原发性膀胱淀粉样变临床诊治分析

贺文彦1 ，王涛1，张建勋1 ，张芙蓉2，郭亚雄1

（1. 延安市人民医院泌尿外科，陕西 延安，716000；2.延安大学附属医院老年病科，陕西 延安，716000）

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摘要：

目的 探讨原发性膀胱淀粉样变的发病机制、临床表现、诊断及治疗，提高对该病的认识。方法 回顾性分析我院和延安大学附属医院诊治的11例原发性膀胱淀粉样变患者的临床资料并进行文献复习。结果 5 例行经尿道电切+术后二甲基亚砜（DMSO）灌注和1例输尿管淀粉样变行输尿管狭窄段切除+膀胱瓣输尿管成形术，随访6 月至11 年，未见复发；2 例单纯行 膀胱部分切除术，分别于术后2、4年复发，给予经尿道电切+术后DMSO灌注，再未复发；1 例单纯行经尿道电切者，术后8 月复发，再次经尿道电切+术后DMSO 灌注，再未复发；1 例抗炎、对症处理，术后2 次复发，第2次行经尿道电切+DMSO灌注 后，再未复发；1 例行膀胱全切+回肠膀胱术者失访。结论 原发性膀胱淀粉样变在临床上较少见，极易误诊为膀胱癌，确诊主 要依赖于病理学检查及刚果红复染反应，治疗上多采用经尿道病变切除术+术后DMSO灌注疗法，疗效及预后良好。

关键词：膀胱；淀粉样变；诊断；预后

中图分类号：R699文献标志码：A文章编号：2096-1413(2017)35-0006-04

Diagnosis and treatment of primary amyloidosis of the bladder
HE Wen-yan 1, WANG Tao 1, ZHANG Jian-xun 1, ZHANG Fu-rong 2, GUO Ya-xiong 1
(1. Urology Surgery Department, Yan``an People``s Hospital, Yan``an 716000; 2. Geriatrics Department,

Yan``an University Affiliated Hospital, Yan``an 716000, China)

ABSTRACT: Objective To investigate the pathogenesis, clinical manifestations, diagnosis and treatment of primary amyloidosis of the bladder, and to improve the acknowledge of this disease. Methods The clinical data of 11 cases of patients with primary amyloidosis of the bladder in our hospital and the Yan``an University Affiliated Hospital were analyzed, and the related literatures were reviewed. Results Five cases received transurethral resection + DMSO bladder instillation, and 1 case of primary amyloidosis in ureter received excision of ureteral stricture + reconstruction of bladder and ureter, none recurrence was found in 6 months to 11 years`` follow-up. Two cases underwent partial cystectomy recurred at 2, 4 years after surgery respectively, and no recurrence after receiving transurethral resection + DMSO bladder instillation. One case received transurethral resection recurred after 8 months, and no recurrence after receiving transurethral resection + DMSO bladder instillation. One case accepted anti-inflammatory, symptomatic treatment, and recurred for 2 times, then received transurethral resection + DMSO bladder instillation, and no recurreence occurred at second time. One case received cystectomy and bricker operation loss to follow-up. Conclusion Primary amyloidosis of the bladder is rare in clinical practice, it is easily misdiagnosed as the bladder cancer, its diagnosis mainly depend on the pathological examination and Congo red after dyeing reaction, the rules of the treatment include resecting the lesions + DMSO bladder instillation, and the effects and outcomes are good.
KEYWORDS: bladder; amyloidosis; diagnosis; outcome

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