阴道直肠隔子宫内膜内异症57例的诊断与治疗

Diagnosis and management of 57 cases with rectovaginal endometriosis

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：回顾性分析我院近2年收治的57例阴道直肠隔子宫内膜异位症患者的临床资料。结果：57例患者平均发病年龄为40.1岁,占同期子宫内膜异位症的0.17%;临床表现主要为痛经,月经改变和肛门刺激症状;异位病灶结节常为多个,三合诊检查结节直径范围为1~6 cm;阴道B超检查7例阳性。18例患者行血清CA125检查,11例出现增高。术前13例曾接受药物治疗,无效后手术。所有患者均采取开腹手术,56例行病灶完整切除术,术后23例加用药物治疗。随访48例,完整切除病灶的47例患者无深部结节的复发,其中1例出现右侧卵巢内异囊肿的复发;1例未能完整切除病灶者症状较前缓解。结论：阴道直肠隔子宫内膜异位症的诊断主要依靠妇科检查三合诊,结合症状和辅助检查的结果。术前药物治疗可减小病灶体积,有利于手术;完整切除病灶是治疗该病的主要手段;保留卵巢的患者术后加用药物治疗可减少其复发率。

Objective： To study the diagnosis and therapy of the rectovaginal endometriosis. Methods： Clinical data of 57 women with rectovaginal endometriosis admitted to the West China Second University Hospital of Sichuan University in last two years, were retrospectively reviewed. Results： The average age of patients was 40. 1 years. The main clinical manifestations were dysmenorrheal, changes of menorrhea and endometriosis nodules was between 1-6 cm,and 77 gestive stimulation. The diameter of deep were＇found to＇have more than one nodules. Seven of these patients had positive results in transvaginal ultrasonography; 61%（11/18） patients had elevated CA125 levels. Thirteen patients were given preoperational medical treatment, but had no effect. All patients,except one accepted laparotomie therapy of complete excision of endometriosis nodules; 23 cases underwent drug therapy after operation. No patients had l recurrence in recto-vaginal septum after complete excision; only one recurred in right ovary. Patients who failed to remove the total lesion showed improvement in pain. Conclusions：Diagnosis of the rectovaginal endometriosis is based On symptoms, vaginal and rectal examination,and auxiliary examination. Complete excision of endometriosis nodules is the main therapeutic method.