腺性膀胱炎的病因和治疗 the diagnosis 汕头大课件

腺性膀胱炎的病因和治疗 THE DIAGNOSIS AND TREATMENT OF CYSTITIS GLANDULARIS 病因 不甚明了 与慢性炎症、梗阻、结石等慢性刺激有 关。 也有人推测可能存在维生素缺乏症，有 毒代谢产物，激素失衡和特殊致癌物等 因素。 病理 典型表现为发现有BRUNN巢 慢性刺激使膀胱基底细胞增生，灶性生长，向 固有层生长为Brunn芽，进而形成Brunn巢，接 着巢中心腺性化生，粘液逐渐积聚而形成囊腔 ，与周围尿路上皮相延续，囊内液体为浅黄色 粘液成分，称为囊性膀胱炎。 囊壁细胞进一步化生为柱状上皮细胞，称为腺 性膀胱炎。所以，囊性膀胱炎和腺性膀胱炎是 一种疾病的二个病理阶段，常在同一病灶同时 存在，称为囊腺性膀胱炎。 膀胱镜下表现 滤泡状有核水肿型 为大多数表现。作者经验，囊腺性膀胱炎镜下的 典型表现为：有核的囊泡状颗粒弥漫地分布于 正常的粘膜之中，其核常为淡黄色，类似“粉 瘤”的内容物。有此表现者几乎100%可凭膀胱 镜作出诊断 。 慢性炎性型； 乳头状增生型； 混合型。 临床表现 症状： 尿频、尿急、尿痛； 排尿时尿道不适； 下腹部酸胀感； 肉眼血尿； 镜下血尿； 并发膀胱结石。 临床表现 病变部位： 单位于膀胱颈； 单位于三角区； 两者均有，为多数； 其它部位，侧壁或顶部，为少数。 转归 是粘膜的良性病变，但可能是恶性肿瘤的先兆 。 Edwards等报道了2例由腺性膀胱炎发展为腺癌 的典型病例。 Melicow发现在膀胱肿瘤中及邻近组织中的膀胱 移行上皮细胞不典型增生、间变或腺性化生。 国内张志根等报道腺性膀胱炎150例，其中31例 与膀胱肿瘤有关，腺性膀胱炎术后发生膀胱癌7 例(10)。 LU等运用免疫组化检测5例腺性膀胱炎和11例 腺癌组织中BCL-2的表达，发现BCL-2在二者中 的表达均升高。 治疗 激光治疗； 单纯电灼或电切膀胱粘膜； 膀胱部分切除，甚至膀胱全切除； 也有主张单纯药物灌注，所用药物有浓 酸水，1%硝酸银，普鲁卡因+庆大霉素 ，辣椒水，BCG，噻替哌，5-FU，丝裂 霉素，羟基喜树碱 等。 作者主张的方法 应先去除与膀胱慢性刺激有关的病变， 根据病变类型、部位、范围采取相应治 疗方法。 是电切加化疗药物膀胱灌注。 谢 谢 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