输尿管子宫内膜异位症的诊断和治疗

目的 探讨输尿管子宫内膜异位症(内异症)的诊断和治疗策略.方法 1983年至2010年在北京协和医院住院且经手术证实为输尿管内异症的46例患者,分析其临床表现、辅助检查、手术方式、手术发现、病理结果、术后药物治疗、复发的处理及相关因素.结果 46例患者在本院接受了 1～2次的手术治疗,其中48%(22/46)的患者术前没有能够诊断输尿管内异症,46%(21/46)的患者没有症状或仅有痛经表现.输尿管粘连松解术和开腹手术是最主要的手术类型和手术路径,分别为72%(33/46)和63%(29/46).64%(25/39)的患者仅左侧输尿管受累,80%(37/46)为外生型输尿管内异症.87%(40/46)的患者合并盆腔内异症和子宫腺肌病.总计15%(7/46)的患者复发,术后至复发时间的中位数为24个月(13～49个月);复发后均接受再次手术治疗.仅术后是否使用促性腺激素释放激素激动剂与复发有显著相关性,与术后用药的患者相比,术后没有用药的患者复发的OR值为23.2(95%CI为2.4～221.7,P=0.002).结论 输尿管内异症与生殖道内异症关系密切,发病隐匿,早期诊断困难.手术切除后盆腔深部内异症及处理卵巢子宫内膜异位囊肿,对预防内异症进一步累及输尿管有意义.术后积极治疗盆腔内异症是防止复发的关键.

Abstract：

Objective To investigate strategies of diagnosis and treatment of ureter endometriosis. Methods From 1983 to 2010, the cases registered in Peking Union Medical College Hospital and confirmed as ureter endometriosis by surgery were enrolled in this study. Clinical manifestatios, preoperative examinations, surgical categories and routes, surgical and pathological findings, post-operative medical treatment, relapse and relating factors were collected and studied. Results Totally 46 patieuts with ureter endometriosis underwent one or two surgeries. Forty-eight per cent (22/46) of patients were not be diagnosed with ureter endometriosis pre-operatively, and 46% (21/46) only presented dysmenorrhea or even no symptoms. Ureterolysis (72%, 33/46) and laparotomy (63%, 29/46 ) were the most common surgical category and surgical approach. There were 64% (25/39) of patients had left ureter involved and 80% (37/46) had extrinsic ureter endometriosis. Fifteen per cent (7/46) of patients had relapsed disease with median recurrent time of 24 months (13 -49 months), and they all received second surgeries. Logistic regression analysis showed that only gonadotropin releasing hormone analogue agents were related with recurrence when compared with those patients without medical treatment post-operatively significantly ( OR =23.2, 95% CI:2. 4 -221.7, P =0. 002). Conclusions Ureter endometriosis was related with reproductive tract endometriosis. It has insidious process resulting in difficulty for early diagnosis. It's important to treat pelvic deep infiltrating endometriosis and ovarian endometrioma to prevent ureter from further involvement. Post-operative treatment of pelvic endometriosis is the key point of preventing relapse of ureter endometriosis.

Diagnosis and treatment of ureter endometriosis

Objective To investigate strategies of diagnosis and treatment of ureter endometriosis. Methods From 1983 to 2010, the cases registered in Peking Union Medical College Hospital and confirmed as ureter endometriosis by surgery were enrolled in this study. Clinical manifestatios, preoperative examinations, surgical categories and routes, surgical and pathological findings, post-operative medical treatment, relapse and relating factors were collected and studied. Results Totally 46 patieuts with ureter endometriosis underwent one or two surgeries. Forty-eight per cent (22/46) of patients were not be diagnosed with ureter endometriosis pre-operatively, and 46% (21/46) only presented dysmenorrhea or even no symptoms. Ureterolysis (72%, 33/46) and laparotomy (63%, 29/46 ) were the most common surgical category and surgical approach. There were 64% (25/39) of patients had left ureter involved and 80% (37/46) had extrinsic ureter endometriosis. Fifteen per cent (7/46) of patients had relapsed disease with median recurrent time of 24 months (13 -49 months), and they all received second surgeries. Logistic regression analysis showed that only gonadotropin releasing hormone analogue agents were related with recurrence when compared with those patients without medical treatment post-operatively significantly ( OR =23.2, 95% CI:2. 4 -221.7, P =0. 002). Conclusions Ureter endometriosis was related with reproductive tract endometriosis. It has insidious process resulting in difficulty for early diagnosis. It's important to treat pelvic deep infiltrating endometriosis and ovarian endometrioma to prevent ureter from further involvement. Post-operative treatment of pelvic endometriosis is the key point of preventing relapse of ureter endometriosis.