输尿管子宫内膜异位症的手术方式探讨

Discuss the choice of different surgical procedures for ureteral endometriosis

目的探讨治疗输尿管子宫内膜异位症的手术方式。方法回顾分析2002～2011年病理证实的23例输尿管子宫内膜异位症患者的临床诊治资料。结果 23例患者中,3行输尿管粘连松解术,6例行输尿管狭窄段切除+输尿管膀胱再吻合术,12例行输尿管狭窄段切除+输尿管端端吻合术,2例行输尿管镜下病损电切术。术后病理诊断均为子宫内膜异位症。8例接受了术后激素辅助治疗。术后随访成功的20例患者均未出现复发。结论输尿管子宫内膜异位症是一种临床少见的疾病。对于伴有肾积水的患者,治疗上以手术治疗为主,内分泌治疗为辅。对于轻度的输尿管梗阻患者,推荐行输尿管粘连松解术治疗;对于中重度输尿管梗阻患者,推荐行输尿管狭窄段切除的手术治疗。

Objective To discuss the appropriate choice of different surgical procedures for ureteral endometriosis. Methods We performed a retrospective analysis of 23 cases of ureteral endometriosis with histopathological results from 2002 to 2011. Results In these cases, the treatments consisted of ureterolysis in 3 cases, ureterocystoneostomy in 6, par- tial ureteral resection and end-to-end ureteral anastomosis in 12, and endoscopic resection of ureteral endometriosis lesion in 2. All the patients pathologic results were of endometriosis. Adjuvant hormonal therapy was applied to 8 postoperative eases. For the 20 cases with follow-up, no recurrence was found. Conclusions Ureteral endometfiosis is an uncommom disease. For patients of ureteral endometriosis with hydronephrosis, surgical procedures should be accepted as the first clin- ical therapeutic choice, whilst hormonal therapy as an adjuvant management. For patients with mild ureteral obstruction, the recommended management is ureterolysis ; while for those with moderate and severe ureteral obstruction, the recommen- ded procedure is partial ureteral resection.