本文選題：子宮內(nèi)膜異位癥 + 輸尿管梗阻��； 參考：《吉林大學》2017年碩士論文

【摘要】：目的:明確輸尿管子宮內(nèi)膜異位癥在女性輸尿管中下段梗阻疾病中所占的比例,然后進一步對該病的診斷與治療方法進行歸納分析,旨在提高對本病的重視與認識。方法:回顧性分析吉林大學白求恩第一醫(yī)院泌尿外科從2014年1月-2016年12月收治的184例影像學提示輸尿管中下段梗阻疾病的女性患者,對其病因進行分類,然后著重分析其中11例術(shù)后病理診斷為輸尿管子宮內(nèi)膜異位癥患者的臨床材料并復習相關(guān)文獻。結(jié)果:入組的184名患者中包括輸尿管結(jié)石70例,腫瘤56例,管外腫物壓迫22例,子宮內(nèi)膜異位癥11例,非特異炎性狹窄8例,腹膜后纖維化8例,先天性巨輸尿管癥7例,結(jié)核2例。其中11例輸尿管子宮內(nèi)膜異位癥患者占所有梗阻病因比例5.98%,年齡最小31歲,最大53歲,平均年齡(42.82±7.58)歲。梗阻位于左側(cè)4例,位于右側(cè)6例,雙側(cè)1例。首發(fā)癥狀包括腰痛5例(45.45%),下腹痛2例(18.18%),血尿1例(9.09%),臨床癥狀陰性、檢查發(fā)現(xiàn)3例(27.27%)。病程從3天-4年不等,平均病程1年7月余。入院時均攜帶泌尿系彩超,入院后進一步行輸尿管CT、泌尿系造影等檢查,提示11例患者梗阻截面以上腎盂、腎盞及輸尿管呈程度不一擴張積水改變。在這11例患者中,2例提示尿路感染,4例檢查提示子宮腺肌病,4例檢查提示子宮肌瘤,1例既往行子宮內(nèi)膜異位癥手術(shù),2例子宮全切術(shù)后,8例合并痛經(jīng)病史。11例患者術(shù)前均診斷為輸尿管梗阻,根據(jù)梗阻長度、位置、腎功能狀況,5例行輸尿管狹窄段切除加端端吻合術(shù),2例行輸尿管狹窄段切除加輸尿管膀胱再植術(shù),3例行患腎加輸尿管全切術(shù),1例行輸尿管膀胱壁瓣成型術(shù),術(shù)后病理提示符合輸尿管子宮內(nèi)膜異位癥。住院時間從8天-14天不等,平均住院10.8天。術(shù)后2例接受促黃體生成釋放激素(LH-RH)衍生物治療4-6月。刨去3例患腎及輸尿管全切患者,對剩下其他8例行電話咨詢或門診復查,其中成功隨訪7例,失訪1例,隨訪時間最短3個月,最長34個月,平均16個月。7例患者中1例復發(fā),其余6例腎盂分離程度較術(shù)前明顯緩解,血肌酐、尿常規(guī)檢測,提示腎功能穩(wěn)定,尿白細胞陰性。結(jié)論:1、輸尿管子宮內(nèi)膜異位癥是導致女性輸尿管中下段梗阻的重要因素,應引起臨床醫(yī)生足夠重視。2、本病起病隱匿,臨床表現(xiàn)和診斷方法多樣,但無特異性,其最終診斷需靠術(shù)后病理。3、治療方法以手術(shù)治療為主,另輔以藥物和放療。
[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.

【學位授予單位】：吉林大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R713.4;R699.4

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