腹腔镜手术治疗直肠阴道隔子宫内膜异位症

Laparoscopic Treatment of Retrovaginal Septum Endometriosis

目的评价腹腔镜手术治疗直肠阴道隔子宫内膜异位症（EMs）的可行性和有效性。方法回顾性分析1995年5月至2010年12月17例于北京大学第一医院妇产科行手术治疗并经组织病理学检查证实为直肠阴道隔EMs患者的临床资料。其中5例行开腹或阴式直肠阴道隔EMs病灶切除术，纳入开腹／阴式组；12例行腹腔镜EMs病灶切除术，纳入腹腔镜组（本研究遵循的程序符合本院人体试验委员会制定的伦理学标准）。结果开腹／阴式组手术时间为（25～276）min，平均为105min；术中出血量为（50～2000）mL，平均为464mL。术后，4例患者盆腔痛症状改善显著，1例合并直肠刺激症状患者术后症状部分改善，1例术后6个月性交痛症状复发。腹腔镜组手术时间为（70～360）min，平均为188min；术中出血量为（20～1500）mL，平均为253mL。术后，1例发生直肠浆肌层损伤并发症；8例患者盆腔痛症状改善显著；2例部分改善；4例合并直肠刺激症状患者术后症状部分改善；1例不孕患者术后9个月时妊娠。结论腹腔镜切除直肠阴道隔EMs病灶可有效缓解疼痛症状，手术应由有经验的医师完成，治疗安全性和远期有效性尚需扩大样本量进一步评价。

Objective To evaluate the feasibility and efficacy of laparoscopic excision of retrovaginal septum endometriosis. Methods A total of seventeen cases with retrovaginal septum endometriosis were included in this retrospective study between May 1995 and December 2010. Five cases were received abdominal or vaginal operations（abdominal/vaginal group） and twelve cases were received laparoscopic operations（ laparoscopie group）. The study protocol was approved by the Ethical Review Board of Investigation in Human Being of Peking University First Hospital. Informed consent was obtained from all participants. Results In the abdominal/vaginal surgery group, the mean operation time was 105 min （25 min to 276 rain）, and the mean blood loss volume was 464 mL （50 mL to 2000 mL）. After operation, the pelvic pain was relieved in 4 cases, the sexual intercourse pain recurred in 1 case, rectal irritation symptom was partly relieved in lcase. Whereas, in laparoscopy group, the mean operation time was 188 min （70 min to 360 rain）, and the mean blood loss volume was 153 mL （20 mL to 1500 mL）. Rectal muscular injury happened in one case. After operation, the pelvic pain was relieved in 8 cases （partly relieved in 2 cases）, the rectal irritation symptom was partly relieved in 4 cases. A successful pregnancy after the nine months of trying the operation. Conclusion Laparoscopic excision of retrovaginal septum endometriosis was feasible and can effectively relieve pain symptom. However, large randomized controlled studies would be required to validate this approach.