膀胱子宫内膜异位症的超声诊断(附三例临床分析及文献复习)

本文通过3例经活检和手术证实的膀胱子宫内膜异位症的超声图像分析,讨论了膀恍子宫内膜异位症的超声诊断价值。 半数以上的膀胱子宫内膜异位症有盆腔手术史。临床表现为月经期伴尿频尿急和尿痛等尿道刺激的症状,抗炎治疗常难奏效,而月经净后症状自行缓解和消退。 超声图见子宫峡部的前壁外缘有不规则的隆起,呈低回声区并向膀胱后壁突起。在月经来潮前和来潮时此隆起包块稍见增大饱满。用丹那唑或三苯氧胺治疗病灶将逐渐缩小。本文比较了膀胱镜检查的优越性及其局限性,认为超声检查可作为首选的检查方法进行早期诊断,尤其对需采取保守治疗的患者,超声检查可作定期随访以观疗效,而不需反复进行膀胱镜检。超声检查此症应与膀胱血管瘤,膀胱癌,息肉和炎症溃疡等鉴别。

Ultrasound Diagnosis of Endometriosis of the Urinary Bladder: Report of Three Cases and Review

Three cases of endometriosis of the bladder were diagnosed with ultrasound and confirmed by operation and pathological inspection.Up to 1994, there have been about 190 cases of endometriosis of the bladder reported in the world. Most cases were diagnosed with cystoscopy and it was the first report of the disorder diagnosed with ultrasound in China. It is reported that the incidence of of the disease accounts one to two per cents of total endometriosis.More than half of the patients had history of pelvic surgery, complaining dysuria, urgency during the time of menstration. Antibiotics showed little effects and after menses, the symptoms subsided and disappeared.Pelvic ultrasound identified an irregular hypoecho mass arising from posterior wall of the bladder and the mass might be slightly enlarged during menstration. After taking danazol or tamoxifen the mass might gradually shrink.As compared with cystoscopy, sonography is a simple and painless inspection technique and should be of first choice for earlier diagnosis, especially for those who need conservative treatment and periodic follow up. In confirmation of the disease by ultrasound, angioma, carcinoma and inflammatory ulcer of the bladder should be excluded.