重度直肠子宫内膜异位症的手术治疗

Surgical Treatment of the Severe Rectum Endometriosis

目的 :探讨减少重度直肠子宫内膜异位症患者在切除直肠前壁异位病灶时出血多、肠吻合口狭窄及肠吻合口瘘等并发症发生的新术式。方法 :新术式组82例重度子宫内膜异位症病例采用直肠前壁病灶切除 ,直肠后壁剔除黏膜层 ,保留完整直肠后壁肌层 ,将直肠后壁肌层行1～2个折叠缝合 ,使肠管两断端拉近 ,最后将直肠端 -端吻合。传统术式组54例采用直肠切除及直肠套式吻合术进行对照研究。结果 :新术式手术时间缩短 ,术中出血明显减少。保留肠系膜、直肠上动脉及直肠后壁肌层 ,保证了肠吻合口血运 ;保留的直肠后壁肌层折叠缝合 ,加固了肠吻合口后壁 ,防止肠吻合口瘘的发生。术后随访两组均无肠吻合口瘘发生 ,新术式组无直肠狭窄发生 ,传统术式有3例发生轻度直肠狭窄。结论 :新术式切除直肠子宫内膜异位病变 ,操作简单 ,病灶清除广泛、彻底 ,降低了复发率 ,杜绝了肠管狭窄及肠吻合口瘘的发生。

Objective:This paper introduced a new operative method used in patients with severe rectal endometriosis for reducing bleeding,decreasing duration of surgery and postoperative complications.Method:The new surgical method was applied in82cases.The surgical proceeding included resection the lesion at rectal anterior,removal mucous membrane stratum of posterior rectum,muscle stratum of posterior rectum made1-2fold,and end-to-end rectal anastomosis.The traditional operation,which included low-anterior rectum removal and/or sleeve colocutaneous,was used in54cases as control.Results:Duration of surgery was obviˉously shorted in the new surgical operation group.Since the mesentery of sigmoid colon,the superior rectal artery and the muscle stratum of posterior rectum were retained.Proper blood supply of the two end sections of rectum was ensured.The muscle stratum of posterior rectum was folded and sutured.Thus,the posterior recˉtum wall was strengthened and the rectal anastomosis fistula was prevented.During the following-up,there was no rectal anastomosis fistula in the two groups.There was no rectal stricture in the new surgical method group.Conclusion:The novel approach could be easily applied in surgical operation,by which the lesion of severe rectal endometriosis was removed extensively and thoroughly.Furthermore,using this method,postoperative recurrence and incidence of intestinal anastoomsis fistula were reduced.