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腹腔镜输尿管松解术联合葱状输尿管自膨式支架治疗左侧输尿管深部浸润型子宫内膜异位症:一例报告

Deep Infiltrating Endometriosis of the Left Ureter Managed with Laparoscopic Ureterolysis Combined with Allium Ureteral Self-Expandable Stent: A Case Report.

作者信息

Jozwik Marcin, Miłobędzka Magdalena, Wojtkiewicz Joanna, Neymeyer Jörg, Jakimiuk Artur, Jozwik Maciej

机构信息

Department of Gynecology and Obstetrics, Collegium Medicum, University of Warmia and Mazury in Olsztyn, 10-045 Olsztyn, Poland.

Scientific Circle of the Department of Gynecology and Obstetrics, Collegium Medicum, University of Warmia and Mazury in Olsztyn, 10-045 Olsztyn, Poland.

出版信息

J Clin Med. 2024 Nov 11;13(22):6769. doi: 10.3390/jcm13226769.

Abstract

: In endometriosis, urinary tract involvement occurs in 1-5.5% of cases, where the ureter is affected in 9-23%. Unfortunately, endometriosis may remain asymptomatic even with significant anatomical progression. A delay in the diagnosis and treatment of ureteral endometriosis may result in hydronephrotic kidney damage and functional impairment. : We present a case of a 36-year-old woman with a left ureteral stricture caused by deep infiltrating endometriosis accompanied by severe kidney-induced arterial hypertension. In March 2022, the patient underwent both laparoscopic excision/evaporation of deep infiltrating endometriosis from the left ovarian fossa and left ureterolysis, followed by an ureterorenoscopic dilatation of the left ureter via the placement of an Allium self-expandable stent. : This stent was successfully removed 18 months later. A computed tomography check-up confirmed normal ureteral patency with no signs of endometriosis. Elevated blood pressure also resolved. : Deep infiltrating endometriosis can lead to asymptomatic yet serious complications. A successful treatment of ureteral endometriosis may require multidisciplinary management, including a simultaneous laparoscopic and ureterorenoscopic approach. Ureteral stent placement is a minimally invasive state-of-the-art solution for ureteral stricture(s) and should be considered the first choice in women of reproductive age suffering from ureteral deep infiltrating endometriosis.

摘要

在子宫内膜异位症中,泌尿道受累见于1%至5.5%的病例,其中输尿管受累占9%至23%。不幸的是,即使存在明显的解剖学进展,子宫内膜异位症也可能没有症状。输尿管子宫内膜异位症的诊断和治疗延迟可能导致肾积水性肾损伤和功能损害。我们报告一例36岁女性,因深部浸润性子宫内膜异位症导致左输尿管狭窄,并伴有严重的肾性动脉高血压。2022年3月,患者接受了腹腔镜下从左卵巢窝切除/汽化深部浸润性子宫内膜异位症及左输尿管松解术,随后通过放置葱状自膨式支架经输尿管肾镜扩张左输尿管。18个月后成功取出该支架。计算机断层扫描检查证实输尿管通畅正常,无子宫内膜异位症迹象。血压升高也得到缓解。深部浸润性子宫内膜异位症可导致无症状但严重的并发症。成功治疗输尿管子宫内膜异位症可能需要多学科管理,包括同时采用腹腔镜和输尿管肾镜方法。输尿管支架置入是治疗输尿管狭窄的一种微创的先进解决方案,对于患有输尿管深部浸润性子宫内膜异位症的育龄女性应被视为首选。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9d21/11594299/e9ab417aaa00/jcm-13-06769-g001.jpg

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