开放手术联合内分泌疗法治疗子宫内膜膀胱异位症

Open surgery combined with endocrinotherapy for endometriosis of bladder

目的:探讨子宫内膜膀胱异位症的临床诊断及治疗。方法:回顾分析3例患者的临床资料,结合文献复习讨论。结果:3例患者均有剖宫产史,1例无任何症状,系在查体中发现。2例出现与月经有关的周期性腹痛及膀胱刺激征(1例表现为尿痛及血尿,1例表现为尿急、尿频)。3例患者行膀胱镜检查均见位于膀胱黏膜下有增大隆起的肿块。2例患者行膀胱部分切除术,1例行膀胱及子宫部分切除术。结论:子宫内膜膀胱异位症起病隐匿,临床症状不典型,不易确诊,应引起泌尿科医师的高度重视。膀胱镜检查对诊断此病最有价值。正确的手术治疗配合术前、术后的药物治疗能治愈此病。提高对本病的认识是诊断和治疗的关键。

Objective： To investigate the method of diagnosis and treatment for endometriosis of bladder. Method： The clinical data of 3 patients were analysed retrospectively. Results： Caesarean procedure had been performed in all the 3 patients. Endometriosis of bladder was found in 1 patient by routine checkup and in 2 by periodic abdominal pain and bladder irritation during the menses （one with urodynia and hematuria, another with precipitant urination and urinary frequency）. Submucous prominent lumps of bladder were found with cystoscopy in all the 3. Two patients were performed partial eysteetomy, and 1 partial hysterectomy additional. In order to prevent relapse, nemestran or mifepristone was given preoperatively and postoperatively to inhibit endometrial proliferation. During a follow-up of 3-7 years, none relapsed. Conclusion： Because of latent and atypical clinical symptoms, endometriosis of bladder is difficult to diagnose, as well cystoscope has a salutary effect for diagnosis. It seems to be cured by surgical therapy with preoperative and postoperative medication.