会阴子宫内膜异位症18例临床分析

Clinical analysis of 18 cases of perineal endometriosis.

目的 探讨会阴子宫内膜异位症的诊断与治疗。方法 1 998年 1月至 2 0 0 3年 1 2月对南通医学院附属医院妇产科 1 8例会阴子宫内膜异位症的诊断与治疗进行回顾性研究。结果 1 7例经阴道分娩 ,均有阴道侧切伤、会阴撕裂伤 ,1例剖宫产分娩无阴道分娩及人工流产史 ;1 6例术前明确诊断 ,2例分别误诊为肛周纤维瘤、肛周皮脂囊肿 ;1 8例中有 4例病灶累及肛门括约肌。所有病例均行病灶切除 ,除 1例多病灶患者术后 30个月复发外 ,其余病例均无复发。结论 会阴子宫内膜异位症可根据病史、典型临床表现与妇科检查作出诊断 ,部分病例累及肛门括约肌者应慎重 ,以防误诊 ;手术治疗是首选手段 ,手术时机的合理选择、术中正确处理及术后假绝经治疗有利于伤口愈合和防止复发。

Objective To analyze the diagnosis and treatment of perineal endometriosis.Methods 18 cases of perineal endometriosis were analyzed retrospectively.Results 17 patients with perineal endometriosis had history of episiotomy and perineal tear.Only one case was with obstetric history of cesarean section and without vaginal delivery and spontaneous abortions.All except two cases were misdiagnosed as anal fibromatosis and sebaceous cyst respectively were firmly diagnosed before opration.4 in the 18 endometriosis related with and sphinctor muscle.All patients received complete surgical excision.Only one case relapsed after 30 months.Conclusion Perineal endometriosis is mainly diagnosed by its history and clinical manifestations.Complete surgical excision is the best choice of treatment.The reasonable choice of operation chance and correct surgical treating will be of benefit to wound healing and forbidding endometriosis recurrence.