输尿管子宫内膜异位症致肾积水61例临床诊治分析  

Diagnosis and treatment of ureteral endometriosis with hydronephrosis:an analysis of 61 cases

作　　者：李曾[1] 廖洪[1] 谭政[1] 毛顿[1] 吴毅[1] 肖英明[1] 杨盛柯 钟磊[1] 

机构地区：[1]四川省肿瘤医院泌尿外科

出　　处：《现代泌尿外科杂志》2017年第5期368-372,共5页Journal of Modern Urology

摘　　要：目的总结61例输尿管子宫内膜异位症(EM)致肾积水患者的临床诊疗经验,提高对该疾病的认知和诊疗水平。方法回顾性分析我们曾收治的1例和国内个案报道的60例输尿管EM患者的临床资料,就其临床、病理特点、治疗和预后等进行分析。结果 61例均证实为输尿管EM,单侧56例(91.8%),其中左侧26例(46.4%),右侧30例(53.6%),双侧5例(8.2%);病灶位于输尿管下段56例(91.8%),输尿管中段5例(8.2%);腔外型44例(72.1%),腔内型12例(19.7%),混合型4例(6.6%),分型不详1例(1.6%);61例均伴有肾积水,轻度19例(31.1%),中、重度42例(68.9%)。除1例行药物治疗外,其余60例均行手术,16例同期行盆腔其他部位EM病灶切除术,25例较重者术后给予激素药物辅助治疗3~6个月。随访2~120个月,平均15.6个月左右。肾积水术后36例消失,22例缓解,3例肾切除患者对侧肾功能良好,无输尿管梗阻。60例手术者无复发。结论输尿管EM是引起肾积水的一种较罕见疾病,早期诊断较困难,影像学检查重要,但需病检明确,应根据输尿管狭窄的具体情况等决定手术方式,手术治疗效果较好,病变严重的病例术后应用激素类药物治疗可降低复发率。ObjectiveTo summarize the clinical experience in the diagnosis and treatment ureteral endometriosis （EM） with hydronephrosis, in order to improve the level of recognition, diagnosis and treatment of the disease.MethodsThe clinical data of 1 case treated by us and 60 cases of domestic patients with EM were retrospectively analyzed, including the clinical and pathological characteristics, treatment and prognosis.ResultsAll cases were confirmed ureteral EM.Unilateral lesions occurred in 56 cases （91.8%）, 26 cases on the left side （46.4%）, and 30 on the right side （53.6%）.Bilateral lesions occurred in 5 cases （8.2%）.Lesions located in the distal ureteral were observed in 56 cases （91.8%）, in the middle ureter in 5 cases （82%）.Lesions were external in 44 cases （72.1%）, internal in 12 cases （19.7%）, mixed type in 4 cases （6.6%）, and unknown type in 1 case （1.6%）.All cases had hydronephrosis, including mild hydronephrosis in 19 cases （31.1%）, and moderate-severe hydronephrosis in 42 cases （68.9%）.Only 1 case was treated with medications, and the others were treated with surgery.Sixteen patients who had endometriosis in other parts of the pelvic had lesions resected at the same time, and 25 cases with serious lesions received hormonal treatment for 3～6 months.During the follow-up of 2～120 months （average 15.6 months）, hydronephrosis disappeared in 36 cases, and relieved in 22 cases.The 3 patients with nephrectomy had satisfactory kidney function.No ureteral obstruction or relapse occurred.ConclusionUreteral endometriosis is a relatively rare disease leading to hydronephrosis, which is difficult to diagnose in the early stage.Imaging examination is important for the diagnosis, but it should be confirmed by pathologic examination.Surgical approaches should be decided based on conditions of ureteral stricture.Surgical treatment can produce good efficacy.Postoperative hormonal drug treatment can reduce the recurrence rate of severe cases.

关 键 词：输尿管 子宫内膜异位症 .肾积水 诊断 治疗 

分 类 号：R711.71[医药卫生—妇产科学]