尿路エンドメトリオーシス本邦152例の臨床統計 : 2例を経験して

Abstract

1)平均年齢は37.1歳で, 臨床症状は膀胱エンドメトリオーシス(94例)は膀胱刺激症状が, 尿管エンドメトリオーシス(57例)では上部尿路閉塞症状が多く認められ, 月経周期に一致するものがそれぞれ81.5%, 25%あった。2)発生部位は膀胱エンドメトリオーシスは後壁が最も多かった。尿管エンドメトリオーシスは右尿管29例(51.8%), 左尿管19例(34%), 両側8例(14.3%)でtype別ではextrinsic typeが36例(63.2%)で最も多かった。3)診断には主訴, 症状, 既往歴の詳細な分析が大切で, 周期的に変化する超音波像, X線像, 内視鏡像も重要である。確定診断には生検もしくは手術を要したものが多かった。4)治療法は保存的手術療法が主体であった。ホルモン療法は単独で行われているものは少なく, ほとんどが手術との併用であった。しかし近年ダナゾール, LHRHアナログ等のホルモン剤が単独で使用されつつあり今後の効果が期待される

One hundred and fifty two cases of genito-urinary tract endometriosis reported in Japan including our 2 cases were reviewed. The incidence and mean patients' age were respectively 0.7% and 22 years old for kidneys, 37.5% and 38.8 years old for ureter and 61.8% and 36.2 years old for bladder. Clinical symptoms in ureteral endometriosis were similar to those in upper urinary tract obstruction and in vesical endometriosis, lower urinary tract symptoms such as pain on urination, irritative bladder symptoms and macrohematuria were frequently observed. Vesical lesions tend to be located on the posterior wall in the retrotrigone or trigone, and ureteral lesions tend to be located in the bilateral lower segments. The incidence of extrinsic type of ureteral endometriosis was 6 times higher than that reported as intrinsic type, and mixed type was reported in only 3.5%. Recent first choice for mild endometriosis is hormonal therapy with Danazole or LH-RH analogue. Surgical treatment is recommended in severe cases or patients in whom hormonal therapy is not effective.