手术切口子宫内膜异位症3例

子宫内膜异位症（内异症）是指具有生长功能的子宫内膜组织出现在子宫腔被覆粘膜以外的其它部位。该病是育龄妇女的常见病及多发病，近年来其发病率逐年升高。异位的子宫内膜可发生于身体的许多部位，其中主要发生于子宫肌层、子宫韧带、卵巢、腹膜（覆盖于子宫、输卵管、直肠、乙状结肠或膀胱的部分），但也可发生于腹部的手术切口。由于临床上切口瘢痕内异症的临床表现、诊断及治疗不同于盆腔内异症，因此本文报道近2年我院接诊的3例切口瘢痕内异症，以供同道参考。     

膀胱子宫内膜异位症一例超声所见

患者女 ,34岁。因反复尿频、尿痛 6年 ,加重 2年于 1 999年5月入院。患者 6年前无明显诱因出现尿频、尿痛 ,无肉眼血尿 ,每次月经来潮时伴有下腹疼痛 ,非月经期消失。近 2年上述症状加重。孕 2产 1 ,曾有痛经史。Ｂ超检查 :膀胱充盈 ,膀胱三角区近膀胱颈部右后壁见一囊性肿块 ,大小 1 .7ｃｍ× 1 .5ｃｍ壁厚约 0 .2 5ｃｍ ,欠光滑 ,囊壁与膀胱粘膜层连续 ,肿块基底部与膀胱壁界限不清 ,囊内见弱回声充填 (图 1 ,2 )。子宫及双侧卵巢正常。提示 :膀胱子宫内膜异位症。膀胱镜检 :尿道内口右侧约 1 .5ｃｍ× 2 .0ｃｍ包块 ,粘膜充血。图 1　下…     

超声诊断膀胱子宫内膜异位症1例

患者,女,3 1岁,因周期性尿频、尿急、尿痛2年,加重2个月就诊。患者2年前开始随月经周期出现尿频、尿急、尿痛,无血尿。抗炎治疗无效,可自行缓解。多次血常规、尿常规检查正常。患者6年前曾作剖宫产术,后出现渐进性痛经,月经过多。超声检查:膀胱后壁可见( 2 0×3 2 )cm大小不均质性肿块,边界清晰,基底较宽,表面光滑,无乳头状突起,内部回声不均,可见小线片状无回声区。子宫附件未见异常。超声提示:膀胱子宫内膜异位症。患者后到综合性医院就诊,行膀胱镜检查,检查所见:膀胱后壁隆起一肿物,约( 2 0×3 2 )cm大小,基底较宽,表面有多个小囊肿…     

膀胱子宫内膜异位症1例

1病例报告女,40岁。下腹部不适6个月,以月经前为重,加重3d来诊。妇科查体:阴道通畅,宫颈光滑,子宫大小正常,双附件无压痛.超声检查:子宫形态大小正常,肌层回声均质,内膜居中,厚约0.8cm,双附件未见异常,于膀胱后壁探及0.7cm×0.5cm低回声团,边界清,似侵及膀胱肌层,CDFI未见明显血流信号。超声提示:(1)膀胱实性占位,考虑膀胱癌;(2)子宫附件未见异常。膀胱镜下见膀胱后壁小隆起,但膀胱黏膜光滑,完好。取活检,病理变化为异位子宫内膜周期性出血和周围纤维化。2讨论膀胱子宫内膜异位是由具有功能的子宫内膜腺体细胞及间质细胞向膀胱壁侵蚀,引起…     

腹壁子宫内膜异位症病灶切除术患者的围手术期护理

目的 探讨腹壁子宫内膜异位症病灶切除术的围手术期护理体会.方法 回顾性分析2009年1月至2011年5月入住我院的31例腹壁子宫内膜异位症病灶切除术患者的围手术期的临床及护理资料,并对护理方法进行总结.结果 通过精心的围手术期护理,31例患者手术顺利,且无一例复发.结论 全面的围手术期护理程序在腹壁子宫内膜异位症的治疗中有十分显著的作用,提高了患者的治愈率.     

肠道子宫内膜异位症患者的护理

子宫内膜异位症是指有生长功能的子宫内膜组织出现在子宫腔被覆黏膜以外的身体各部位。肠道子宫内膜异位症非常罕见，1985年1月-2005年11月于我院妇产科治疗，经手术后病理证实为子宫内膜异位症的患者共9329例，但肠道子宫内膜异位症患者仅2例，现报道如下。     

膀胱子宫内膜异位症1例的超声表现

患者女,39岁。8年前曾行卵巢畸胎瘤及子宫肌瘤切除术。近7年因经期反复下腹痛,以月经前一天及月经第一天为重,经净后自然缓解。3年前经期腹痛加重,经量增多、经期延长或缩短,经期尿急及排尿不畅,月经干净后可缓解。平时有头晕无力。2年前曾于我院行超声及膀胱镜检查,考虑:(1)子宫肌腺病;(2)膀胱炎性占位。但抗炎后效果不佳。妇查:外阴(-)、阴道(-)、宫颈°糜烂,宫体如2 月妊娠大小,质硬,压痛。双附件区(-)。彩色多普勒超声显示:子宫体约7.9cm×7.2cm×6.2cm,内膜向前壁偏移,厚0.9cm,后壁可见5.5cm×3.9cm中低回声,回声不均匀,无明显边缘,内…     

Diagnosis and management of endometriosis

Signs and symptoms of endometriosis are nonspecific, and an acceptably accurate noninvasive diagnostic test has yet to be reported. Serum markers do not provide adequate diagnostic accuracy. The preferred method for diagnosis of endometriosis is surgical visual inspection of pelvic organs with histologic confirmation. Such diagnosis requires an experienced surgeon because the varied appearance of the disease allows less-obvious lesions to be overlooked. Empiric use of nonsteroidal anti-inflammatory drugs or acetaminophen is a reasonable symptomatic treatment, but the effectiveness of these agents has not been well-studied. Oral contraceptive pills, medroxyprogesterone acetate, and intrauterine levonorgestrel are relatively effective for pain relief. Danazol and various gonadotropin-releasing hormone analogues also are effective but may have significant side effects. There is limited evidence that surgical ablation of endometriotic deposits may decrease pain and increase fertility rates in women with endometriosis. Presacral neurectomy is particularly beneficial in women with midline pelvic pain. Hysterectomy and bilateral salpingo-oophorectomy definitively treat pain from endometriosis at 10 years in 90 percent of patients.     

经阴道超声诊断膀胱子宫内膜异位症1例

患者，女．45岁。因周期性尿急、尿频、尿痛1年到我院检查。患者孕2产1．既往月经规律．继发性痛经进行性加重，并于2007年1月因子宫腺肌症行子宫切除术；术前无腰痛、血尿及尿急、尿频、尿痛等症状。B超检查：子宫已切除，于膀胱左后壁可见一范围约2．8cm×1．6cm低回声光团。膀胱适度充盈状态下进一步经阴道超声检查：低回声光团位于膀胱左后壁肌层内，膀胱黏膜层光滑，连续性良好。低回声光团内部可见多个小无回声区，呈“筛孔状”结构（图1）。     

膀胱嗜铬细胞瘤诊断与治疗探讨

目的探讨膀胱嗜铬细胞瘤的诊断与治疗。方法回顾性分析2005年1月至2015年1月本院收治的经病理确诊为膀胱嗜铬细胞瘤的6例患者的临床诊治情况及病理结果。结果 6例患者中男4例;女2例;高血压患者2例,血尿患者4例;高血压及血尿症状均存在2例,2例患者无任何临床症状;2例行膀胱部分切除术,1例行膀胱部分切除术及右侧输尿管膀胱再植术,3例行经尿道膀胱肿瘤电切术;术后病理证实为膀胱嗜铬细胞瘤。结论膀胱嗜铬细胞瘤诊断应充分结合其病史及辅助检查,治疗上早期膀胱嗜铬细胞瘤治疗首先膀胱部分切除术,晚期恶性膀胱嗜铬细胞瘤考虑放射治疗、化学治疗和分子靶向治疗。     

Diagnosis and treatment of bladder carcinoma

A variety of diagnostic techniques has enhanced our ability to detect and accurately stage urothelial carcinoma. Urine cytology is a sensitive method for detecting occult high-stage tumors in both the upper and lower tracts. Rigid ureteroscopy has extended direct visualization from the bladder (with cystoscopy) to the renal pelvis. The evaluation of metastatic disease has been improved by CT and MRI. However, caution must be applied in interpreting bladder masses demonstrated by these studies after transurethral resections. The mainstay of local therapy continues to be transurethral resection. This established technique has been aided by intravesical chemotherapy and immunotherapy. Intravesical instillation of chemotherapeutic drugs or BCG may help preserve some bladders that would otherwise be sacrificed. The appropriate role of laser therapy as a primary form of treatment remains to be defined. Photodynamic therapy appears to be a powerful new treatment modality for carcinoma in situ. However, photodynamic therapy should still be considered a clinical experiment at this time. Patients with more advanced local disease will require either cystectomy or definitive radiation therapy. The survival results with primary surgical therapy appear to be slightly better than radiation therapy, particularly when younger individuals are being treated. Persons with metastatic disease are best treated with chemotherapy. Combination cisplatin-based regimens appear to be particularly promising and offer a high incidence of objective remissions with good duration of response. Although the five-year survival of patients with bladder carcinoma has steadily improved, there is still room for additional progress. The basis for any such improvement rests in accurate diagnosis and treatment and careful surveillance for recurrent disease.     

膀胱非尿路上皮癌的诊断与治疗

目的探讨膀胱非尿路上皮癌的发病特点,总结其诊治经验。方法回顾分析2001年1月至2009年12月收治的59例膀胱非尿路上皮癌的临床资料。其中男37例,女22例,平均年龄72.6岁;临床主要表现为无痛性肉眼血尿和膀胱刺激症状;辅助检查包括B超、盆腔CT及膀胱镜检＋活检。另选同期膀胱尿路上皮癌51例作为对照。比较两组患者围手术期治疗,术后1、3和5年生存率等差异。结果 59例膀胱非尿路上皮癌患者,术后病理检查证实膀胱腺癌13例、膀胱鳞癌10例、膀胱小细胞癌5例、膀胱平滑肌肉瘤2例、副神经节瘤4例和混合癌肿25例。其中行全膀胱切除术41例,膀胱部分切除术6例,经尿道膀胱肿瘤电切术（TUBRT）12例。术前新辅助治疗4例,术后辅助放疗14例,术后辅助化疗35例。有效随访53例,术后1、3和5年生存率分别为83.1%、54.7%和28.3%。51例膀胱尿路上皮癌术后均经病理证实诊断,其中行全膀胱切除术12例,膀胱部分切除术3例,TUBRT36例。术后成功随访43例,术后1、3和5年生存率分别为81.8%、76.7%和72.7%。结论膀胱非尿路上皮癌临床少见,恶性程度较高,预后较差。根治性膀胱全切除术是首选手术方法,结合不同肿瘤类型的病理特点,辅助或新辅助放、化疗可望提高疗效。