深部浸润型子宫内膜异位症复发处理

Treatment for recurrent deeply infiltrating endometriosis

复发是子宫内膜异位症(endometriosis,EM,内异症)临床诊治中常见、难以处理、需管理的一项重要问题。深部浸润型内异症(deeply infiltrating endometriosis,DIE)经彻底切除后很少复发,前次手术残留的病灶被认为是复发的主要原因。复发的患者盆腔粘连严重、病灶侵入深,手术并发症多,为再次手术增加了极大的难度,对于术者的技术水平要求则更高。因此,二次手术必须基于细致的风险、收益评估方可实施。加强术前及术后各个环节治疗方案的评估,强调有计划的终身管理。

Recurrence is an important,common issue,and is difficult to handle in the diagnosis and treatment of endometriosis.Deeply infiltrating endometriosis has low recurrence rate,and residual lesions of previous surgery is considered to be the main reason of recurrence.Recurrent patients have massive adhesions,deeply focal invasion,increased surgical complications and difficulty for surgery,and could be technically demanding.A second surgery must be based on a detailed risk-benefit evaluation before implementation.Preoperative and postoperative evaluation and drug treatment should be stressed,and systematic management should be emphasized.