肠道子宫内膜异位症诊断及治疗

Diagnosis and treatment of bowel endometriosis

肠道子宫内膜异位症是指子宫内膜异位症病灶侵入或生长于部分或全部肠壁的浆肌层,主要表现是痛经、性交痛、排便痛。肠道子宫内膜异位症可以位于整个消化道的许多部位,但以乙状结肠和直肠交界处最常见。直肠气钡双重造影、经阴道超声、直肠内镜超声、磁共振成像(MRI)、多层螺旋CT等有助于明确诊断。药物治疗可以暂时控制症状,但不能使患者长期获益。根治性子宫内膜异位症病灶切除,包括肠道子宫内膜异位症病灶切除,是治疗肠道子宫内膜异位症的有效方法。肠道子宫内膜异位结节切除方法有表面病灶切除术,病灶碟形切除术和肠管节段性切除吻合术。尽管手术切除肠道子宫内膜异位症病灶还存在争议,但是越来越多的研究显示创伤性的手术改善了肠道子宫内膜异位症患者的症状及生存质量,增加了患者受孕机会。

Bowel endometriosis, defined as endometri- otic lesions infiltrating or growing in partial or entire bowel wall, is characterized by dysmenorrhea, dyspa- reunia and pain during defecation. The whole gastro- intestinal tract, but most commonly the rectosigmoid junction,can be involved. Double air-barium contrast examination of the rectum, transvaginal ultrasound, transrectal ultrasound, magnetic resonance imaging （MRI） and multislice spiral computed tomography enteroclysis could help to diagnose the disease. Med- ication can have transient control of the clinical symptoms, but without long-term benefit. Radical resection of the endometriotic lesions, including resec- tion of those infiltrating the bowel, is an effective treatment for bowel endometriosis. Surgical tech- niques to remove the bowel endometriotic nodules in- clude shaving resection, discoid resection, and seg- mental bowel resection plus anastomosis. Although the indications for surgical resection of bowel endom- etriotic foci are controversial,an increasing number of researches have demonstrated postoperative improve- ment of clinical symptoms and quality of life, and in- creased conception rate.