腹腔镜手术治疗肠道子宫内膜异位症54例临床分析  

Laparoscopic management of bowel endometriosis : a report of 54 cases

作　　者：陈淑琴[1] 金文艳[1] 姜红叶[1] 张惠民[1] 姚书忠[1] 

机构地区：[1]中山大学附属第一医院妇产科,广东广州510080

出　　处：《中国实用妇科与产科杂志》2013年第1期38-42,共5页Chinese Journal of Practical Gynecology and Obstetrics

摘　　要：目的探讨腹腔镜手术治疗肠道子宫内膜异位症(bowel endometriosis,BE)的安全性和有效性。方法回顾性分析2008年6月至2012年5月中山大学附属第一医院妇产科行腹腔镜手术治疗并经病理证实的54例BE患者的临床资料。手术治疗的有效性通过患者的疼痛视觉模拟评分(visual analog scale,VAS)和症状改善的主观感觉(完全缓解、显著缓解、无缓解、加重)进行评价,并观察术后并发症及术后妊娠情况。结果 54例BE患者中15例患者行肠道表面病灶切除术,8例患者行病灶碟形切除术,31例进行腹腔镜节段性肠管切除及吻合术。术后患者各种疼痛症状的VAS评分显著下降(P<0.05)。术后并发症13例,发生率24.1%(13/54),包括直肠阴道瘘2例、尿潴留10例、盆腔脓肿1例。在术后随访超过6个月恢复正常月经的14例不孕且有生育要求的患者中,7例患者妊娠,术后妊娠率50.0%(7/14),其中6例自然受孕(2例足月经阴道分娩、1例足月剖宫产、1例现孕30周、1例孕20周因胎膜早破难免流产、1例孕8周因胚胎停育行清宫术),1例因双侧输卵管阻塞行体外受精-胚胎移植(IVF-ET)术,于孕足月剖宫产。结论腹腔镜手术能有效缓解BE患者的相关疼痛症状,改善术后妊娠情况,是治疗BE的首选手术方式。Objective To estimate the safety and efficacy of laparoscopic management of bowel endometriosis. Methods 54 consecutive patients underwent laparoscopic surgery during June 2008 and May 2012 First Affiliated Hospital of Sun Yat-Sen University for symptomatic bowel endometriosis. A visual analogue scale （VAS） was used to assess the compo- nents of bowel endometriosis-related symptoms. Results 31 patients underwent a laparoscopic colorectal resection, 15 patients underwent superficial excision with shaving technique while the remaining 8 patients underwent rectosigmoid dis- coid resections. A signifi cant improvement （P 〈 0.05 ） was confirmed in all endometriosis-related symptoms in VAS scores. In the 14 infertile patients ,7 pregnancies occurred with a total cumulative pregnancy rate of 50. 0% （7/14）, com- prising 6 spontaneous singleton pregnancy （1 vaginal delivery, 1 cesarean section ,2 ongoing pregnancy and 2 abortion）, and one singleton pregnancy obtained by IVF-ET （cesarean section）. The total complications rate was 24. 1% （13/54）, including 2 rectovaginal fistula, 10 urinary retention, 1 pelvic abscess. Conclusion Laparoscopic treatment of severe bowel endometriosis appears to be effective with markedly relieving endometriosis-related symptoms and high rates of preg- nancy. Despite the risk of complications, this surgical approach could be exploited as primary treatment of patients with colorectal endometriosis.

关 键 词：肠道子宫内膜异位症 腹腔镜 

分 类 号：R711.71[医药卫生—妇产科学]