中华泌尿外科杂志
中華泌尿外科雜誌
중화비뇨외과잡지
CHINESE JOURNAL OF UROLOGY
2012年
4期
268-271
,共4页
朱绪辉%杜鹏%善辉%李涛%张鹏%杨勇
硃緒輝%杜鵬%善輝%李濤%張鵬%楊勇
주서휘%두붕%선휘%리도%장붕%양용
膀胱疼痛综合征%间质性%膀胱炎%随机活检%水扩张
膀胱疼痛綜閤徵%間質性%膀胱炎%隨機活檢%水擴張
방광동통종합정%간질성%방광염%수궤활검%수확장
Bladder pain syndrome%Cystitis%Interstitial%Random biopsy%Hydrodistention
目的 探讨膀胱镜随机活检及麻醉下水扩张对诊断和治疗膀胱疼痛综合征/间质性膀胱炎(bladder pain syndrome/interstitial cystitis,BPS/IC)的临床意义. 方法 回顾性分析2005年至2010年我院因膀胱疼痛等下尿路症状入院的119例患者的临床资料.男32例,年龄47～ 64岁,平均56岁；女87例,年龄23 ～ 67岁,平均49岁.初步诊断均为BPS/IC.入院后行排尿日记、疼痛及症状评分、QOL、尿细菌学培养、尿找肿瘤细胞、尿找抗酸杆菌等检查.全麻后行膀胱镜检膀胱黏膜随机活检,然后进行膀胱镜麻醉下水扩张,对水扩张前后IC患者每日排尿次数、最大排尿量、疼痛评分、O 'Leary-Sant问卷症状评分、QOL等指标进行比较. 结果 119例经膀胱镜随机活检及麻醉下水扩张,确诊为IC患者102例,治疗前每日排尿次数为(42.1±5.6)次,最大排尿量为(141.0 ±8.3)ml,疼痛评分为(7.6±3.0)分,O'Leary-Sant问卷症状评分为(27.7±4.2)分,QOL为(7.6±2.4)分.治疗后每日排尿次数为(23.3±3.4)次,最大排尿量为(352.0±1.7)ml,疼痛评分为(3.3±4.3)分,O 'Leary-Sant问卷症状评分为(12.5±7.3)分,QOL为(3.2±5.1)分,与治疗前比较差异均有统计学意义(P＜0.05).非IC患者17例,确诊为膀胱尿路上皮癌8例,其中原位癌4例、低级别非浸润性膀胱癌l例、高级别浸润性膀胱癌3例,其中4例无血尿症状,膀胱疼痛症状出现至确诊的平均时间为10.8个月.确诊为结核性膀胱炎3例,嗜酸性膀胱炎1例,化学性膀胱炎3例,放射性膀胱炎2例.结论 BPS仍需采用排除性诊断才能确诊为IC.膀胱镜随机活检及麻醉下水扩张对BPS的诊疗有重要意义.
目的 探討膀胱鏡隨機活檢及痳醉下水擴張對診斷和治療膀胱疼痛綜閤徵/間質性膀胱炎(bladder pain syndrome/interstitial cystitis,BPS/IC)的臨床意義. 方法 迴顧性分析2005年至2010年我院因膀胱疼痛等下尿路癥狀入院的119例患者的臨床資料.男32例,年齡47～ 64歲,平均56歲；女87例,年齡23 ～ 67歲,平均49歲.初步診斷均為BPS/IC.入院後行排尿日記、疼痛及癥狀評分、QOL、尿細菌學培養、尿找腫瘤細胞、尿找抗痠桿菌等檢查.全痳後行膀胱鏡檢膀胱黏膜隨機活檢,然後進行膀胱鏡痳醉下水擴張,對水擴張前後IC患者每日排尿次數、最大排尿量、疼痛評分、O 'Leary-Sant問捲癥狀評分、QOL等指標進行比較. 結果 119例經膀胱鏡隨機活檢及痳醉下水擴張,確診為IC患者102例,治療前每日排尿次數為(42.1±5.6)次,最大排尿量為(141.0 ±8.3)ml,疼痛評分為(7.6±3.0)分,O'Leary-Sant問捲癥狀評分為(27.7±4.2)分,QOL為(7.6±2.4)分.治療後每日排尿次數為(23.3±3.4)次,最大排尿量為(352.0±1.7)ml,疼痛評分為(3.3±4.3)分,O 'Leary-Sant問捲癥狀評分為(12.5±7.3)分,QOL為(3.2±5.1)分,與治療前比較差異均有統計學意義(P＜0.05).非IC患者17例,確診為膀胱尿路上皮癌8例,其中原位癌4例、低級彆非浸潤性膀胱癌l例、高級彆浸潤性膀胱癌3例,其中4例無血尿癥狀,膀胱疼痛癥狀齣現至確診的平均時間為10.8箇月.確診為結覈性膀胱炎3例,嗜痠性膀胱炎1例,化學性膀胱炎3例,放射性膀胱炎2例.結論 BPS仍需採用排除性診斷纔能確診為IC.膀胱鏡隨機活檢及痳醉下水擴張對BPS的診療有重要意義.
목적 탐토방광경수궤활검급마취하수확장대진단화치료방광동통종합정/간질성방광염(bladder pain syndrome/interstitial cystitis,BPS/IC)적림상의의. 방법 회고성분석2005년지2010년아원인방광동통등하뇨로증상입원적119례환자적림상자료.남32례,년령47～ 64세,평균56세；녀87례,년령23 ～ 67세,평균49세.초보진단균위BPS/IC.입원후행배뇨일기、동통급증상평분、QOL、뇨세균학배양、뇨조종류세포、뇨조항산간균등검사.전마후행방광경검방광점막수궤활검,연후진행방광경마취하수확장,대수확장전후IC환자매일배뇨차수、최대배뇨량、동통평분、O 'Leary-Sant문권증상평분、QOL등지표진행비교. 결과 119례경방광경수궤활검급마취하수확장,학진위IC환자102례,치료전매일배뇨차수위(42.1±5.6)차,최대배뇨량위(141.0 ±8.3)ml,동통평분위(7.6±3.0)분,O'Leary-Sant문권증상평분위(27.7±4.2)분,QOL위(7.6±2.4)분.치료후매일배뇨차수위(23.3±3.4)차,최대배뇨량위(352.0±1.7)ml,동통평분위(3.3±4.3)분,O 'Leary-Sant문권증상평분위(12.5±7.3)분,QOL위(3.2±5.1)분,여치료전비교차이균유통계학의의(P＜0.05).비IC환자17례,학진위방광뇨로상피암8례,기중원위암4례、저급별비침윤성방광암l례、고급별침윤성방광암3례,기중4례무혈뇨증상,방광동통증상출현지학진적평균시간위10.8개월.학진위결핵성방광염3례,기산성방광염1례,화학성방광염3례,방사성방광염2례.결론 BPS잉수채용배제성진단재능학진위IC.방광경수궤활검급마취하수확장대BPS적진료유중요의의.
Objective To evaluate the diagnostic and therapeutic role in bladder pain syndrome/interstitial cystitis (BPS/IC) of random bladder biopsy and hydrodistention with cystoscopy under anesthesia.Methods A retrospective review of cases in our BPS/IC center was performed from 2005 to 2010. One hundred and nineteen patients were included who are diagnosed as the bladder pain syndrome/interstitial cystitis (BPS/IC).There were 32 male patients,aged 47 to 64 years,and 56 years on average; 87 female cases,aged 23 to 67 years,49 years on average.Patients with bladder pain symptoms underwent a thorough evaluation which include voiding diary,pelvic pain、urgency and frequency questionnaire,urine culture,cytology,acid fast bacilli and upper tract imaging.Cystoscopy and random bladder biopsy had been undertaken with general anesthesia.Before and after hydrodistention with cystoscopy,the patients daily frequency of urination,the maximum urine volume,pain scores,symptom scores,QOL score were observed to understand whether there are significant improvement. Results One hundred and nineteen BPS/IC cases underwent random bladder biopsy and hydrodistention with cystoscopy under anesthesia,and finally 102 cases were confirmed of IC; 17 cases were not IC. Eight patients who were previously diagnosed as BPS/IC were found bladder transitional cell carcinoma as the cause of bladder pain symptoms( including 4 cases carcinoma in situ,1 case Low grade non-invasive bladder cancer,3 cases High grade invasive bladder cancers),and 4 of whom had no hematuria. Mean time from the occurrence of BPS to diagnosis of transitional cell carcinoma was 10.8 months. Three patients previously diagnosed as BPS/IC were found tuberculous cystitis as the cause of symptoms,and one eosinophilic cystitis,three chemical cystitis,two radiation cystitis were also detected.Before hydrodistention with cystoscopy under anesthesia,the daily frequency of urination in 102 cases diagnosed for IC patients was 42.1 ±5.6; the maximum urine volume was 141.0 ± 8.3 ml; pain score 7.6 ± 3.0; O'Leary-Sant questionnaire symptom score was 27.7 ± 4.2; QOL score was 7.6 ± 2.4.After hydrodistention with cystoscopy under anesthesia,the daily frequency of urination in 102 IC patients was 23.3 ± 3.4,and the maximum urine volume was 352.0 ± 1.7 ml ; pain score was 3.3 ± 4.3 ; O'Leary-Sant questionnaire symptom score was 12.5 ± 7.3 ; QOL score was 3.2 ± 5.1. Before and after hydrodistention with cystoscope under anesthesia,all of the daily frequency of urination,the maximum urine volume,pain scores,symptom scores,QOL score in 102 IC patients were significant improved (P ＜ 0.05 ). Conclusions BPS/IC remains a diagnosis of exclusion.Random bladder biopsy and hydrodistention with cystoscopy under anesthesia play an important diagnostic and therapeutic role in BPS/IC.
