泌尿道子宫内膜异位症15例临床诊疗分析

Diagnosis and treatment of 15 cases of urinary tract endometriosis

目的:探讨泌尿道子宫内膜异位症(UTE)的诊断方法及治疗效果。方法:回顾分析2000年1月至2019年1月北京大学人民医院收治且经病理证实的15例UTE患者的临床资料。结果:15例患者中有8例诊断为膀胱子宫内膜异位症(BE),7例诊断为输尿管子宫内膜异位症(UE)。12例术前行泌尿系影像学检查(80%),其中泌尿系超声10例(66.67%),泌尿系CT 12例(80%),盆腔MRI 6例(40%);8例行妇科超声检查(53.3%);10例术前行泌尿道内镜检查(66.67%),活检病理诊断UTE率达80%。15例均行手术治疗。8例BE患者中,1例(12.5%)行膀胱镜下膀胱病损切除术、5例(62.5%)行开腹膀胱部分切除术、2例(25%)行腹腔镜下膀胱病损切除术;7例病灶位于膀胱后壁(87.5%),1例病灶位于膀胱顶部正中(12.5%)。7例UE患者中,4例行输尿管部分切除+输尿管膀胱再植术(57.1%),2例行输尿管部分切除+输尿管端端吻合术(28.6%),1例行右肾、右输尿管全长切除术(14.3%);双侧输尿管受累1例,左侧输尿管受累1例,右侧输尿管受累5例。术后病理均诊断膀胱/输尿管子宫内膜异位症。6例术中同时切除卵巢EMs,4例合并子宫腺肌症者同时行全子宫切除术。15例患者均获得随访,平均随访时间7.9年(1~19.4年),5例患者术后联合GnRH-a药物治疗,15例患者术后无UTE复发,仅1例B超提示卵巢EMs复发。结论:UTE诊断依靠临床特点、病史、影像学及膀胱/输尿管镜检查。治疗方法的选择取决于患者年龄、生育要求、病变范围、泌尿系症状严重程度,手术切除为首选治疗方式且临床效果可靠。

Objective:To investigate the diagnosis and treatment of urinary tract endometriosis(UTE).Methods:The clinical datas of fifteen cases of UTE admitted to Peking University People's Hospital from January 2000 to January 2019 were retrospectively analyzed.Results:Eight of the fifteen patients were diagnosed with bladder endometriosis(BE),and seven were diagnosed with ureter endometriosis(UE).Twelve of the fifteen patients underwent urological imaging examination(80%)before surgery,of which ten underwent urological ultrasound(66.67%),twelve underwent urological computerized tomography(CT)(80%),and six underwent pelvic Magnetic Resonance Imaging(MRI)(40%).Urinary tract endoscopy(66.67%)were performed in ten of the fifteen patients before surgery,and the accuracy of biopsy pathological diagnosis of UTE was 80%.All patients underwent surgical treatment,and among the eight BE patients,one received cystoscopic resection of the bladder lesion(12.5%),five underwent open partial cystectomy(62.5%)and two underwent laparoscopic pelvic adhesion release(25%).The lesions of seven cases were located in the posterior wall of the bladder(87.5%),and one was located in the middle of the top of the bladder(12.5%).Among the seven UE patients,four received partial ureteral resection and ureterocystoneostomy(57.1%),two received partial ureteral resection and end-to-end ureteral anastomosis(28.6%),and 1 received nephroureterectomy(14.3%).One case of UE was affected with bilateral ureter and seven were unilateral involved with five in right and one in left.All patients were followed up,with an average follow-up time of 7.9 years(1~19.4 years).Five patients were treated with GnRH-a after surgery,and only one patient had a recurrence of ovarian endometriosis about 30 months after surgery.Conclusion:The diagnosis of UTE depends on clinical features,medical history,imaging and cystoscopy or ureteroscopy findings.The choice of treatment depends on the patient's age,fertility requirements,the extent of the lesion,and the severity of the urinary symptoms.Surgical resection combined with GnRH-a therapy is an effective and rational treatment modality for UTE.