输尿管子宫内膜异位症的诊断和治疗（附5例报告）

Diagnosis and treatment of ureteral endometriosis （ report of five cases）

目的探讨输尿管子宫内膜异位症的诊断和治疗方法，提高输尿管子宫内膜异位症的诊治水平。方法结合文献回顾分析5例输尿管子宫内膜异位症患者的临床资料、术后随访资料。结果3例患者表现为腰骶部酸胀不适或下腹部隐痛不适（其中1例经期症状加重），1例表现为急性腰腹部绞痛，1例绝经患者无明显症状。首诊误诊4例，不能明确诊断1例；术前影像学检查误诊为输尿管炎性狭窄3例、输尿管肿瘤1例，术中、术后病理检查证实均为输尿管子宫内膜异位症。术后随访1．5～9年，4例肾积水消失，1例肾输尿管切除者对侧未见肾积水。结论输尿管子宫内膜异位症早期易误诊，妇科、泌尿科医师应加强对于输尿管子宫内膜异位症的认识；输尿管子宫内膜异位症影像学检查缺乏特异性，对于诊断不明者，建议手术探查，既可立即解除梗阻，又可明确诊断并指导进一步治疗。

Objective To study and improve the diagnosis and treatment of ureteral endometriosis. Methods Five cases of ureteral endometriosis were analyzed retrospectively, in addition, related literatures from Medline and Chinese journals were reviewed. Results Three patients presented with non -specific symptoms, such as chronic pelvic pain or chronic loin pain, and one patient＇s symptom related to menstruation; one patient presented with renal colic ; one post- menopausal patient had no clinical signs. In the first visits four cases were misdiagnosed, and one case could not confirm the diagnosis; with the preoperative imaging, three cases were misdiagnosed as inflammatory ureteral stricture, and one case was misdiagnosed as ureteral tumor. All were confirmed as ureteral endometriosis with the intraoperative and postoperative pathological examinations. All five cases were followed for 1.5 - 9 years, and the nephrohydrosis had no recurrence. Conclusion Ureteral endometriosis is easy to be misdiagnosed in the early stage, so the obstetrician - gynecologists and urologists should be strengthened the awareness of ureteral endometriosis; As ureteral endometriosis is short of specificity in imaging, surgical exploration is recommended for the unknown diagnosis. It can not only relieve the urinary obstruction immediately, but also make a definite diagnosis.