膀胱输尿管子宫内膜异位症的诊断和治疗(附1例病例报道)

目的探讨膀胱输尿管子宫内膜异位症(EMS)的诊治方法。方法回顾性分析上海市徐汇区中心医院治疗1例EMS患者的诊治经过及随访结果;术前均行膀胱镜检查及取组织病检明确诊断,常规CT检查明确病变范围。结果膀胱输尿管EMS主要表现为与月经密切相关的尿频、尿急、尿痛、下腹胀痛、镜下或肉眼血尿;手术方式为部分膀胱切除及全子宫双附件切除,术后Ⅰ期治愈,随访至今无复发。结论下尿路症状与月经密切相关时应高度怀疑EMS可能,膀胱镜及病理学检查是最有价值的诊断方法;部分膀胱切除是内、外在型EMS者治疗的首选方法,根据情况加行子宫、卵巢手术。

Diagnostic and Therapeutic Approach to Patient with Urinary Tract Endometriosis: A Case Report

Objectives To discuss the diagnostic and treatment strategy of endometriosis（EMS） of the urinary tract. Methods We report a female patient with bladder endometriosis, an unusual clinical presentation of the disease. A retrospective investigation of clinical data, therapeutic aspects and outcome was made. The characteristics of the lesion were defined after a complete evaluation of endometriosis disease by clinical exam and imaging techniques. The diagnosis of endometriosis was performed by cystoscopy and biopsies of lesions. Results Pollakiuria, urgency, odynuria, haematuria, and pelvic pain that only occurred during the menstrual period present as predominant symptoms of urinary tract endometriosis. The patient successfully underwent partial cystectomy and total hysterectomy and unilateral adnexectomy. Pathological diagnosis from the resected specimen was identical to preoperative diagnosis, i.e., bladder endometriosis. Conclusions Urinary endometriosis should be considered when a women presents with low urinary tract symptoms. Its management is first diagnostic and then remedial. Surgery is the primary treatment of choice. We believe partial cystectomy should be considered as an initial option, and total hysterectomy and unilateral adnexectomy may be considered in selected cases.