输尿管子宫内膜异位症的诊断与治疗（附5例报告）

Diagnosis and Treatment of Ureteral Endometriosis （ a report of 5 cases ）

目的探讨输尿管子宫内膜异位症的诊断、治疗方法，提高输尿管子宫内膜异位症的诊治水平。方法回顾性分析5例输尿管子宫内膜异位症的临床特征、诊断、治疗方法。其中左侧3例，右侧2例。B超检查均发现输尿管中上段扩张、。肾积水。IVU检查，5例均提示输尿管下段狭窄、输尿管上段扩张、肾积水。结果5例均行手术治疗，1例切除盆腔包块、松解输尿管并内置双J管；3例行输尿管境检、输尿管狭窄段切除及输尿管膀胱再吻合；1例行输尿管境检、输尿管狭窄段切除及输尿管端端吻合；术后病理检查均证实为输尿管子宫内膜异位症。随访5例，随访时间12个月～1年半，症状均消失，定期复查B超及IVU，肾积水均缓解。结论输尿管子宫内膜异位症缺乏典型临床表现，一旦发现，应尽早解除梗阻，保护肾功能。

Objectives To study and improve the diagnosis and treatment of ureteral endometriosis. Methods The clinical data of 5 ureteric endometriosis were retrospectively analyzed. Their mean age was 38 years （range,30- 45 years）. Of the 5 cases,3 cases were on the left side ,2 on the right. All the cases were subjected to ultrasound and intravenous urogram （IVU）as preoperative diagnosis. B -ultrasound indicated upper urinary tract dilation and hydrops in all cases, and IVU also showed upper urinary tract dilation and hydrops in 5 cases. All the cases were treated surgically. One was treated with operation of resecting pelvic cavity masses and lysis of adhesions of ureter, and was detained with Double - J stent. 3 cases was treated with resection of ureteropathy affection and uret- erovesicostomy. 1 was treated with ureteroscopy and detaining with Double - J stent. Results Pathological findings confirmed the diagnosis of ureteral endometriosis. During the follow - up period of 12 months to 1.5 years for 5 cases, all symptoms were vanished. All cases were subjected to regular B - ultrasound and IVU. Nephrohydrosis was reduced. Conclusions Ureteral endometriosis is lack of typically clinical manifestation. Therapeutic principle is to relieve obstruction of ureter and treat pelvic endometriosis immediately while being diagnosed.