Donnez Jacques, Nisolle Michelle, Squifflet Jean
Université Catholique de Louvain, Cliniques Universitaires Saint-Luc, Service de Gynécologie, Brussels, Belgium.
Fertil Steril. 2002 Jan;77(1):32-7. doi: 10.1016/s0015-0282(01)02921-1.
To present data from 18 cases of ureteral endometriosis.
Prospective clinical study.
Department of gynecology at a university hospital.
PATIENT(S): Four hundred and five patients with severe dysmenorrhea or deep dyspareunia due to a rectovaginal endometriotic (adenomyotic) nodule.
INTERVENTION(S): Patients were prospectively evaluated using intravenous pyelography. All patients underwent laparoscopic surgery to remove rectovaginal adenomyosis and ureterolysis.
MAIN OUTCOME MEASURE(S): Presurgical and postsurgical evaluation and histologic analysis.
RESULT(S): Preoperative intravenous pyelography revealed ureteral stenosis with ureterohydronephrosis in 18 patients (4.4%). A significantly higher prevalence (11.2%) was observed in nodules > or = 3 cm in diameter. Five women (20%) had complete ureteral stenosis. Kidney scintigraphy revealed damaged kidney parenchymal function, which ranged from 18% to 42%. Laparoscopic ureterolysis was done in 16 women; 2 women underwent ureteral resection and uretero-ureterostomy. A significant postoperative decrease in ureterohydronephrosis was noted in all patients; however, renal function improved only slightly.
CONCLUSION(S): Ureteral endometriosis was found in 4.4% of patients with rectovaginal endometriotic (adenomyotic) nodules. Ureterolysis and removal of associated adenomyotic lesions was sufficient therapy in most patients; two required resection of the ureteral stenotic segment. Intravenous pyelography should be performed in all women with rectovaginal nodules > or = 3 cm to prevent nonreversible loss of renal function.
呈现18例输尿管子宫内膜异位症的数据。
前瞻性临床研究。
一所大学医院的妇科。
405例因直肠阴道子宫内膜异位（腺肌病）结节导致严重痛经或深部性交困难的患者。
对患者进行前瞻性静脉肾盂造影评估。所有患者均接受腹腔镜手术以切除直肠阴道腺肌病并进行输尿管松解术。
术前和术后评估及组织学分析。
术前静脉肾盂造影显示18例患者（4.4%）存在输尿管狭窄伴输尿管积水性肾盂积水。在直径≥3 cm的结节中观察到更高的患病率（11.2%）。5名女性（20%）存在完全性输尿管狭窄。肾闪烁显像显示肾实质功能受损，范围为18%至42%。16名女性进行了腹腔镜输尿管松解术；2名女性接受了输尿管切除术和输尿管输尿管吻合术。所有患者术后输尿管积水性肾盂积水均显著减轻；然而，肾功能仅略有改善。
在4.4%的直肠阴道子宫内膜异位（腺肌病）结节患者中发现输尿管子宫内膜异位症。对大多数患者而言，输尿管松解术及切除相关腺肌病病变是足够的治疗方法；2例患者需要切除输尿管狭窄段。所有直肠阴道结节≥3 cm的女性均应进行静脉肾盂造影，以防止肾功能不可逆转的丧失。
