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目的探讨输尿管子宫内膜异位症(简称输尿管内异症)的诊断、治疗及预后。方法回顾性分析2000年1月至2013年10月北京大学第一医院诊治的33例输尿管内异症患者的临床资料。结果患者平均年龄(41.3±5.8)岁,占同期总内异症的1.1%(33/3 131)。33例患者中,6例无临床症状,27例痛经、腰腹痛及泌尿系统症状。其中输尿管内异症致左侧肾积水14例,右侧19例;输尿管下段梗阻29例,中段4例;内在型内异症9例,外在型24例。17例行肾功能检查,其中轻度损伤2例,中度3例,重度7例,无损伤5例。开腹手术18例,腹腔镜手术15例;盆腔粘连松解、输尿管病灶切除+膀胱植入、病灶切除+输尿管端端吻合和肾切除分别为10例、13例、6例和4例。术后随访25例(75.8%),中位随访时间53.4个月,1例肾积水复发。结论输尿管内异症虽发病率低,但易引起较严重后果,应重视早期诊断。手术治疗为首选,可以有效保护肾功能。
Objective To investigate the diagnosis, treatment and prognosis of ureter endometriosis (ureter endometriosis). Methods The clinical data of 33 patients with ureteral endometriosis diagnosed and treated by Peking University First Hospital from January 2000 to October 2013 were retrospectively analyzed. Results The average age of patients (41.3 ± 5.8) years, accounting for 1.1% of total endometriosis over the same period (33/3 131). Of the 33 patients, 6 had no clinical symptoms and 27 had dysmenorrhea, abdominal pain and urinary symptoms. Among them, 14 cases of left hydronephrosis and 19 cases of right ureteric atherosclerosis, 29 cases of lower ureteral obstruction, 4 cases of middle ureter, 9 cases of intrinsic endometriosis and 24 cases of extrinsic type. 17 cases of renal function tests, including 2 cases of mild injury, moderate in 3 cases, severe in 7 cases, 5 cases without injury. 18 cases of laparotomy and 15 cases of laparoscopic surgery; pelvic adhesions release, ureteral resection + bladder implantation, resection of the lesion + ureteral end anastomosis and nephrectomy were 10 cases, 13 cases, 6 cases and 4 cases. Follow-up was performed in 25 cases (75.8%) with a median follow-up time of 53.4 months. One case had hydronephrosis recurrence. Conclusions Although the incidence of ureteral endometriosis is low, it may lead to more serious consequences. Early diagnosis should be emphasized. Surgical treatment is the first choice, which can effectively protect renal function.