23例输尿管子宫内膜异位症患者诊断和治疗的临床分析

Clinical Analysis of the Diagnosis and Treatment of Ureteral Endometriosis

目的:总结23例输尿管子宫内膜异位症患者的临床诊断和治疗经验。方法:回顾性分析23例病理证实为输尿管子宫内膜异位症患者的临床诊治以及术后随访资料,并对结果进行对比分析。结果:23例患者均接受了超声检查,其中21例接受了静脉肾盂造影检查,11例接受了逆行肾盂造影检查,16例接受了CT检查,8例接受了MRI检查;23例均行手术治疗,其中3例接受了输尿管粘连松解术治疗,6例接受了输尿管狭窄段切除+输尿管膀胱再吻合术治疗,12例接受了输尿管狭窄段切除+输尿管端端吻合术治疗,2例接受了输尿管内镜下子宫内膜异位病损电灼术治疗。23例患者均为单侧发病,左侧14例,右侧9例。术后病理检查证实为子宫内膜异位症,异位病灶均位于输尿管下段。结论:输尿管子宫内膜异位症是一种泌尿外科罕见的疾病,早期诊断难度较大,影像学检查在输尿管子宫内膜异位症的诊断中起着重要作用。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术治疗;对于病变程度严重的病例,推荐术后应用激素类药物治疗降低术后的复发率。

Objective： To review our experience in the diagnosis and treatment for 23 cases with ureteral endometriosis. Methods： A retrospective analysis was performed on 23 cases ofureteral endometriosis with histopathological from 2002 to 2011. Results： 23 cases of ureteral endometriosis were diagnosed by ultrasound, in which 21 cases were examined by intravenous pyelography, 11 cases were examined by retrograde urography, 16 cases were examined by CT scan and 8 cases were examined by MRI. All the cases were treated by surgery, including ureterolysis in 3 cases, partial ureteral resection and ureterocystoneostomy in 6 cases, partial ureteral resection and end-to-end ureteral anastomosis in 12 cases, and endoscopic resection of ureteral endometriosis lesion in 2 cases. All the pathologic results of the 23 cases were endometriosis. Conclusion： Ureteral endometriosis was a rare disease in urology clinical scenarios. The early diagnosis of the disease was very difficult. Image analysis played an important role in the diagnosis of ureteral endometriosis. For cases with mild ureteral obstruction, the recommended management was ureterolysis while for those with moderate and severe ureteral obstruction, the recommended procedure was partial ureteral resection. For pathological severe cases, it was remmendable to apply hormone therapy to reduce postoperative recurrence rate.