膀胱及其腹膜子宫内膜异位症的诊断和处理  

The diagnosis and treatment of bladder and its peritoneal endometriosis

作　　者：曾海涛[1] 杨越波[1] 任姿[2] 闻安民[2] 李小毛[1] 

机构地区：[1]中山大学附属第三医院妇产科,广州510630 [2]广东省人民医院妇产科,广州510080

出　　处：《中华腔镜泌尿外科杂志（电子版）》2011年第4期29-31,共3页Chinese Journal of Endourology(Electronic Edition)

基　　金：国家自然科学基金青年基金(81000248;30901605);广东省自然科学基金博士启动项目(8451008901007302)

摘　　要：目的探讨盆腔子宫内膜异位症病灶在膀胱及其腹膜的发病特点以及腹腔镜用于诊断和手术治疗的注意事项。方法回顾分析了2001年1月至2010年12月中山大学附属第三医院和广东省人民医院3297例采用腹腔镜或开腹手术诊断为子宫内膜异位症患者的临床资料。结果膀胱腹膜的子宫内膜异位症的发生率为29.5%,其中红色病灶占25.7%,蓝色病灶63.2%,白色病灶占11.1%。红色病灶多存在于Ⅱ期(P<0.05),蓝色病灶多存在于Ⅱ(P<0.05)和Ⅲ期(P<0.05),白色病灶多存在于Ⅳ期(P<0.01)。蓝色病灶部位常引起膜状粘连(P<0.05),而白色病灶部位常引起紧密粘连(P<0.05)。5例紧密粘连患者在腹腔镜手术中采用单极电凝行粘连松解,因膀胱破损或可疑破损而行病变部位切除加修补术。7例膀胱子宫内膜异位症,其中5例行腹腔镜下膀胱部分切除术,术后均无复发。结论膀胱腹膜是子宫内膜异位症中后期的常见病变部位,紧密粘连是腹腔镜手术引起膀胱破损的主要因素。Objective In order to investigate the characteristics of pelvic endometriosis lesions in the bladder and its peritoneum, and the considerations of laparoscopic surgery for diagnosis and treatment. Methods The clinical data of 3297 patients with diagnosis of endometriosis by laparoscopic or open surgery in the Third Affiliated Hospital of Sun Yat-sen University and the Guangdong Provincial People＇s Hospital from January 2001 to 2010 December were analyzed retrospectively. Results The incidence of bladder peritoneal endometriosis was 29.5%, among of them, 25.7% red lesions, 63.2% blue lesions, and 11.1% white lesions. Red lesions were more present in stage Ⅱ （P〈0.05）, while blue lesions were more present in stage Ⅱ （P〈0.05） and Ⅲ （P〈0.05）, and white lesions were often present in stage Ⅳ（P〈0.01）. Membrane adhesions were often caused at the blue lesion site （P〈0.05）, while the white lesion site presented closed adhesion （P〈0.05）. There were 5 patients with damage or suspicious damage of bladder and repair when separating the closed adhesion in the laparoscopic surgery using monopolar coagulation. 7 cases of bladder endometriosis with partial cystectomy, including 5 cases by laparoscopy, patients had no recurrence. Conclusion Peritoneal bladder lesion is common phenomenon in the later phase of endometriosis, and close adhesion is main factor for the damage of bladder at laparoscopic surgery.

关 键 词：子宫内膜异位症 膀胱 腹膜 腹腔镜 

分 类 号：R711.71[医药卫生—妇产科学]