深部浸润型子宫内膜异位症的综合治疗:17例临床经验

A Clinical Analysis of Comprehensive Treatment of Deep Infiltrating Endometriosis: Report of 17 Cases

目的探讨深部浸润型子宫内膜异位症(deep infiltrating endometriosis,DIE)的手术经验以及术后管理。方法回顾性分析2016年7月～2018年6月17例DIE资料,均经腹腔镜手术切除DIE病灶,术后按照中华医学会指南管理。结果 17例中,输尿管被DIE浸润组织包裹6例,无输尿管壁浸润; DIE累及骶韧带11例;累及直肠壁7例,其中5例行肠壁病灶剔除术,1例行浸润肠壁部分切除术,1例行部分直肠切除;累及乙状结肠壁1例;累及阴道壁3例;累及膀胱壁1例。均顺利完成DIE病灶切除,2例40岁以上、无生育要求者行全子宫切除。11例合并卵巢子宫内膜异位囊肿者行囊肿剥除术。总手术时间50～295 min,(113. 7±67. 0) min,无并发症发生。术后病理均证实为子宫内膜异位症。术后中位随访时间6个月(2～25个月),主诉症状均缓解,未发现复发。结论 DIE初次手术需尽量将病灶切尽,术后需规范的管理预防复发。

Objective To explore the surgical experience and postoperative management of deep infiltrating endometriosis （DIE）. Methods A retrospective analysis was applied to summarize the clinical data of 17 cases of DIE, which admitted to our hospital from July 2016 to June 2018. All the patients underwent laparoseopie surgery for DIE lesions and were managed according to the guidelines. Results Of the 17 cases, the ureter was wrapped by DIE lesions in 6 cases without ureteral wall infiltration. The DIE infiltrated sacral ligament in 11 cases, infiltrated rectal wall in 7 cases （5 of which underwent intestinal wall lesion shaving, 1 of which underwent partial resection of infiltrating intestinal wall, and 1 of which underwent partial rectal resection） , infiltrated sigmoid colon in 1 case, vaginal wall in 3 cases, and bladder wall in 1 case. All the DIE lesions were successfully reseeted. Two patients over 40 years old without fertility requirements underwent hysterectomy. And 11 cases combined with ovarian endometriosis cyst underwent cysteetomy. The total operation time was 50 - 295 rain （ mean, 113. 7±67. 0 min）. No complications occurred. Postoperative pathology confirmed endometriosis. The median follow-up time was 6 months （ range, 2 - 25 months）. The postoperative symptom relief rate was 100%. No recurrence was found. Conclusions For initial operation of DIE, the lesion should be removed completely. Regular management should be taken postoperatively to prevent recurrence.