直肠子宫内膜异位症12例漏诊误诊分析

Missed diagnosis and misdiagnosis in patients with rectal endometriosis: an analysis of 12 cases

目的分析总结直肠子宫内膜异位症病人漏诊误诊的原因。方法回顾性分析哈尔滨医科大学附属第三医院结直肠外科自1980年1月至2009年12月共收治的13例直肠子宫内膜异位症病人中漏诊误诊的12例的临床资料,结合文献总结其诊治情况。结果 13例病人中术前正确诊断仅1例,正确诊断率7.7%(1/13),其余12例属漏诊误诊,其中误诊3例,误诊率23.1%(3/13)。腹痛或盆腔痛是其最常见的症状,在9例病人中出现;2例病人有经期血便。在7例行妇科检查的病人中有4例(57.1%)可触及子宫直肠窝肿物,4例行肛诊检查的病人有3例(75.0%)有阳性发现。12例病人均行开腹手术,8例行节段性肠切除,4例行单纯直肠前壁结节切除。结论直肠子宫内膜异位症术前诊断困难,正确诊断率低,影像学检查是必不可少的检查手段;手术是治疗的首选方式。

Objective To explore the reasons of missed diagnosis and misdiagnosis in patients with rectal endometriosis. Methods The clinical data of 12 cases of missed diagnosis and misdiagnosis among all 13 cases with rectal endometriosis admitted between January 1980 and December 2009 in the Department of Colorectal Surgery, the Third Hospital of Harbin Medical University were analyzed retrospectively. Results Only one （7.7%） of 13 cases was diagnosed correctly before surgery. Among other 12 cases, 3 （23.1%） cases were misdiagnosed. Abdominal or pelvic pain was the most regullar symptom, which was occurred in 9 cases. Two cases showed hematochezia during menstrual period. Four （57.1%） in 7 cases of gyneclogical examinations were touched nodules in Douglas＇ pouch. While 3 （75.0%） in 4 cases of anal examinations had positive founding. All 12 cases were received surgery including 8 cases of segment intestinal excision and 4 cases of rectal anterior wall excision only. Conclusion Rectal endometriosis is difficult to be diagnosed before operation. Imaging techniques are mandatory and surgery is the first choice for treatment.