膀胱子宫内膜异位症的诊断和治疗

Diagnosis and treatment of endometriosis of the bladder

目的探讨膀胱子宫内膜异位症(endometriosis,EMS)的诊治方法。方法回顾性分析我院1992-2006年收治的8例EMS患者的诊治经过及随访结果;术前均行膀胱镜检查及取组织病检明确诊断,常规盆腔CT检查明确病变范围。结果膀胱EMS主要表现为与月经密切相关的尿频、尿急、尿痛、下腹胀痛、镜下或肉眼血尿等;8例膀胱EMS患者中6例既往有手术史者均为内在型,2例无手术史者为孤立型;孤立型2例行经尿道电切术,内在型6例行膀胱部分切除术,其中2例与子宫黏连紧密而无生育要求者加行子宫切除,术后均Ⅰ期治愈,随访1年无复发。结论下尿路症状与月经密切相关时应高度怀疑EMS可能,膀胱镜及病理学检查是其最有价值的诊断方法;膀胱部分切除是内、外在型EMS者治疗的首选方法,或根据情况加行子宫、卵巢手术,孤立型EMS者行经尿道电切疗效亦确切。

Objective To probe the diagnosis and treatment of endometriosis of the bladder. Methods Clinical data of 8 cases of female patients with cndomctriosis of the bladder were reviewed retrospectively. The diagnosis had been confirmed by cystoscopy and pathology. The extent of lesions was ascertained by CT scan of the pelvic cavity, Results The main symptoms of cndometriosis of bladder were frequency, urgency, voiding pain, microscopic hematuria or gross hematuria and bladder pain, especially during the emmenia time. Of the 8 cases, 6 were internal-type who had been treated with operation, 2 isolated-type without operation. The 2 isolated-type cases were treated with TUR, and the 6 internal-type cases were treated with partial cystectomy. Conclusion Patients with lower urinary tract symptoms associated with emmenia should be alert of endometriosis. Cystoscopy and pathology are the most valuable measurements for the diagnosis of endometriosis of bladder and partial cystectomy is the first-choice therapeutic method for the internal-type and extra-type. Hysterectomy and operation on ovary will be done according to the patient＇s condition. TUR can be considered for patients of isolated-type.