输尿管子宫内膜异位症致肾萎缩的1例报告  

A case report of renal atrophy caused by uterine endometriosis of the ureter

作　　者：曹英莹 徐洪斌 CAO Yingying;XU Hongbin(The Second Clinical Medical College of Jinan University,Guangdong Province,Shenzhen 518020,China;Department of Gynaecology,Shenzhen People's Hospital,Guangdong Province,Shenzhen 518020,China)

机构地区：[1]暨南大学第二临床医学院,广东深圳518020 [2]深圳市人民医院妇科,广东深圳518020

出　　处：《中国当代医药》2024年第15期133-137,共5页China Modern Medicine

基　　金：广东省深圳市科技计划项目(JCYJ20140416122811911)。

摘　　要：输尿管子宫内膜异位症(UE)指异位子宫内膜种植、侵袭输尿管及输尿管周围组织,使其发生病变,属于特殊子宫内膜异位症(内异症),其病因尚不明确,但异位内膜反复性周期性的出血导致炎症反应、组织纤维化、粘连等,使病变浸润种植于输尿管内膜、肌层或者外膜。该病发病率低,临床上认识不足,容易发生漏诊、误诊。2023年2月6日深圳市人民医院收治的1例UE患者,47岁女性,反复右侧腰部隐痛4年余,既往内异症病史,因“内异症”行2次手术治疗,剖宫产1次,子宫肌瘤剔除术史2次,曾诊断为输尿管狭窄行经尿道右输尿管镜检查术+输尿管狭窄扩张术+输尿管支架置入术,术后3个月拔除输尿管支架后疼痛情况同前。本次入院后完善彩超、MRI等检查,诊断为UE可能,行手术治疗,手术顺利,术后病理诊断UE,术后予促性腺激素释放激素激动剂类似物(GnRH-a)治疗6个周期,现已完成,术后随访半年患者状况良好。Ureteral endometriosis(UE)refers to the ectopic implantation of uterine endometrial tissue that invades the ureter and the surrounding tissues,leading to pathological changes.It is a rare subtype of endometriosis,and its exact etiology remains unclear.However,recurrent cyclic bleeding from ectopic endometrium can trigger inflammatory reactions,tissue fibrosis,adhesions,and subsequent infiltration into the ureteral mucosa,muscular layer,or outer serosa.This condition has a low incidence and is often underrecognized in clinical practice,leading to misdiagnosis or delayed diagnosis.On February 6th,2023,a 47-year-old female patient with a history of recurrent right-sided lower back pain for over 4 years and a prior diagnosis of endometriosis,was admitted to Shenzhen People's Hospital.She had undergone two surgeries for“endometriosis”,one cesarean surgery,and two uterine fibroid removal procedures.She had also been previously diagnosed with right ureteral stenosis and had undergone a right ureteroscopy,ureteral dilation,and placement of a ureteral stent.However,her pain persisted even after the removal of the ureteral stent.During this hospitalization,comprehensive imaging studies,including ultrasound and MRI were performed,leading to a possible diagnosis of ureteral endometriosis.Surgical treatment was carried out successfully,and postoperative pathology confirmed right ureteral endometriosis.The patient received gonadotropin-releasing hormone agonist(GnRH-a)therapy for six cycles and has shown good efficacy during the six-month follow-up.

关 键 词：子宫内膜异位症 输尿管 输尿管梗阻 肾萎缩 

分 类 号：R711.71[医药卫生—妇产科学]