|摘要||目的 探讨膀胱副神经节瘤的临床诊治特点. 方法 回顾性分析1994年6月至2012年4月5例膀胱副神经节瘤患者的临床资料.男2例,女3例.年龄23 ～ 68岁,平均43岁.体检发现膀胱肿物2例,以间断无痛肉眼血尿为主要临床症状1例,1例表现为进行性排尿困难10年,另1例排尿时伴心悸、胸前区不适2年.1例有高血压病史6年,术前血压最高160/90 mm Hg(1 mm Hg=0.133 kPa).膀胱镜检查可见膀胱内突起肿物或膀胱内呈外压性改变,肿瘤位于三角区1例,后壁1例,顶部1例,膀胱前壁2例,3例行病理活检,均为阴性.3例行术前内分泌检查提示血去甲肾上腺素明显升高,分别为1957、3581、60 500 pmol/L.2例术前诊断为膀胱副神经节瘤,1例考虑为脐尿管癌,另2例诊断为膀胱肿瘤. 结果 行开放膀胱部分切除1例,经尿道膀胱肿瘤电切1例,腹腔镜下膀胱部分切除3例.4例患者术中出现高血压危象,其中行经尿道膀胱肿瘤电切患者术中出现应激性心肌病,1例手术顺利.出血量20 ～800 ml,平均126 ml,1例输血600 ml.术后恢复顺利.随访3 ～ 48个月,患者血压正常,未见肿瘤复发. 结论 膀胱副神经节瘤临床少见,极易误诊,对于排尿时伴有血压变化、心悸、头晕等表现的膀胱肿瘤患者应高度警惕膀胱副神经节瘤的可能.膀胱部分切除术是治疗膀胱副神经节瘤的主要方法.
Objective To review the clinical characteristics of paraganglioma of the urinary bladder with 5 cases reprt.Methods The clinical data of 5 patients (2 males and 3 females,age 23-68 years)with paraganglioma of the urinary bladder were reported.Two cases were diagnosed by ultrasonography during health examination,1 case was found by hematuria,1 had difficulty of voiding,and 1 presented with palpitation,chest discomfort while urination.Two cases were clinical diagnosed as bladder paraganglioma,1case urachal carcinoma,and 2 cases bladder tumor.Cystoscopy showed a protruding tumor within the bladder or bladder had compressed changes.One case of tumor located in the triangle,1 in the posterior wall,1in the top,2 in the anterior wall.Three cases of biopsy were negative.Three cases of preoperative endocrine examinations showed norepinephrine significantly higher.Results Laparoscopic partial cystectomy was performed in 3 cases,open partial cystectomy in 1 case,and transurethral resection of bladder tumor (TURBT) in 1 case.One case had the complication of stress cardiomyopathy during TURBT,3 cases found intraoperative hypertensive crisis.The bleeding volume was 20-800 ml (average 126 ml),and I case received blood transfusion.During the follow-up period for 3-48 months,the blood pressure was normal,and no recurrence was found.Conclusions Bladder paraganglioma is uncommon and easily misdiagnosed.For the patients with bladder tumor,accompanied by changes in blood pressure,palpitations during urination should be highly suspicious of bladder paraganglioma.Partial cystectomy is the main treatment method.|