泌尿系子宫内膜异位症的诊治——附5例报道

Urinary Endometriosis

目的阐述泌尿系子宫内膜异位症早期诊断的重要性，讨论其诊断和处理。方法报告５例病情不同的泌尿系子宫内膜异位症：均经手术明确过盆腔内膜异位症的诊断，泌尿系内膜异位的部位：输尿管３例，输尿管及膀胱１例，尿道１例。所有患者均有尿路受损表现。输尿管梗阻则有输尿管扩张和肾盂积水，较严重的２例已有肾功能损害。尿道子宫内膜异位症则有排尿困难及剧烈尿痛症状。结合文献复习，讨论泌尿系内膜异位症的早期诊断和处理，药物或手术治疗的选择。结果泌尿系症状经孕激素或促性腺激素抑制剂（ＧｎＲＨ－ａ）治疗后的显著改善进一步支持了泌尿系内膜异位的诊断。５例中单纯药物治疗３例，药物和手术综合治疗２例。均有显著疗效。结论泌尿系子宫内膜异位症少见，故常被误诊或漏诊，甚至造成肾脏长期的不可恢复的损害。所以早期诊断极为重要。依靠影像学诊断，包括Ｂ超、肾血流图或静脉肾盂造影，可提高诊断率。药物保守治疗及手术治疗各有其优缺点。

Objective Aimed at illustrating the means of early diagnosis for prevention of the impairment of kidney function,the results of conservative medical therapy and the sur gical treatment in patients with endometriosis of urinary tract.Methods Surgical interventions were done in5cases with pathological of endometriosis.Ureters were involved by endometriotic lesion in3patients,ureters and bladder in one and urethra in another patient .All of the cases were shown at least partial obstr-uction of the urinary tract by clinical symptoms,dia gnostic examinations and the outcomes of various kinds of treatment.Results Hydropnephrosis and hydroureter were shown by ultrasonography,IVP or retrograde pyelography in one case of ureteral obstruction.A small lump of endometriotic foci along the urethra was detected by manual examination and uttra-sonography in one patient.The relieving of the symptoms and signs of the obstruction of the urinary tract in two cases by GnRH-a or progest in was the evidence of the endometriotic lesion.There were two patients underwent surgical resection of the endometriotic foci surrounding the ureter after medical therapy.Conclusions Urinary tract endometriosis are rarely seen and usually escape the atten tion of the physicians,while they usually cause obstruction of the urinary tract and finally impairm ent of kidney function if not treated in time.This kind of disease can be easily diagnosed by ima ging detection with ultra-sonography,IVP or retrograde pyelography.Conservative treatment with GnRH-a and long acting progesterone as well as surgical treatments are effective for this kind of disease.