泌尿系输尿管子宫内膜异位症临床的诊断及治疗特点分析

Diagnosis and treatment of ureteral endometriosis

目的:探讨泌尿系输尿管子宫内膜异位症临床的诊断及治疗特点。方法:收集我院从2000年3月～2006年3月间入院治疗的输尿管子宫内膜异位症患者35例。平均年龄39±1.5(25～55)岁,病程平均时间为1.3±0.6(1～4)年。按照病变部位分型分为:输尿管左侧18例,右侧17例。临床上以腰腹部不适为发病特点,影像学检查肾盂分离2.5±0.2(2.0～4.5)cm,输尿管中上段扩张1.3±0.1(1.0～2.0)crn。15例患者均行手术治疗,术后病理结果显示均为输尿管子宫内膜异位症。术后为患者服用17α-乙炔睾丸酮200 mg,2次/d,疗程为半年～1年。结果:35例患者均得到完整随访,随访年限平均为3.8±0.9(1～5)年,其中33例患者治疗效果良好,未见复发。2例输尿管子宫内膜异位症患者于术后2年出现复发,进行内置输尿管支架管后给予口服17α-乙炔睾丸酮及注射戈舍瑞林治疗,治疗4个月后治疗成功。结论:输卵管子宫内膜异位症由于前期无特异性的临床表现术前确诊困难,需术后进行病理确诊。在治疗上采取手术效果显著,术后进行药物配合可减低和预防复发的机率。

Objectives： To study the diagnosis and treatment of ureteral endometriosis. Methods： We carried out a retro- spective review of 35 female patients at the average age of 39 ± 1.5 （ 25 ± 55 ） with ureteral endometriosis for 1.3 - 0. 6 （ 1 - 4 ） years. 18 of 35 of ureteral endometriosis were in the left side and 17 cases were the in right side. The symptoms featured waist and abdominal discomfort. B - ultrasound indicated pelvis separation 2. 5± 0. 2 （ 2.0 ± 4. 5 ） cm and ureteral expansion 1.3 ±0. 1 （1.0 ± 2. 0）cm. All cases were treated surgically. The pathologic result confirmed ureteral endometriosis. After the operation, testosterone and goserelin were used for 0.5 - 1 year. Results： Postoperative pathological findings confirmed the diagnosis of en- dometriosis. All patients were followed for 3.8 ± 0. 9 （ 1 - 5 ） years. Two cases had ureteral endometriosis a second time in 2 years. They received the treatment of ureteral stent, testosterone and goserelin. Conclusions： Endometriosis is difficult to diag- nose due to non - specific symptoms in the early phase. A definite diagnosis should be carried out after operation. Surgical treat- ment is effective. Medication after the surgery can reduce the reoccurrence rate.