输尿管子宫内膜异位症12例报告

目的 提高输尿管子宫内膜异位症的诊治水平。方法 输尿管子宫内膜异位症患者12例，年龄29～59岁。临床表现为腰痛或下腹部疼痛不适9例，月经紊乱1例，有痛经史8例。B超均提示单侧上尿路扩张并积水，肾盂分离26～52mm。IVU检查示显影不佳5例，发现单侧上尿路扩张并积水7例。7例术前行放射性核素肾动态显像，患肾肾小球滤过率（GFR）均低于正常，其中1例GFR〈10ml／min，1例巨大肾积水无功能。结果 11例行手术治疗，1例行内分泌治疗。术后病理检查均证实为输尿管子宫内膜异位症，异位病灶均位于输尿管下段。12例随访3～110个月。1例术后19个月肾积水复发，予以内置输尿管支架，配合注射戈舍瑞林治疗后痊愈。余11例定期复查B超，积水未复发。结论 输尿管子宫内膜异位症多引起隐匿性尿路梗阻，确诊有赖于影像学检查及输尿管镜检，治疗的主要原则是解除梗阻、消除症状、保护肾功能。本病治疗主要有激素治疗和手术治疗，预后良好。

Diagnosis and treatment of ureteral endometriosis ( report of 12 cases)

Objective To improve the diagnosis and treatment of ureteral endometriosis. Methods The clinical data of 12 women (age range,29 -59 years) with ureteral endometriosis were analyzed retrospectively. The clinical presentations included flank pain or lower abdomen pain in 9 cases, menstrual disorder in 1 ,and previous dysmenorrhea in 8. B-ultrasound indicated unilateral upper urinary tract dilation and hydrops in all cases,with pyelic separation from 26 to 52 mm. IVU showed poor image in 5 cases and u-nilateral upper urinary tract dilation and hydrops in 7. Preoperatively,7 cases underwent bilateral renal ECT scan,which showed that the glomerular Filtration rates ( GFR) of the diseased kidneys were lower than normal. Of the 7 cases, 1 had GFR < 10 ml/min and 1 had giant hydronephrosis without renal function. Re-Slilts Of the 12 cases, 11 were treated surgically. Postoperative pathological findings confirmed the diagnosis of ureteral endometriosis. The ectopic endometria were all located at the lower ureter. One case was treated with hormonotherapy. All 12 cases were followed for 3 - 110 months. One case had recurrent hydronephrosis in 19 months postoperatively. This case received ureteral stent and cured by goserelin subcutaneous injection for 6 months. The other 11 cases underwent regular B-ultrasound and had no recurrence. Conclusions Most cases of ureteral endometriosis present with silent urinary obstruction. The diagnosis of ureteral endometriosis relies on imaging and ureteroscopic techniques. The goal of therapy of ureteral endometriosis is to relieve obstruction, eliminate symptoms and preserve renal function. The management of ureteral endometriosis depends on the extent of the disease,desire of preserving fertility and renal function. The treatment options include hormonotherapy and a variety of surgical approaches with good prognosis.