泌尿系子宫内膜异位症临床诊治特点分析

目的 探讨泌尿系子宫内膜异位症的临床诊治特点.方法 女性泌尿系子宫内膜异位症患者10例.平均年龄39(28～49)岁.病史6个月～3年.膀胱子宫内膜异位症4例,临床表现为月经期尿路刺激症、下腹部坠痛不适感,其中伴肉眼血尿1例.B超、CT检查提示膀胱占位病变直径2.0～3.5 cm.输尿管子宫内膜异位症6例,左侧4例,右侧2例.临床表现为腰腹部不适4例,间断无痛性肉眼血尿1例,查体B超偶然发现肾积水1例.B超检查肾盂分离2.0～4.5 cm,输尿管中上段扩张1.0～2.0 cm,其中1例输尿管下端占位伴肾重度积水;CT检查输尿管下段狭窄5例,长度2.0～3.0 cm;输尿管下段占位病变1例.结果 10例均行手术治疗.膀胱部分切除4例,其中同时切除双卵巢、子宫1例;输尿管部分切除输尿管膀胱吻合术3例,输尿管端端吻合术2例,肾输尿管全长切除1例.术后病理诊断均为子宫内膜异位症.术后9例服用17α-乙炔睾丸酮200 mg,2次/d,持续6～12个月.10例患者随访12～60个月,8例恢复良好;2例输尿管子宫内膜异位症患者术后18、24个月复发,予内置输尿管支架管,分别口服17α-乙炔睾丸酮及注射戈舍瑞林治疗3个月后症状缓解.结论 泌尿系子宫内膜异位症多无特异性表现,术前确诊困难,手术切除病灶效果好,辅助药物治疗可预防复发.

Clinical diagnosis and treatment for urinary tract endometriosis

Objective To evaluate the diagnosis and treatment of urinary tract endometriosis.Methods Retrospective review of 10 female cases of urinary tract endometriosis was carried out. All cases age was from 28-49, and the average age was 39-year-old. The course of this disease was from 6 months to 3 years. Four of 10 cases were bladder endometriosis. The clinical presentations included the urgency, frequency, pain at micturition and lower abdomen pain during menstruation, gross hematuria coinciding with menstruation 1 case. B-ultrasound and CT showed the mass of bladder from 2. 0 -3.5 cm but were not specific. Four of 6 cases ureteral endometriosis were the left side and 2 cases were the right side. This clinical presentation included non-specific flank or abdomenal discomfort in 4 cases, intermittent gross hematuria in 1 case and 1 case renal hydronephrosis was found incidentally by B-ultrasound. B-ultrasound indicated unilateral upper urinary tract dilation and hydrops in all cases,with pyelic separation from 2.0-4.5 cm and ureteral separation from 1-2 cm. CT indicated stenosis of the lower ureter in 5 cases, ureter tumor in 1 case. Results All cases were treated surgically.Partial cystectomy were performed in 4 cases of bladder endometriosis, of which, 1 case bilateral oophorectomy and hysterectomy. Five cases were performed ureteral segmental resection, of which, 3 ureterocystostomy and 2 terminoterminal anastomosis. 1 case was performed radical nephrectomy and ureterectomy. Postoperative pathological findings confirmed the diagnosis of endometriosis. Postoperative oral hormone therapy was given to 9 cases for 6-12 months. All cases were followed for 12-60months. 2 cases ureteral endometriosis had recurrent hydronephrosis in 18-24 months. The 2 cases received ureteral stent and cured by oral hormone therapy or goserelin subcutaneous injection for 3 months. Conclusions Urinary tract endometriosis usually shows non-specific symptoms. The diagnosis can be missed on both clinical examination and preoperative work-up. Surgical treatment is effective and adjuvant hormone therapy is often recommended to prevent the recurrence.