阴道直肠隔子宫内膜异位症25例的诊断治疗

The diagnosis and management of recto-vaginal endometriosis with a report of 25 patients.

目的 :探讨阴道直肠隔子宫内膜异位症的诊断和治疗方法。方法 :回顾分析1986至 2 0 0 2年手术病理证实的阴道直肠隔子宫内膜异位症 2 5例。结果 :发病年龄平均39岁 ,临床表现为各种形式的盆腔痛及不育 ,6 6 .7%合并有肠道症状。病灶位于阴道直肠隔内 ,单发 2 0例 ,多发 5例 ,直径 1～ 4cm。术前药物治疗中假孕疗法 7例 ,4例症状缓解 ,3例无效 ;假绝经疗法 8例 ,6例症状缓解 ,2例无效。 2 3例行手术治疗 ,2例行病灶切除术 ,11例行全子宫及阴道直肠隔异位病灶切除术 ;3例行全子宫单侧附件及阴道直肠隔异位病灶切除术 ;7例行全子宫双附件及阴道直肠隔异位病灶切除术。术后 6例用药物治疗 ,3例假孕疗法 ,3例假绝经疗法。在平均 15 .2月的随诊中 ,2 0例 (80 % )症状缓解 ,5例 (2 0 % )复发 ,其中 4例于术后 1年内复发 ,多发灶位于阴道直肠隔 ,1例于术后 14月复发 ,多发灶位于阴道残端。根治性手术组 (全子宫双附件及阴道直肠隔异位病灶切除术 )无 1例复发 ,非根治手术组 5例复发 ,两组差异有显著性 (P <0 .0 1)。结论 :阴道直肠隔子宫内膜异位症临床少见 ,通常有盆腔痛及不育 ,肠道症状的发生率高。临床诊断依靠妇科三合诊 ,药物治疗可以短期缓解症状 ,根据年龄、症状。

Objective:To study the diagnosis and treatment methods of recto-vaginal endometriosis.Method:25 patients with recto-vaginal endometriosis were analyzed retrospectively.Results:Recto-vaginal endometriosis manifested vary kinds of pelvic pain and infer tility and 66.7% accompanied with intestinal symptoms. Endometriotic foci lay in the recto-vaginal septum. The focus was single in 20 cases and multiple in 5 cases.25 cases were diagnosed before surgery and 7 cases underwent pseudo-pregn ancy therapy, 4 of them functioned while 3 failed.8 cases underwent pseudo-meno pause therapy, 6 cases functioned while 2 failed. After operation,6 cases underw ent drug therapy, against which 3 cases underwent pseudo-pregnancy therapy,3 un derwent pseudo-menopause therapy. 23 cases underwent surgery: 2 cases had focus resection;11 cases had hysterectomy and focus resection;3 cases had hysterect omy and unilateral adnexectomy with focus resection;7 cases had hysterectomy an d bilateral adnexectomy with focus resection. After average 15.2 months of follo w-up, 20 cases (80%) had permanent relief of complaint. Endometriotic focus rec urred in 4 cases within the first year after surgery and 1 case in the 14th mont h. 4 of 5 cases recurred in the recto-vaginal septum, one in the vaginal residu al. In the radical surgery group there was no recurrent cases but in the non-ra dical group 5 cases recurrent. The difference was significant (P <0.01).Conclusion:Recto-vaginal endometriosis is a rare con dition and manifests vary kinds of pelvic pain and infertility with high occurre nce of intestinal symptoms. Clinical diagnosis can be made by pelvic examinatio n. Drug therapy can produce temporary relief of symptoms.Surgery according to a g e, symptoms and fertility condition is the main therapy. Disease recurred always in the first year after surgery in recto-vaginal septum.