输尿管子宫内膜异位症的手术策略：24例病例分析

发布时间：2017-12-31 14:11

本文关键词：输尿管子宫内膜异位症的手术策略：24例病例分析　出处：《浙江大学》2016年硕士论文　论文类型：学位论文

【摘要】：目的：探讨输尿管子宫内膜异位症的手术治疗方法。方法：回顾性分析2000年～2014年24例输尿管子宫内膜异位症病例。结果：本组24例患者,19例行经腹手术,4例腹腔镜手术,1例腹腔镜转为经腹手术。 20例(83.3%)患者为Ⅲ、Ⅳ期子宫内膜异位症,输尿管子宫内膜异位症8例为右侧,11例为左侧,5例为双侧。术中可见7例患者子宫内膜异位病灶侵犯输尿管周边；7例输尿管被子宫内膜异位病变包裹,但尚未造成输尿管积水；10例患者内异病灶累及输尿管造成输尿管狭窄,输尿管上段扩张积水。5例患者行单纯输尿管松解术,游离输尿管,切除周边内异病灶；7例患者行输尿管松解术及输尿管插管；12例患者行部分输尿管切除术,其中6例行输尿管端端吻合术,6例行输尿管膀胱种植术。中位随访25月(11-154),患者痛经、性交痛、异常阴道流血症状显著缓解(P0.05),1例患者复发。结论：输尿管子宫内膜异位症手术目的在于去除输尿管梗阻,切除病灶,避免肾功能恶化。对于不伴有肾积水或轻度肾积水的患者输尿管松解术必要时结合输尿管导管置入术是首选手术方式；对于中重度肾积水患者,部分输尿管切除及输尿管膀胱种植或输尿管端端吻合是主要手术方式。腔镜技术在输尿管子宫内膜异位症的诊断和治疗中有重要作用,对于手术经验丰富的医生,腹腔镜手术具有微创优势。
[Abstract]:Objective: To explore the surgical treatment of ureteral endometriosis. Methods: a retrospective analysis from 2000 to 2014 24 cases of ureteral endometriosis cases. Results: of the 24 patients, 19 cases of abdominal surgery, 4 cases of laparoscopic surgery, 1 cases of laparoscopic abdominal surgery for 20 cases (83.3%) patients. III, IV endometriosis, ureteral endometriosis 8 cases were right, 11 cases in left, 5 cases were bilateral. There were visible in 7 cases of endometriosis lesion involving the ureteral peripheral; 7 cases of ureteral endometriosis lesions were wrapped, but not caused by ureter in 10 patients; endometriosis lesions involving the ureter caused by ureteral stricture, ureteral dilatation hydrocephalus.5 cases underwent simple ureterolysis, ureter resection, peripheral lesions in 7 cases of patients with endometriosis; ureterolysis and ureteral intubation; 1 2 cases of patients with ureter resection, including 6 cases of ureteral anastomosis, 6 cases underwent ureterovesical implantation. The median follow-up was 25 months (11-154), dysmenorrhea, dyspareunia, abnormal vaginal bleeding symptoms (P0.05), 1 cases of recurrence. Conclusion: ureteral endometriosis surgery the purpose is to remove ureteral obstruction, resection of the lesion, to avoid the deterioration of renal function. For without hydronephrosis or mild hydronephrosis patients ureterolysis was combined with ureteral catheter implantation is the preferred surgical method; for moderate and severe hydronephrosis patients, partial ureteral resection and bladder ureter or ureter implant end-to-end anastomosis is the main mode of operation. Endoscopic technique plays an important role in the diagnosis and treatment of ureteral endometriosis, surgery for experienced doctors, laparoscopic surgery has the advantages of minimally invasive.

【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R713

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