腹腔镜输尿管膀胱吻合术治疗内在型输尿管子宫内膜异位症12例

目的 评价腹腔镜输尿管膀胱吻合术治疗输尿管子宫内膜异位症（内异症）合并重度肾积水的有效性和安全性.方法 回顾性分析2012年2月至2013年12月在中山大学附属第一医院妇科收治的12例合并重度肾积水的深部浸润型内异症（DIE）患者的临床资料,包括患者的术前症状、术前肾积水直径、手术时间、术中出血量、切除病变输尿管长度、病灶距离膀胱的长度、术后住院天数和并发症等.结果 12例患者均在腹腔镜下完成患侧输尿管狭窄部分节段切除术并输尿管膀胱吻合术和盆腔内异症根治术.术前肾积水直径平均为8.85 cm,手术时间为平均361 min,术中出血量平均为429ml,切除输尿管的长度平均为2.26 cm,病灶距离膀胱的长度平均为4.36 cm,平均术后住院天数为12.45 d.发生并发症5例（41.67％）.术后全部患者疼痛症状明显减轻或消失,肾盂积水明显好转.结论 腹腔镜输尿管膀胱吻合术治疗输尿管内异症合并重度肾积水预后良好,但需警惕并发症的发生.

Laparoscopic ureteroneocystostomy for infiltrative ureteral endometriosis with severe hydroureteronephrosis of 12 cases

Objective To evaluate the efficacy and safety of laparoscopic ureteroneocystostomy in patients with ureteral endometriosis exhibiting severe hydroureteronephrosis.Methods Clinical data twelve cases admitted to the First Affiliated Hospital of Sun Yat-sen University from Feb.2012 to Dec.2013 were analyzed retrospectively,who received laparoscopic ureteroneocystostomy following the resection of part of ureteral lesion and radical resection of pelvic endometriosis.And the average diameter of hydroureteronephrosis,the mean operative time,mean bleeding loss,average length of ureteral stenosis resection,average range of ureteral lesion to vesica,the mean hospitalization days and complications were reviewed.Results All cases were diagnosed of deep infiltrating endometriosis （DIE）with severe hydronephrosis pre-operation and confirmed ureteral stenosis due to endometriosis intraoperation.12 patients underwent laparoscopic ureteroneocystostomy and radical excision of endometriosis.The average diameter of hydroureteronephrosis was 8.85 cm by preoperative ultrasonography.The mean operative time was 361 min,mean blood loss was 429 ml,average length of ureteral stenosis resection was 2.26 cm,average range of ureteral lesion to vesica was 4.36 cm,the mean hospitalization days was 12.45 d.Six months after sugery,12 patients had dysmenorrhea relief,the degree of hydroureteronephrosis alleviation.Five patients suffering complications including 1 anastomotic detachment,2 hemorrhage during surgery （one case complicated by pelvic infection after surgery）,1 pulmonary edema and 1 urinary infection.The rate of complications was 41.67%（5/12）.Conclusions Laparoscopic ureteroneocystostomy is an effective method for patients with severe ureteral stenosis due to endometriosis with severe hydroureteronephrosis.But the complications should be concerned.