目的：分析国人嗜酸细胞性膀胱炎临床特点，探索临床诊断及治疗原则。方法报告1例嗜酸细胞性膀胱炎，并回顾性分析1986年1月—2014年12月嗜酸细胞性膀胱炎患者179例文献报道。结果嗜酸细胞性膀胱炎患者均经膀胱镜检查、活检后经病理明确诊断。男119例，女61例，年龄0 fl．8～78（38．5±18．5）岁，常见症状有肉眼或镜下血尿（68．89％）以及尿频、尿急和尿痛（46．67％），其他症状还包括耻骨上疼痛（30．56％）、排尿困难（30．00％）、腰痛（7．18％）、尿潴留（2．78％）等。绝大多数患者无异常体征（86．11％），部分患者可有耻骨上压痛（10．56％），下腹部包块（3．33％）和肾区叩击痛（3．33％）。影像学检查异常阳性率依次是CT扫描93．50％（115／123）、膀胱B型超声91．39％（138／151）和静脉肾盂造影（IUV）77．65％（66／85）。膀胱镜检查病变呈多处和广泛弥漫性病变76例（44．71％），累及膀胱三角区23例（13．53％），左、右或双侧输尿管开口24例（14．12％），右侧壁22例（12．94％），后壁19例（11．18％），膀胱底部13例（7．65％），左侧壁和膀胱顶部各9例（5．29％），前壁和膀胱颈均为6例（3．53％）。并发肾积水37例（20．55％），膀胱容量明显缩小、膀胱充盈困难或无法充盈19例（10．55％），尿潴留10例（5．56％），膀胱结石2例（1．11％），肿物表面沙粒样钙化和膀胱颈硬化症各1例（0．56％）。确诊后单纯内科治疗59例（32．78％），膀胱部分切除31例（17．22％），膀胱部分切除＋内科治疗25例（13．89％），膀胱镜治疗＋内科治疗23例（12．78％），单纯膀胱镜治疗18例（10．00％），膀胱全切和膀胱自体扩大术各1例（0．56％），余22例（12．22％）未详述内科治疗。本组病例中治愈156例（86．67％）。结论嗜酸细胞性膀胱炎可发于各年龄段，男性多于女性。常见症状包括血尿，尿频、尿急、尿痛，和耻骨上疼痛，排尿困难等。经尿道切除膀胱病变，结合皮质激素、抗过敏等综合治疗，多数患者预后良好。%Objective To analyze the clinical characteristics of eosinophilic cystitis , explore the clinical diagnosis and treatment principles .Methods We reported 1 case of eosinophilic cystitis , and retrospective analysis the literature from January 1986 to December 2014 which related to eosinophilic cystitis .Results The eosinophilic cystitis patients were con-firmed by cystoscopy, biopsy.119 patients were male, 61 patients were female, the age were 0.8~78 (38.5 ±18.5) years, symptom included gross or microscopic hematuria (68.89%) and frequent urination, urgency, dysuria (46.67%).Other symptoms included suprapubic pain (30.56%), dysuria (30.00%), low back pain (7.18%), and urinary retention (2.78%).The vast majority of patients with no abnormal signs (86.11%), some patients showed suprapubic tenderness (10.56%), abdomen bag block (3.33%) and kidney area pain (3.33%).The abnormal positive rate of imaging examina-tion was 93.50%(115/123) of CT, 91.39%(138/151) of ultrasound, and 77.65%(66/85) of IVU.The lesions showed multiple and diffuse lesions in 76 cases (44.71%), bladder triangle area lesions in 23 cases (13.53%), left, right, and bi-lateral orificium ureteris in 24 cases (14.12%), right wall in 22 cases (12.94%), posterior wall in 19 cases (11.18%), bladder basal area in 13 cases (7.56%), left wall and bladder top area in 9 cases (5.29%), anterior wall and bladder neck in 6 cases (3.53%), and concurrent hydronephrosis in 37 cases (20.55%), significantly reduced bladder capacity ,bladder filling difficult or impossible to filling in 19 cases (10 M.55%), urinary retention in 10 patients (5.56%), bladder stones in 2 cases (1.11%), tumor surface sand-like calcification and bladder neck sclerosis in 1 case (0.56%).After the diagnosis, internal-medical therapy alone in 59 cases (32.78%), partial resection of the bladder in 31 cases (17.22%), partial cystec-tomy +medical treatment in 25 cases (13.89%), cystoscopy treatment +medical treatment in 23 cases (12.78%), sim-ple bladder mirror in 18 cases (10.00%), cystectomy and autologous bladder augmentation in 1 case (0.56%), and 22 ca-ses (12.22%) with medical treatment were not described in detail .The patients were cured of 156 cases (86.67%).Con-clusion The eosinophilic cystitis occurs in all ages , more men than women .Common symptoms including hematuria , urinary frequency, urgency, dysuria, and suprapubic pain, dysuria.Transurethral resection of bladder lesions , combined with corti-costeroid, anti-allergy and other comprehensive treatment , the majority of patients showed good prognosis .
展开▼
