输尿管子宫内膜异位症临床分析

Clinical analysis of ureteral endometriosis

目的探讨输尿管子宫内膜异位症的临床表现及诊治方案。方法回顾性分析输尿管子宫内膜异位症患者15例的临床资料。结果患者均表现出月经前期及月经期下腹疼痛及腰部不适。7例有子宫腺肌病,8例有卵巢子宫内膜异位囊肿盆腔子宫内膜异位症。10例患者术前B超均提示上尿路轻至重度扩张并积水,肾盂分离12~50 mm,静脉尿路造影（intravenous urography,IVU）检查发现单侧上尿路扩张并积水7例,3例显影不清。有5例术前行泌尿系B超未发现输尿管扩张而在术中发现输尿管中、下段有结节增生物。15例均进行手术治疗,5例行输尿管病灶切除及输尿管松解术,9例行输尿管狭窄部节段切除并输尿管再植术或端端吻合术后置输尿管支架,1例行左肾切除,术后使用促性腺激素释放激素（gonadotropin-releasing hormone,GnRH-a）治疗或孕三烯酮治疗痊愈,患者症状消失。结论输尿管子宫内膜异位症采用手术及药物治疗预后良好。

Objective To explore the clinical features,diagnosis and treatment of ureteral endometriosis.Methods The clinical data in 15 patients with ureteral endometriosis were analyzed retrospectively.Results All patients in this group were manifested by the main symptoms of lower abdominal pain or lumbar discomfort during premenstrual and menstrual periods.7 cases suffered from adenomyosis and other 8 cases from ovarian endometriosis or pelvic endometriosis.Preoperative B-ultrasound in 10 cases indicated mild to severe upper urinary tract dilation and hydrops,pelvis was separated by 12-50 mm.Preoperative intravenous urography（IVU） showed upper urinary tract dilation and hydrops in 7 cases and unclear developing in 3 cases.Preoperative urinary B-ultrasound in 5 cases found no ureteral dilation,but found nodular proliferation in middle and lower segment of urethra during intraoperative period.All the cases were treated surgically,5 cases were performed ureteral lesion resection and ureterolysis,9 cases were treated with ureterostenosis segment resection and ureteral reimplantation or placing ureteral stent after end-to-end anastomosis,and 1 case received left kidney resection and GnRH-a or gestrinone for consolidation therapy after operation and the symptoms were disappeared.Conclusion Ureteral endometriosis can be effectively treated by operation and medication with good prognosis.