子宫内膜异位症淋巴结转移3例病例报道并文献复习  

Retrospectively analysing of lymph node involvement in endometriosis and literature review

作　　者：冯宗昊 刘林枝[1] 张岩[1] Feng Zonghao;Liu Linzhi;Zhang Yan.(Department of Obstetrics and Gynecology, the Peking University First Hospital, Beijing 100034)

机构地区：[1]北京大学第一医院妇产科,北京100034

出　　处：《现代妇产科进展》2018年第3期186-190,共5页Progress in Obstetrics and Gynecology

摘　　要：目的:探讨子宫内膜异位症(EMs)淋巴结转移的临床特点及相关机制。方法:回顾分析2012年5月至2015年9月北京大学第一医院收治的2例结直肠EMs及1例输尿管EMs伴淋巴结转移病例,结合相关文献,分析其病因及临床特点。结果:1例患者因腹腔播散性腺肌瘤累及肠道,行肿物、小肠及右半结肠切除术,结肠周淋巴结内可见子宫内膜异位。1例患者因深部浸润型EMs行手术治疗,术中见病变累及直肠,切除直肠,术后病理示EMs,肠周淋巴结可见异位子宫内膜。1例患者因右肾积水、右输尿管肿物行右输尿管镜检查,后行开腹右输尿管局部切除+右输尿管膀胱瓣吻合术,术后病理示髂内淋巴结可见子宫内膜异位。结论:EMs淋巴结转移发病率可能被低估,临床表现无特异性。术中对于区域淋巴结的切除及术后药物辅助治疗可减少疾病复发。对于EMs淋巴结转移的发病机制尚不明确,仍需进一步研究。Objective：To discuss the clinical characteristics and pathogenesis of lymph node involvement in endometriosis.Methods：Retrospectively analysing cases of lymph node involvement in deep infiltrating rectosigmoid endometriosis and ureteric endometriosis in Peking University First Hospital from May 2012 to Sep.2015.Combining reports about this disease in international and domestic,retrospectively analyzing the clinical characteristics and pathogenesis of lymph node involvement in endometriosis. Result：From 2012 to 2015,there were 2 cases of lymph node involvement in deep infiltrating rectosigmoid and 1 case in ureteric endometriosis in Peking University First Hospital.One case was characterized by abdominal mass.In the operation find lesions infiltrating the intestines.The histology of the removed specimen revealed the intraperitoneal dissemination of adenomyoma,involving of the small intestine and right-side colon,finding the lymph node involvement by endometriotic foci.The operation of another case was due to deep infiltrating rectosigmoid endometriosis.The histology of the removed rectum revealed the involvement of the endometriosis,finding the lymph node involvement by endometriotic foci too.The ureteric endometriosis case was characterized by uronephrosis and mass surrounding the ureter.The histology of partial ureter and the iliac lymph nodes revealed the involvement of the endometriosis. Conclusion：The morbidity of lymph node involvement in endometriosis without specific symptoms and signs may be underestimated.The surgery of excision the lesions and regional lymph nodes associated with post-operative hormone therapy can reduce the risk of recurrence.More and more subsequent studies need to verify the pathogenesis of this disease.

关 键 词：子宫内膜异位症 淋巴结转移 前哨淋巴结 结直肠子宫内膜异位症 输尿管子宫内膜异位症 

分 类 号：R711.71[医药卫生—妇产科学]