线阵超声内镜对直肠子宫内膜异位症的诊断价值

Value of linear endoscopic ultrasonography in the diagnosis of rectal endometriosis

目的:探讨线阵超声内镜对直肠子宫内膜异位症(rectal endometriosis,RE)的诊断价值.方法:对20例子宫内膜异位症患者于外科手术前行线阵超声内镜检查直肠,超声扫描频率为7.5MHz,根据直肠壁内有无边界不规则的低回声结节或团块判断直肠是否受累,并将超声内镜检查结果与手术中所见及术后病理进行比较.结果:20例患者中有12例经线阵超声内镜检查发现直肠壁内有异位子宫内膜病灶,其余8例患者的直肠壁正常.超声内镜诊断为RE的12例患者术中均见盆腔异位子宫内膜病灶与肠壁粘连紧密,手术切除的直肠病灶送检均见子宫内膜组织.超声内镜下未见直肠受累的8例患者盆腔子宫内膜异位病灶与肠壁无粘连或轻度粘连,易分离,分离缘组织送检未见子宫内膜组织.线阵超声内镜检查结果与手术中所见及术后病理完全一致.结论:线阵超声内镜检查是诊断RE的可靠方法,可对子宫内膜异位症患者是否伴有直肠受累做出准确的术前评估.

AIM：To assess the value of linear endoscopic ultrasonography （EUS） in the diagnosis of rectal endometriosis （RE）.METHODS：Twenty patients with endometriosis were referred for linear EUS prior to the surgical intervention to evaluate the rectal involvement.RE was diagnosed by the presence of a hypoechoic nodule or mass with irregular margins in the rectal wall.Linear EUS findings were compared with the results of surgical exploration and histopathologic examination.RESULTS：Linear EUS allowed to detect endometriotic lesions in the rectal wall in 12 cases,and the rectal wall was considered normal in 8 cases.In RE cases diagnosed by linear EUS,surgical exploration showed that pelvic ectopic endometrial lesions adhered closely to the rectal wall,and the histopathologic results confirmed infiltration of the rectal wall by endometriotic lesions.For the 8 patients with no linear EUS evidence of rectal infiltration,there was mild adhesion or no adhesion between pelvic ectopic endometrial lesions and the rectal wall,and histopathologic examination showed that the rectum was not involved by endometriotic lesions.The findings of linear EUS were coincident with those of surgical exploration and histopathologic examination.CONCLUSION：Linear EUS is a reliable method for diagnosis of rectal endometriosis and can be used for accurate pre-surgical assessment of the rectal involvement in patients with endometriosis.