直结肠子宫内膜异位症超声声像图特征及临床病例分析  

Ultrasonographic and clinical features of rectosigmoid endometriosis

作　　者：刘勤[1] 汪龙霞[1] 罗渝昆[1] 王艳秋[1] 王岳 LIU Qin;WANG Longxia;LUO Yukun;WANG Yanqiu;WANG Yue(Department of Ultrasound;Department of Gynaecology and Obstetrics Chinese PLA General Hospital,Beijing 100853,China)

机构地区：[1]解放军总医院超声科,北京100853 [2]解放军总医院妇产科,北京100853

出　　处：《解放军医学院学报》2018年第9期772-774,786,共4页Academic Journal of Chinese PLA Medical School

摘　　要：目的总结直结肠壁子宫内膜异位症诊断经验,提高临床诊断水平。方法回顾性分析2010年1月-2017年12月在本院超声科疑诊直结肠子宫内膜异位症并经手术病理证实的13例患者影像学资料及临床资料。结果 13例年龄26~47(38±7)岁,累及肌层11例,累及黏膜层1例,累及浆膜层1例;3例行直肠壁病灶部分切除,9例行病灶节段直肠前切除术,1例术中未处理病灶。13例行肛诊均能触及肠壁僵硬,累及黏膜层的患者肛诊示黏膜面不光滑;超声诊断11例,漏诊2例;5例行核磁共振检查(MRI),诊断4例,漏诊1例。典型的声像图特征为子宫宫颈后方、直结肠壁可见增厚,呈低回声改变,扁平、匍匐走行,病灶或增厚节段的肠壁可呈"C"形改变,部分病灶呈锥形改变,锥底与该节段直结肠前方组织粘连,锥尖指向肠腔;彩色多普勒超声显示病灶几乎不能探及到血流信号。结论直结肠内膜异位症有较典型的声像图特征,主要表现为直结肠壁不规则增厚,当患者出现周期性里急后重感或肛门疼痛时,需要警惕结直肠内膜异位症的存在。Objective To summarize the clinical characteristics and diagnosis of rectosigmoid endometriosis and improve clinical practice. Methods Imaging and clinical data about 13 patients with suspected colorectal endometriosis who were confirmed as rectosigmoid endometriosis by postoperative pathology in the department of ultrasound of Chinese PLA General Hospital from January 2010 to December 2017 were retrospectively analyzed. Results Of the 13 patients with average age of（38±7） years old（ranging from 26 to 47 years）, the muscular layer was involved in 11 cases, rectal serosa layer in 1 case, and mucosal layer in 1 case; 3 cases received partial resection of the rectal wall lesions, 9 cases underwent resectorial anterior resection of the lesion, while 1 patient had no intraoperative treatment. The intestinal wall of all patients were stiffness by rectal examination, and one patient with mucosal layer involvement demonstrated firmness on mucosal surface. Eleven cases were diagnosed by ultrasound, 2 cases were missed diagnosis; 5 cases were examed with MRI, and 4 cases were diagnosed, 1 case was missed diagnosis. The typical sonographic features were thickened rectosigmoid wall, lesions manifested as hypoechogenic nodules with obtuse margins that were attached to the intestinal wall, C-shaped segment of the colon and extrinsic compression of the bowel. In the axial plane, rectal lesions showed a typical pyramidal shape, with the base adhering to the anterior rectal wall and the apex oriented toward the retrocervical space. Color Doppler ultrasound showed that blood flow signals were hardly to be detected in the lesions. Conclusion Rectosigmoid endometriosis has typical sonographic feature, mainly characterized by irregular thickening of the rectal wall. When the patient has periodic irritability or rectal pain, it needs to be alert to the presence of rectosigmoid endometriosis.

关 键 词：肠道子宫内膜异位症 深部浸润性子宫内膜异位症 超声诊断 

分 类 号：R711.71[医药卫生—妇产科学]