节段性肠切除术治疗肠道子宫内膜异位症患者的临床疗效及生命质量分析

Clinical analysis of efficacy and quality of life of segmental bowel resection for bowel endometriosis

目的探讨节段性肠切除术治疗肠道子宫内膜异位症患者的临床疗效并分析其生命质量。方法收集2008年1月1日至2013年12月31日于中山大学附属第一医院妇产科行节段性肠切除术治疗的肠道子宫内膜异位症患者62例，所有患者分别于术前及术后至少12个月完成视觉模拟评分法（VAS）疼痛评分、健康调查简表（SF-36）生命质量评分，比较术后较术前相关症状的改善情况，并记录妊娠情况。结果62例肠道子宫内膜异位症患者的随访时间为术后12-74个月，平均随访时间为术后18．9个月。所有患者术前均有明显的疼痛症状，包括痛经、性交痛、排便痛和慢性盆腔痛，其中，痛经、性交痛、排便痛术后的VAS评分[分别为（2．9±2．2）、（0.7±0．5）、（1．6±0．7）分]均显著低于术前[分别为（7．5±2．9）、（4．3±2．2）、（7．3±1．9）分]，分别比较，差异均有统计学意义（P〈0．01）。术后SF-36评分的8个项目评分均较术前明显提高（P〈0．01）。术后发生并发症共28例（45％，28／62），分别为尿潴留18例、直肠阴道瘘4例、阴道后穹隆裂口2例，血栓形成、盆腔脓肿、弥漫性腹膜炎、肠梗阻各1例，经积极处理后均恢复良好。62例患者中合并不孕者共16例，术后有生育要求者10例，术后妊娠率为6／10，其中自然分娩2例，剖宫产分娩2例，流产1例，胚胎停止发育行清宫术1例。结论节段性肠切除术治疗肠道子宫内膜异位症可明显缓解患者的症状，改善患者的生命质量，具有良好的临床疗效。

Objective To evaluate the efficacy and quality of life of segmental bowel resection for bowel endometriosis. Methods Totally 62 symptomatic patients with bowel endometriosis undergoing segmental bowel resection were recruited. A visual analogue scale （VAS） and the 36-item short form health survey （SF-36） questionnaire were administered before and at least 1 year after surgery, respectively. Pregnancy rates were also recorded. Results Sixty-two patients in total underwent follow-up ranging from 12 to 74 months. All patients complained of obvious pain symptoms, including dysmenorrhea, dyspareunia, pain on defecation and chronic pelvic pain. The relief of dysmenorrhea （2.9 ＋ 2.2 versus 7.5-＋ 2.9）, dyspareunia （0.7 ＋0.5 versus 4.3±2.2） and pain on defecation （1.6±0.7 versus 7.3±1.9） after surgery was statistically signific, ant （all P〈0.01）. The scores for all 8 domains of the SF-36 questionnaire were significant improved after segmental bowel resection （all P〈0.01）. The complication rate was 45% （28/62）, including 18 cases of urinary retention, 4 rectovaginal fistulas, 2 cases of vaginal dehiscence, and 1 case each of thrombogenesis, pelvic abscess and general peritonitis. All of the patients with complications recovered well throughout follow-up. The postoperative pregnancy rate of the previous infertile patients was 6/10. Among the 6 gestational cases, 2 had labour, 2 underwent caesarean sections, one had a spontaneous natural abortion, and one underwent uterine curettage. Conclusion Segmental bowel resection could significantly relieve pain and improve quality of life for patients with bowel endometriosis.