理检查,以明确诊断;治疗上,应根据膀胱肿瘤大小及分级进行个体化治疗,最大限度地减少创伤,保留患者膀胱。
Bladder stones are common and frequent urological diseases, bladder cancer is one of the most common urological tumors in our country. However, clinical cases of bladder stones with bladder cancer are rare. This article analysis of 4 cases of bladder stones combined with bladder cancer diagnosis and treatment. Patients showed frequent urination, urgency, dysuria and occasional hematuria and other clinical symptoms, duration of 3 days to 2 years. First of all outside the hospital for treatment, diagnosed as bladder stones, missed diagnosis of bladder cancer, including 1 case of missed diagnosis up to 6 months. Into our hospital after urinary tract ultrasound, cystoscopy, tumor biopsy and CT examination confirmed by pathological examination of low-grade urothelial carcinoma in 3 cases, 1 case of high-grade urothelial carcinoma. Bladder stones combined with low-grade urothelial carcinoma in 3 cases, transurethral resection of bladder lithotripsy and green laser resection of bladder tumor, were a success of gravel, bladder tumor resection clean, intraoperative bladder perforation, no major bleeding and Water poisoning symptoms. Catheter indwelling 5 to 7 days after surgery without fever, urinary X-ray examination showed no residual bladder stones. Postoperative routine pirarubicin bladder irrigation treatment, no follow-up urethral stricture and bleeding and other complications. Bladder stones combined with high-grade urothelial carcinoma in 1 cases, routine conventional total bladder resection, ileal bladder surgery, follow-up so far, no local tumor recurrence and metastasis. Combined with the 4 cases of diagnosis and treatment of this group, patients with bladder stones in clinical cases should be carefully asked to analyze the history, especially for patients with chronic infection and bladder stones larger, longer duration, older patients should be given high priority, such as images School suspicious findings should be immediately cystoscopy to avoid misdiagnosis, and take the tumor and the suspicious parts of the organization for pathological examination to confirm the diagnosis; treatment should be based on the size and grading of bladder cancer individualized treatment to minimize Trauma, keep the patient’s bladder.