Takahashi Y, Horie M, Isogai K, Kuriyama M, Ban Y
Department of Urology, Ogaki Municipal Hospital.
Hinyokika Kiyo. 1987 Nov;33(11):1884-9.
We present a case of ureteral endometriosis in a 48-year-old postmenopausal patient who was hospitalized complaining of right flank pain & microhematuria. She had no bladder irritability. She had a past history of simple hysterectomy and left oophorectomy because of adenomyomatosis. At that time, right ovary and other pelvic organs were normal. Physical examination revealed slight swelling of the liver without tenderness. Laboratory data at admission revealed severe liver dysfunction due to liver cirrhosis. Excretory urography demonstrated right hydronephroureterosis and severe stricture of the right lower ureter. Right ureteral catheterization demonstrated a high degree of stricture at the distal third. Cytology of right pelvic urine was negative. Right nephroureterectomy was done because long segment of right lower ureter adhered to the peritoneum tightly and we could not rule out ureteral cancer. Pathological diagnosis was extrinsic endometriosis of the right ureter. Ureteral endometriosis is rare and postmenopausal endometriosis is also rare. In our case hyperestrogenemia caused by liver cirrhosis might have played a role in the genesis and progression of endometriosis.
我们报告一例48岁绝经后输尿管子宫内膜异位症患者，该患者因右侧胁腹疼痛和镜下血尿入院。她无膀胱刺激征。既往因子宫腺肌瘤病行单纯子宫切除术和左侧卵巢切除术。当时，右侧卵巢及其他盆腔器官正常。体格检查发现肝脏轻度肿大，无压痛。入院时实验室检查显示因肝硬化导致严重肝功能障碍。排泄性尿路造影显示右侧肾盂输尿管积水及右侧下段输尿管严重狭窄。右侧输尿管插管显示远端三分之一处高度狭窄。右侧盆腔尿液细胞学检查阴性。因右侧下段输尿管长段与腹膜紧密粘连，且无法排除输尿管癌，故行右侧肾输尿管切除术。病理诊断为右侧输尿管外在性子宫内膜异位症。输尿管子宫内膜异位症罕见，绝经后子宫内膜异位症亦罕见。在我们的病例中，肝硬化引起的高雌激素血症可能在内膜异位症的发生和发展中起了作用。
