背景:嗜酸细胞性膀胱炎(EC)是临床上罕见的特异性透壁性炎症性疾病。目前,其病因不明,其临床表现多样,其辅助检查缺乏特异性,临床上容易漏诊或误诊。
方法:1例72岁男性下尿路梗阻伴血尿患者,经B超和尿CT检查诊断为良性前列腺增生伴出血。在接受导管插入治疗后,抗感染和止血,他接受了经尿道前列腺电切术的选择性治疗,但是他在手术中看到膀胱右后壁上有一个图案肿块。考虑到膀胱肿瘤,他切除了病灶,并给予吡柔比星膀胱灌注。然而,术后病理结果为EC。
方法:EC的诊断只能依靠病理检查,通过在多点活检的同时尽可能多地获取肌肉组织,可以提高活检的准确性和阳性率。
方法:经尿道切除病灶后口服泼尼松和西替利嗪,并定期给予坦索罗辛和非那雄胺治疗良性前列腺增生。
结果:随访半年无复发及排尿异常,上尿路功能正常。
结论:EC的临床表现不典型,实验室检查和影像学检查没有特异性,手术前很难明确诊断。诊断取决于病理检查。经尿道病灶电切术在彻底清除病灶的同时,可明显提高活检阳性率,联合药物治疗可在短时间内取得满意效果。术后积极的随访对明确病情复发、防止上尿路功能受损非常重要。
BACKGROUND: Eosinophilic cystitis (EC) is a rare and specific transmural inflammatory disease in clinic. At present, its etiology is unknown, its clinical manifestations are diverse, and its auxiliary examination lacks specificity, so it is easy to be missed or misdiagnosed in clinical practice.
METHODS: A 72-year-old male patient with symptoms of lower urinary tract obstruction accompanied by hematuria was diagnosed with benign prostatic hyperplasia with bleeding by B-ultrasound and urinary CT examination. After being treated with catheterization, anti-infection and hemostasis, he was selectively treated with transurethral resection of prostate, but he saw a pattern mass on the right back wall of the bladder during the operation. Considering bladder tumor, he removed the lesion and gave pirarubicin for bladder perfusion. However, the postoperative pathological result was EC.
METHODS: The diagnosis of EC can only rely on pathological examination, and the accurate and positive rate of biopsy can be improved by obtaining muscle tissue as much as possible at the same time of multi-point biopsy.
METHODS: Prednisone and cetirizine were given orally after transurethral resection of lesions, and tamsulosin and finasteride were given regularly to treat benign prostatic hyperplasia.
RESULTS: No recurrence and abnormal urination were found during the follow-up for half a year, and the upper urinary tract function was normal.
CONCLUSIONS: The clinical manifestations of EC are atypical, the laboratory examination and imaging examination are not specific, and it is difficult to make a definite diagnosis before operation. The diagnosis depends on pathological examination. Transurethral resection of the lesion can obviously improve the positive rate of biopsy while completely removing the lesion, and the combined drug treatment can achieve satisfactory results in a short period of time. Active follow-up after operation is very important to identify the recurrence of the disease and prevent the upper urinary tract function from being damaged.