输尿管子宫内膜异位症(附6例报告)

Ureteral Endometriosis

目的:总结输尿管子宫内膜异位症的临床、病理特点及采用不同手术方法治疗的效果。方法:回顾分析6例输尿管子宫内膜异位症患者的临床资料、术后随访资料,并对这些结果进行对比分析。结果:6例患者均为单侧发病、均为下1/3段,3例术前病理确诊,行病变段切除、输尿管膀胱再植术,术后随访1～5年,均无复发梗阻;另外3例术前未确诊,行病变段冷刀内切开+双重双J管内引流2～3个月,拔管后随访过程中,1例失访,另外2例分别于6和11个月复发梗阻,改为病变段切除、输尿管膀胱再植术,再随访1～3年,未发现复发梗阻。6例术后2周始均结合药物内分泌治疗3～6个月,其中3例口服丹那唑0.2g Bid,3例皮下注射康士得3.6mg 1次/月。结论:输尿管镜下冷刀内切开虽然创伤较小,但不能完全去除异位的子宫内膜,梗阻复发率较高,故临床上以采用病变段切除、输尿管膀胱再植术,结合内分泌治疗为妥。

Objective：To summarize the clinical and pathological characteristics of ureteral endometriosis and the prognosis after different treatment. Methods：Reviewed retrospectively and analyzed the clinical and post-operational follow-up data of 6 cases of ureteral endometriosis. Results：All the 6 cases of ureteral endometriosis were all to take place at the lower 1/3 of one-side. 3 cases were to be made a definite diagnosis before operation by pathology. They underwent segmental ureterectomy and ureteral reimplantation. Obstruction was not found in the next 1 to 5 years. The other 3 cases were not considered before operation, the patients were performed ento-slit with cryoprobe under ureteroscope at diseased region and putting in two double-J ducts. The ducts were pulled out after 2 to 3 months. 1 case was out of the follow-up after pulling out. While obstruction was found in the other 2 cases after 6, 11 months. Those 2 cases were performed segmental ureterectomy and ureteral reimplantation then. No relapse was found in the next 1 to 3 years. All of the 6 cases combined the drug with the endocrinotherapy after 2 weeks of operation for 3-6 months, 3 cases took danazol 0.2 Bid, the other 3 cases took subcutaneous injection of Casodex 3.6 mg one time per month. Conclusions： Though ento-slit under ureteroscope has less injury, it can not remove the endometrium completely but resolve the obstruction temporary, and with the high relapse rate of ob- struction, so the clinical treatment of ureteral endometriosis should be performed segmental ureterectomy, ureteral reimplantation and endocrinotherapy.