CAJ | 학술논문

目的：分析儿童膀胱副神经节瘤合并可逆性后部白质脑病综合征（RPLS ）的诊治要点。方法报道1例表现为 RPLS 的儿童膀胱副神经节瘤病例，并以“膀胱副神经节瘤”、“儿童”为检索词，对以下数据库的相关论文进行检索：生物医学文献数据库（PubMed）、中国生物医学文献服务系统（SinoMed）、中国期刊全文数据库（CNKI）、万方数据知识服务平台、维普中文科技期刊数据库。收集并分析检索到的儿童膀胱副神经节瘤病例中以头痛或呕吐等为表现的患儿的资料。结果该例患儿以头痛、呕吐为首发症状，头颅 CT 及 MRI 提示颅内多发异常信号影，病程中发现与排尿有关的阵发性高血压，根据头颅影像学检查可诊断为 RPLS。肾上腺及盆腔 MRI 提示膀胱副神经节瘤可能。其后行腹腔镜下膀胱肿物切除术，病理结果证实为膀胱副神经节瘤。术后患儿再无头痛、呕吐等不适，血压降至正常。检索文献后收集到5例以头痛、呕吐等为表现的儿童膀胱副神经节瘤病例，其中2例行头颅 MRI 检查、1例行头颅 CT 检查，均未见异常，3例接受膀胱部分切除术，术后均恢复良好。结论表现为 RPLS 的儿童膀胱副神经节瘤病例较罕见，易误诊而导致延误病情。早期积极的降压治疗以及进一步切除局部病灶后，患儿一般预后良好。
목적：분석인동방광부신경절류합병가역성후부백질뇌병종합정（RPLS ）적진치요점。방법보도1례표현위 RPLS 적인동방광부신경절류병례，병이“방광부신경절류”、“인동”위검색사，대이하수거고적상관논문진행검색：생물의학문헌수거고（PubMed）、중국생물의학문헌복무계통（SinoMed）、중국기간전문수거고（CNKI）、만방수거지식복무평태、유보중문과기기간수거고。수집병분석검색도적인동방광부신경절류병례중이두통혹구토등위표현적환인적자료。결과해례환인이두통、구토위수발증상，두로 CT 급 MRI 제시로내다발이상신호영，병정중발현여배뇨유관적진발성고혈압，근거두로영상학검사가진단위 RPLS。신상선급분강 MRI 제시방광부신경절류가능。기후행복강경하방광종물절제술，병리결과증실위방광부신경절류。술후환인재무두통、구토등불괄，혈압강지정상。검색문헌후수집도5례이두통、구토등위표현적인동방광부신경절류병례，기중2례행두로 MRI 검사、1례행두로 CT 검사，균미견이상，3례접수방광부분절제술，술후균회복량호。결론표현위 RPLS 적인동방광부신경절류병례교한견，역오진이도치연오병정。조기적겁적강압치료이급진일보절제국부병조후，환인일반예후량호。
Objective To explore the diagnosis and treatment of bladder paraganglioma complicated with reversible posterior leukoencephalopathy syndrome (RPLS)in children.Methods In this study,one child diagnosed with bladder paraganglioma presenting with RPLS symptoms was reported.Using the keywords of “bladder pheochromocytoma”and “child”,relavant literatures were searched from PubMed,SinoMed, CNKI,Wanfang and Chongqing Vip databases.Clinical data of bladder pheochromocytoma children who pres-ented with headache or vomitting as intial symptoms were retrospectively collected and analyzed.Results The child presented with the initial symtoms of headache and vomitting.Cranial CT and MRI revealed multiple ab-normal signals.During the progression of disease,urination-related hypertension was observed.Based upon the imaging findings of head,the child was diagnosed with RPLS.Adrenal and pelvic MRI hinted the possibity of bladder paraganglioma.Subsequently,the child underwent laparoscopic resection of the bladder neoplasm and confirmed as bladder paraganglioma by histological examination.After resection,the symptoms of headache and vomitting disappeared and the blood pressure returned to normal range.In total,five children diagnosed with bladder pheochromocytoma presenting with headache and vomitting as the initial symptoms were searched.A-mong them,two cases underwent head MRI and one received CT scan and no abnormality was noted.Three children underwent partial cystectomy and were well recovered.Conclusions Bladder paraganglioma compli-cated with the symptoms of RPLS is rarely seen in clinical practice.It is likely to be misdiagnosed and delay the treatment.Early blood pressure control and resection of lesions yield good prognosis.