子宫内膜异位症引起输尿管狭窄临床分析

Ureteral Endometriosis(report of 5 cases)

目的 探讨子宫内膜异位症引起输尿管狭窄的临床表现及治疗方案。方法 回顾性分析1990～2000年间收治的输尿管子宫内膜异位症5例。结果 所有病例均表现为患例肾脏及上段输尿管积水。术前诊断明确者3例。4例行输尿管病灶切除、输尿管膀胱再植术。其中3例患侧肾积水消退,肾脏排泄功能恢复正常:1例肾积水无明显好转。另1例行患侧肾脏及输尿管切除术,术后临床症状消失。结论 输尿管子宫内膜异位症多数发展为隐匿性肾功能受损,IVU、RPG、MRU可发现肾积水及病灶部位。对于腔内型和混和型输尿管子宫内膜异位症建议输尿管镜取活检术前明确病理。治疗需切除病变输尿管,行输尿管膀胱再植术或输尿管吻合术。若肯定患侧肾功能已完全消失者,行患例肾脏和输尿管切除。以上治疗的同时需行卵巢切除,有生育要求者保留卵巢而行内分泌治疗。

Objective: To report the diagnosis and treatment of ureteral endometriosis. Methods: 5 cases with ureteral cndometriosis were observed during 1990-2000 and a retrospective analysis is made. Results: Hydroureter and hydronephrosis occured to all 5 cases. 3 cases were diagnosesd correctly preoperative. Ureterolysis of the ureter and excision of the stricture with ureterobladderostomy in 4 and renal function recover in 3 of them and still hydronephrosis in one postoperative. A nephroureterectomy was done in one case with a nonfuctioning kidney and symptoms disappeared postoperative. Conclusions: Most endometriosis cause silent loss of renal function. IVU、RPG and MRU can find hydronephrosis and the site of lesions. Ureteroscopy shiould be considered for intrinsic and mixed forms of ureteral endometriosis to get pathological diagnosis preoperative. Excision of ureter lesion and ureterobladderostomy or ureteroureterostomy should be regularly considered and nephroureterectomy should be performed with nonfunctioning kidney. Additionally, oophorectomy should be done, but hormonal therapy can be altemative for patients who want to preserve fertility.