输尿管子宫内膜异位症的诊断与治疗

doi:10.3969/j.issn.1671-167X.2016.04.016

摘要/Abstract

摘要：

目的：讨论输尿管子宫内膜异位症的诊断与治疗方法。方法：回顾性分析2001年至2015年病理证实的25例输尿管子宫内膜异位症患者的临床资料。结果： 25例患者在术前均行泌尿系超声检查，行CT检查21例（84%），行MRI检查5例（20%），3例（12%）行泌尿系平片（kidney ureter bladder，KUB）和经静脉肾盂造影（intravenous pyelography，IVP）检查，4例（16%）行逆行尿路造影检查，8例（32%）患者行膀胱镜检查，11例（44%）行肾动态显像检查。25例患者均为单侧病变，其中右侧13例（52%），左侧12例（48%），病变位于下段21例（84%），中段4例（16%）。11例（44%）行输尿管狭窄段切除和输尿管断端吻合术，10例（40%）行输尿管狭窄段切除和输尿管膀胱再植术，3例（12%）行腹膜后镜患侧肾及输尿管全长切除术，1例（4%）行输尿管肿物电灼术。术后病理均诊断为输尿管子宫内膜异位症，免疫组织化学染色示 CA125（+）、ER（+）、PR（+）。4例（16%）在术后接受内分泌辅助治疗,术后随访成功的16例（64%）患者均未出现复发。截止到2015年12月随访时间3~76个月，中位随访时间28个月。15例(93.8%)患者术后复查时行泌尿系超声检查，5例(31.3%)行腹部CT检查，均提示肾积水有不同程度的好转，10例（62.5%）患者术后症状消失，放置D-J管的患者在3~6周内拔管。结论：输尿管子宫内膜异位症以手术治疗为主，对轻度肾积水和输尿管扩张的患者可行输尿管粘连松解术，对中重度输尿管扩张和肾积水的患者建议行输尿管狭窄段切除术，对患侧肾功能严重受损者，可行患侧肾及输尿管全长切除术。

关键词: 输尿管, 子宫内膜异位症, 外科手术

Abstract:

Objective：To discuss the therapy for ureteral endometriosis. Methods: The clinical data of 25 cases of histopathologically confirmed ureteral endometriosis during 2001－2015 were retrospectively analyxed. Results: In the 25 cases, all the patients took urinary ultrasound for examination before surgery, of whom 21 (84%) were examined by CT and 5 (20%) by MRI. Three (12%) cases underwent preoperative KUB and intravenous pyelogram (IVP) examination. Four (16%) cases were examined by retrograde pyelography before surgery. Eight (32%) of them took cystoscope for examination and 11 (44%) took preoperative radionuclide renal dynamic imaging examination. All of these cases were affec-ted with unilateral ureter, 13 (52%) in the right and 12 (48%) in the left. The ureter lesions were at the upper part in 21 (84%) cases and at the middle part in 4 (16%) cases. In these cases, 11 (44%) received partial ureteral resection and end-to-end ureteral anastomosis, 10 (40%) received partial ureteral resection and ureterocystoneostomy, 3 (12%) received retroperitoneal laparoscopic nephroureterectomy, and 1 (4%) received endoscopic resection of ureteral endometriosis lesion. All of these cases were confirmed with ureteral endometriosis by post-surgery pathology results, with the expression of CA125 and ER in the glandular tissue and expression of PR in the mesenchymal tissue inside the ureteral muscle detected by immunohistochemistry. Four (16%) cases took postoperative adjuvant hormonal therapy. And no recurrence was found among 16 (64%) cases with the successful follow-up which ranged from 3 to 76 months and the median follow up was 28 months. Fifteen cases were submitted to the follow-up by urinary ultrasound (93.8%) and 5 (31.3%) underwent CT for examination. All the cases relieved from hydronephrosis, and symptoms of 10 (63.5) cases disappeared. The cases with double-J stent all had the stent removed within 3 to 6 weeks. Conclusion: Surgical procedures should be considered as the main therapy for ureteral endometriosis. We recommend ureterolysis for patients with mild ureteral obstruction and hydronephrosis. As for those with moderate and severe ureteral obstruction and hydronephrosis, we recommend partial ureteral resection. When the situation comes to patients with little renal function of the affected side, the recommended management is nephroureterectomy.

Key words: Ureter, Endometriosis, Surgical procedure, operative

中图分类号:

R711.7

贾卓，张雷，李学松，周利群. 输尿管子宫内膜异位症的诊断与治疗[J]. 北京大学学报(医学版), 2016, 48(4): 650-654.

JIA Zhuo, ZHANG Lei, LI Xue-song, ZHOU Li-qun. Diagnosis and therapy for ureteral endometriosis[J]. Journal of Peking University(Health Sciences), 2016, 48(4): 650-654.

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