肠道子宫内膜异位症的临床特点及腹腔镜治疗21例分析

Clinical Characteristics and Laparoscopic Treatment of 21 Cases with Bowel Endometriosis

目的:探讨肠道子宫内膜异位症(bowel endometriosis,BE)的临床特点、诊断方法及腹腔镜手术治疗优势。方法:回顾性分析上海交通大学医学院附属仁济医院妇科肿瘤科自2014年2月—2018年1月收治的21例BE患者的临床表现、诊断方法及腹腔镜手术治疗优势及要点。结果:21例BE患者均有不同程度的肠道症状,如腹泻、便秘、排便痛等不适主诉。所有患者均接受腹腔镜手术治疗,其中7例(33.33%)行肠壁浆肌层病灶切除,14例(66.67%)行节段性肠切除吻合术。21例患者术后均无肠瘘、吻合口出血、吻合口瘘及吻合口狭窄等并发症。术后发生小肠梗阻1例(4.76%),尿潴留2例(9.52%),术后盆腔感染1例(4.76%)。术后患者痛经、性交痛、排便痛、下腹痛视觉模拟评分法(Visual Analogue Score,VAS)评分较术前均显著降低(P<0.05),腹泻、便秘等不适主诉均较术前有所缓解。结论:BE的临床表现不典型,诊断困难。腹腔镜手术能有效缓解相关疼痛症状,是首选的手术方式。

Objective:To explore the clinical manifestation,diagnosis and treatment of bowel endometriosis (BE).Methods:A total of 21 patients with BE from February 2014 to January 2018 were recruited.The clinical characters,diagnosis,treatment and outcomes of 21 cases were summarized and analyzed.Results:The intestinal manifestation in 21 patients included diarrhea,constipation,defecation pain,and so on.Seven patients (33.33%) underwent the laparoscopic superficial excision while the remaining 14 patients (66.67%) underwent the laparoscopic colorectal resection.There were no operative complications of intestinal fistulas,anastomotic bleeding,anastomotic fistulas and anastomotic stenosis.The other complications included small-bowel obstruction (1 case,4.76%),urinary retentions (2 cases,9.52%) and pelvic infection (1 case,4.76%).The scores of visual analogue score (VAS) of dysmenorrheal,dyspareunia,defecation pain and hypogastralgia were significantly lowered (P<0.05).The intestinal symptoms,such as diarrhea and constipation,were remitted.Conclusions:The clinical manifestation of BE is not typical,so the diagnosis of BE is difficult.Laparoscopic treatment of BE can effectively remitted the endometriosis-related symptoms,suggesting that the laparoscopy is the first choice of surgical treatment.