合并肾积水的输尿管子宫内膜异位症92例临床分析

Clinical analysis of ureteral endometriosis complicated with hydronephrosis:92 cases series

目的探讨输尿管子宫内膜异位症合并肾积水患者的诊断、治疗及预后。方法回顾性分析2000年1月至2021年1月北京大学第一医院诊治的92例输尿管子宫内膜异位症患者的临床病理资料。结果92例患者的年龄为(40.0±6.0)岁,输尿管子宫内膜异位症的发生率为0.9%(92/10222)。92例患者中,11例(12%,11/92)无临床症状,81例(88%,81/92)存在痛经或腰腹痛等疼痛症状及泌尿系统症状。全部患者均合并肾积水和输尿管扩张;87例(95%,87/92)为单侧病变,其中左侧48例(52%,48/92),右侧39例(42%,39/92),5例(5%,5/92)为双侧病变;病变位于输尿管下段者73例(79%,73/92),中段19例(21%,19/92);外生型71例(77%,71/92),内生型21例(23%,21/92)。38例(41.3%)行肾功能检查,其中轻度受损6例(16%,6/38),中度受损7例(18%,7/38),重度受损14例(37%,14/38),肾功能正常11例(29%,11/38)。开腹手术25例(27%,25/92),腹腔镜手术67例(73%,67/92);输尿管松解术、输尿管狭窄段切除+输尿管膀胱再植术、输尿管狭窄段切除+输尿管端端吻合术、肾及输尿管全长切除术分别为52例(57%,52/92)、20例(22%,20/92)、12例(13%,12/92)和8例(9%,8/92)。术后成功随访78例(85%,78/92),中位随访时间108个月(范围:6~240个月)。68例(87%,68/78)术后复查泌尿系统超声,其中60例(88%,60/68)肾积水消失,8例(12%,8/68)肾积水较前好转。结论输尿管子宫内膜异位症大多数伴有肾功能受损,早期手术治疗可以有效解除泌尿系统梗阻,保护肾功能。

Objective To investigate the diagnosis,treatment and prognosis of ureteral endometriosis with hydronephrosis.Methods A retrospective study was performed of 92 cases diagnosed as ureteral endometriosis with surgery confirmed in Peking University First Hospital from January 2000 to January 2021.Results The incidence of ureteral endometriosis was 0.9%(92/10222),with an average age of(40.0±6.0)years.Among 92 cases,urological symptoms and pelvic pain including dysmenorrheal,periodic abdominal pain were the main forms of clinical characteristics,while 11 patients(12%,11/92)were asymptomatic.All patients with ureteral endometriosis had hydronephrosis and hydroureter before surgery,hydronephrosis were left sided in 48(52%,48/92)patients,right sided in 39(42%,39/92)patients,both sided in 5(5%,5/92)patients.The distal and middle sections of ureteral obstructions existed in 73(79%,73/92)patients and 19(21%,19/92)patients,respectively.Out of the 92 ureteral lesions 71(77%,71/92)patients were extrinsic lesions,21(23%,21/92)patients presented intrinsic lesions.Of the 38 cases who took preoperative radionuclide renal dynamic imaging examination,there were 6(16%,6/38)cases of mildly damaged,7(18%,7/38)cases of moderately dameged,14(37%,14/38)cases of severely damaged,and 11(29%,11/38)cases of normal renal function.Laparotomy was decided in 25(27%,25/92)patients,and laparoscopic surgery in 67(73%,67/92)patients.In cases of ureteral surgery,ureterolysis,partial ureteral resection and ureterocystoneostomy,partial ureteral resection and end-to-end ureteral anastomosis and nephroureterectomy were undertaken in 52(57%,52/92),20(22%,20/92),12(13%,12/92)and 8(9%,8/92)patients separately.The median follow up was 108 months(range:6 to 240 months).During the follow-up period,68(87%,68/78)patients took urinary ultrasound after surgery,and 60(88%,60/68)cases of hydronephrosis disappeared,and 8(12%,8/68)cases were better than before.Conclusion Most of the patients with ureteral endometriosis are impaired with renal function,and early surgical treatment could effectively relieve urinary obstruction and promote the recovery of renal function.