输尿管子宫内膜异位症在女性输尿管中下段梗阻疾病中的临床研究

发布时间：2018-04-29 06:26

本文选题：子宫内膜异位症 + 输尿管梗阻　；参考：《吉林大学》2017年硕士论文

【摘要】：目的:明确输尿管子宫内膜异位症在女性输尿管中下段梗阻疾病中所占的比例,然后进一步对该病的诊断与治疗方法进行归纳分析,旨在提高对本病的重视与认识。方法:回顾性分析吉林大学白求恩第一医院泌尿外科从2014年1月-2016年12月收治的184例影像学提示输尿管中下段梗阻疾病的女性患者,对其病因进行分类,然后着重分析其中11例术后病理诊断为输尿管子宫内膜异位症患者的临床材料并复习相关文献。结果:入组的184名患者中包括输尿管结石70例,肿瘤56例,管外肿物压迫22例,子宫内膜异位症11例,非特异炎性狭窄8例,腹膜后纤维化8例,先天性巨输尿管症7例,结核2例。其中11例输尿管子宫内膜异位症患者占所有梗阻病因比例5.98%,年龄最小31岁,最大53岁,平均年龄(42.82±7.58)岁。梗阻位于左侧4例,位于右侧6例,双侧1例。首发症状包括腰痛5例(45.45%),下腹痛2例(18.18%),血尿1例(9.09%),临床症状阴性、检查发现3例(27.27%)。病程从3天-4年不等,平均病程1年7月余。入院时均携带泌尿系彩超,入院后进一步行输尿管CT、泌尿系造影等检查,提示11例患者梗阻截面以上肾盂、肾盏及输尿管呈程度不一扩张积水改变。在这11例患者中,2例提示尿路感染,4例检查提示子宫腺肌病,4例检查提示子宫肌瘤,1例既往行子宫内膜异位症手术,2例子宫全切术后,8例合并痛经病史。11例患者术前均诊断为输尿管梗阻,根据梗阻长度、位置、肾功能状况,5例行输尿管狭窄段切除加端端吻合术,2例行输尿管狭窄段切除加输尿管膀胱再植术,3例行患肾加输尿管全切术,1例行输尿管膀胱壁瓣成型术,术后病理提示符合输尿管子宫内膜异位症。住院时间从8天-14天不等,平均住院10.8天。术后2例接受促黄体生成释放激素(LH-RH)衍生物治疗4-6月。刨去3例患肾及输尿管全切患者,对剩下其他8例行电话咨询或门诊复查,其中成功随访7例,失访1例,随访时间最短3个月,最长34个月,平均16个月。7例患者中1例复发,其余6例肾盂分离程度较术前明显缓解,血肌酐、尿常规检测,提示肾功能稳定,尿白细胞阴性。结论:1、输尿管子宫内膜异位症是导致女性输尿管中下段梗阻的重要因素,应引起临床医生足够重视。2、本病起病隐匿,临床表现和诊断方法多样,但无特异性,其最终诊断需靠术后病理。3、治疗方法以手术治疗为主,另辅以药物和放疗。
[Abstract]:Objective: to clarify the proportion of ureteroendometriosis in the middle and lower ureteral obstruction of the ureter, and then to further analyze the diagnosis and treatment of the disease, aiming at improving the attention and understanding of the disease. Methods: a retrospective analysis of the Department of Urology in Bethune First Hospital of Jilin University from -2016 January 2014 12. 184 cases of the female patients with middle and lower ureteral obstruction were classified in this month, and then the clinical materials of 11 cases of ureteral endometriosis diagnosed after operation were analyzed and the related literature were reviewed. Results: 70 cases of ureteral stones were included in the 184 patients, and 56 cases were tumor. 22 cases, 11 cases of endometriosis, 8 cases of non specific inflammatory stenosis, 8 cases of retroperitoneal fibrosis, 7 cases of congenital megacerreter, 2 cases of tuberculosis, 11 cases of ureteroendometriosis accounted for 5.98%, the age was 31 years old, the oldest was 53 years, the average age was (42.82 + 7.58) years. Obstruction was located in left 4. On the right side, 6 cases were located on the right side and 1 cases were bilateral, including 5 cases of low back pain (45.45%), 2 cases of lower abdominal pain (18.18%), 1 cases of hematuria (9.09%), negative clinical symptoms, 3 cases (27.27%). The course of disease ranged from 3 days -4 years, average course of 1 years 7 months. 11 cases of the renal pelvis above the obstruction section of the renal pelvis, the renal calyx and the ureter were not one of the dilatation hydrops. In these 11 patients, 2 were suggestive of urinary tract infection, 4 were diagnosed with uterine adenomyosis, 4 had uterine leiomyoma, 1 had undergone endometriosis surgery, 2 cases of hysterectomy, 8 patients with.11 patients with dysmenorrhea history. 5 cases of ureteral stenosis resection plus end anastomosis, 2 cases of ureteral stenosis resection plus ureter bladder replantation, 3 cases of ureteral total resection and 1 cases of ureteral bladder wall plasty were performed in the ureteral uterus. The postoperative pathological hints were conformed to the ureteral uterus. The hospitalization time ranged from 8 days -14 days, with an average hospitalization of 10.8 days. 2 cases were treated with luteinizing hormone releasing hormone (LH-RH) derivatives for 4-6 months after operation. 3 cases of renal and ureter total resection were taken to the remaining 8 cases of telephone consultation or outpatient review, of which 7 cases were successfully followed up and 1 cases were lost, the duration of follow-up was 3 months and 34 was the longest. 34 In the average 16 months, 1 cases were recurred in.7 patients. The remaining 6 cases of renal pelvis separation were obviously relieved, blood creatinine and urine routine examination, suggesting that the renal function was stable and the ureteral cell negative. Conclusion: 1, ureteral endometriosis is an important factor leading to the lower middle ureteral obstruction of the ureter, which should cause the clinician to pay enough attention to.2. This disease should be caused by this disease. The disease is concealed, the clinical manifestations and diagnostic methods are varied, but there is no specificity. The final diagnosis depends on the postoperative pathological.3. The treatment is mainly performed by surgical treatment, supplemented by drugs and radiotherapy.

【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R713.4;R699.4

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