子宫内膜异位症累及泌尿系的诊治(附4例报告并文献复习)

Diagnosis and treatment for endometriosis of the urinary tract(Report of 4 cases and literature review)

目的:探讨子宫内膜异位症累及泌尿系的诊断和治疗.方法:报告泌尿系子宫内膜异位症4例并复习国内1949～2004文献报道的81篇共136例病例资料.结果:子宫内膜异位症累及泌尿系主要表现为尿频、尿痛、镜下血尿及不同程度的腰腹痛,月经期明显或加重;妇科检查可发现大小不等的痛性盆腔包块.本病以膀胱受累最为多见,国人输尿管受累高于国外报道,约占38%.结论:诊断应注意与月经有关的泌尿系症状及妇科检查,B超、静脉肾盂造影或(和)逆行肾盂造影检查能明确病变大小、泌尿系梗阻部位和程度,膀胱镜检对膀胱子宫内膜异位症具有诊断价值;治疗应以卵巢及病灶切除、输尿管松解、输尿管端端吻合或输尿管膀胱吻合为主,丹那唑等可作为辅助用药.

Objective： To probe the diagnosis and treatment for endometriosis of the urinary tract. Methods： Clinical data of 4 cases of patients with endometriosis of the urinary tract were reported and 136 cases in 81 thesi ses presented from 1949 to 2004 were reviewed simutaneosly. Results： The main sympotoms of endometriosis of u rinary tract are frequent micturition, voiding pain, microscopy hematuria and lumbago-bellyache at dissimilar extent, especially during the emmenia time. Ache basin lumps in different size may be detected in physical examina tion. The endometriosis of bladder is the most common one in endometriosis of the urinary tract. The endometriosis of ureter（about 38% in endometriosis of the urinary tract） is higher in our country than that reported abroad. Conclusions：The sympotoms of urinary system especially associated with emmenia and gynaecology examination should be paid attention. B ultrasonography, intravenous urograms and or retrograde imaging by ureterograms will be helpful for definiting the size of lump, localizing the site and realizing the degree of obstruction. Cystoscopy is the most valuable detection for the diagnosis of endometriosis of bladder. Hysterectomy, ovarectomy, focus resec tion and ureterolysis, ureteroureterostomy or ureterocystostomy are the main treatments of choices, and danazol could be used as the assistant therapeutic method.