Department of Obstetrics and Gynecology, Kurashiki Medical Center, 250 Bakurocho, Kurashiki, Okayama, 710-8522, Japan.
Arch Gynecol Obstet. 2022 Jul;306(1):133-140. doi: 10.1007/s00404-022-06462-y. Epub 2022 Mar 3.
To investigate the short-term outcomes of laparoscopic ureteroneocystostomy in patients with ureteral endometriosis (UE).
Retrospective cohort study of consecutive patients who underwent surgery for the ureter endometriosis with hydronephrosis.
A private hospital that provide primary, secondary and tertiary care.
30 consecutive patients with UE who underwent laparoscopic ureteroneocystostomy at our institution between May 2008 and April 2020.
Laparoscopic ureteroneocystostomy, if necessary, hysterectomy, salpingo-oophorectomy, cystectomy, partial bladder resection, or partial bowel resection were performed.
The most common chief complaint was pelvic pain (40%). Endometriosis affected only the left ureter in 56.7% of patients, only the right ureter in 33.3%, and both ureters in 6.7%. Involvement of the ipsilateral ovary was confirmed in 64.3%. The most frequent location of UE was 1-3 cm above the UVJ (46.7%). A psoas hitch was performed in 7 patients (23.3%), and the Boari flap was used in 9 patients (30%). Hysterectomy was performed in 12 patients (40%), and 6 of them had a concomitant bilateral salpingo-oophorectomy (20%). In addition, 3 patients (10%) underwent partial bowel resection, and 2 patients (6.7%) underwent partial bladder resection. After surgery, 24 of 27 patients (80.0%) were free of sever hydronephrosis after surgery. Hydronephrosis recurred in a single patient (3.3%), but the grade of hydronephrosis improved significantly after surgery (P < 0.001). At 6 months of follow up, 4 patients (13.3%) experienced urinary tract infections and 2 patients (6.7%) reported dysuria. Patients reported a regression of dysmenorrhea symptoms (P < 0.001).
This study shows that ureteroneocystostomy provides good results in terms of relapses and symptom control in patients with ureteral endometriosis.
探讨腹腔镜输尿管-膀胱再吻合术治疗输尿管子宫内膜异位症（UE）的短期疗效。
对在我院因输尿管子宫内膜异位症合并肾积水行手术治疗的连续患者进行回顾性队列研究。
提供初级、中级和高级护理的私立医院。
2008 年 5 月至 2020 年 4 月期间，我院 30 例 UE 患者接受腹腔镜输尿管-膀胱再吻合术。
如果需要，行腹腔镜输尿管-膀胱再吻合术、子宫切除术、输卵管卵巢切除术、膀胱切除术、部分膀胱切除术或部分肠切除术。
最常见的主要症状是盆腔痛（40%）。子宫内膜异位症仅累及左侧输尿管的患者占 56.7%，仅累及右侧输尿管的患者占 33.3%，双侧输尿管均受累的患者占 6.7%。同侧卵巢受累的患者占 64.3%。UE 最常见的部位是在输尿管肾盂连接部上方 1-3cm（46.7%）。7 例患者（23.3%）行腰大肌悬吊术，9 例患者（30%）行 Boari 皮瓣术。12 例患者（40%）行子宫切除术，其中 6 例同时行双侧输卵管卵巢切除术（20%）。此外，3 例患者（10%）行部分肠切除术，2 例患者（6.7%）行部分膀胱切除术。术后 27 例患者中有 24 例（80.0%）术后无严重肾积水。1 例患者（3.3%）肾积水复发，但术后肾积水分级明显改善（P<0.001）。术后 6 个月，4 例患者（13.3%）发生尿路感染，2 例患者（6.7%）出现尿痛。患者报告痛经症状缓解（P<0.001）。
本研究表明，输尿管-膀胱再吻合术在输尿管子宫内膜异位症患者中具有良好的复发控制和症状缓解效果。
