肠道子宫内膜异位症病灶分布特点及其临床意义  

Characteristics of distribution of endometriotic lesions in bowel endometriosis and the clinical significance

作　　者：梁炎春[1] 刘多[1] 黄佳明[1] 王伟[1] 韦雅婧 杨如玉 戴郁菁 程谦益 姚书忠[1] LIANG Yan-chun;LIU Duo;HUANG Jia-ming;WANG Wei;WEI Ya-jing;YANG Ru-yu;DAI Yu-jing;CHENG Qian-yi;YAO Shu-zhong(Department of Obstetrics and Gynecology,First Affiliated Hospital,Sun Yat-sen University,Guangzhou 510080,China)

机构地区：[1]中山大学附属第一医院妇产科,广东广州510080 [2]中山大学中山医学院,广东广州510089

出　　处：《中国实用妇科与产科杂志》2020年第11期1105-1109,共5页Chinese Journal of Practical Gynecology and Obstetrics

基　　金：国家自然科学基金青年科学基金(81701416);2019年广东大学生科技创新培育专项资金重点项目(pdjh2019a0004);2019年中山大学大学生创新训练计划项目(201901097);2019年中山大学青年教师培育项目(19ykpy73);2020年广东省科技创新战略专项资金(“攀登计划”专项资金)(pdjh2020b0015)。

摘　　要：目的探讨肠道子宫内膜异位症(bowel endometriosis,BE)的病灶分布特点以及BE与子宫腺肌病的共存性。方法收集2012年1月至2020年1月于中山大学附属第一医院接受手术治疗的317例BE的患者作为研究对象,记录术后病理结果中所有子宫内膜异位症病灶,分析其病理分布特点,以及与子宫腺肌病的共存性。结果术中诊断为BE的患者317例。其中,术后经病理确诊BE的患者305例,诊断符合率为96.21%(305/317)。BE经术后病理确诊的患者中,同时合并左侧宫骶韧带病灶、右侧宫骶韧带病灶和阴道病灶的概率分别为:48.85%、50.49%和45.90%;同时合并左侧卵巢子宫内膜异位囊肿115例(37.70%)、右侧卵巢子宫内膜异位囊肿114例(37.38%),同时合并双侧子宫内膜异位囊肿的患者为63例(20.66%)。进一步统计分析后发现,BE同时合并单侧和(或)双侧卵巢子宫内膜异位囊肿的概率为54.43%(166/305);BE患者同时伴输尿管受累的患者中,合并单侧和(或)双侧卵巢子宫内膜异位囊肿的概率为53.06%和54.05%。BE合并子宫腺肌病患者共135例,占所有BE患者的44.26%(135/305)。直肠子宫内膜异位症合并子宫腺肌病的患者共127例,占所有直肠子宫内膜异位症患者的44.88%(127/283)。此外,直肠子宫内膜异位症患者中,合并卵巢子宫内膜异位囊肿,无论是单侧还是双侧,都有超过40%以上的患者同时合并子宫腺肌病。结论BE往往同时合并宫骶韧带和阴道壁受累。术前检查如果发现单侧和(或)双侧卵巢子宫内膜异位囊肿,病灶同时累及肠道及输尿管的风险显著升高,合并子宫腺肌病的概率也显著升高。Objective To investigate the distribution characteristics of endometriotic lesions in patients with bowel endometriosis(BE)and reveal the coexistence of bowel endometriosis and adenomyosis.Methods Patients who were operated for BE from January 2012 to January 2020 were included in this study.All of the postoperative endometriotic lesions were recorded;their pathological characteristics were analyzed,and their coexistence with adenomyosis was also analyzed.Results There were 317 patients who were diagnosed with BE intraoperatively;305 of them were confirmed with BE by postoperative pathology,the diagnostic accordance rate being 96.2%(305/317).Within those who were pathologically confirmed with bowel endometriosis,the coexistence rates of different intraperitoneal lesions were as follows:left uterosacral ligament lesions(48.85%);the right uterosacral ligament lesions(50.49%);vagina lesions(45.90%);left ovarian endometrioma(37.70%,115/305);right ovarian endometrioma(37.38%,114/305);bilateral ovarian endometrioma(20.66%,63/305).Further analysis showed that the coexistence rate of BE with unilateral and/or bilateral ovarian endometrioma was 54.43%(166/305);in patients with endometriotic involvement of both the bowel and the ureter,the coexistence rate of unilateral and/or bilateral ovarian endometrioma"was 53.06 and 54.05%.There were 135 cases of BE with adenomyosis,accounting for 44.26%(135/305)of BE patients.There are 283 cases who were confirmed with endometriosis of the rectum,and 127(44.88%)of them were diagnosed with adenomyosis simultaneously.In addition,more than 40%of the patients with both rectal endometriosis and unilateral and/or bilateral ovarian endometrioma were diagnosed with adenomyosis.Conclusion The uterosacral ligament and the vaginal wall are often involved in BE.If preoperative examinations reveal unilateral and/or bilateral ovarian endometrioma,we should notice that there is a higher risk of coexistence of both bo wel endometriosis and ureteral endometriosis,as well as a higher risk of coexisten

关 键 词：肠道子宫内膜异位症 深部浸润型子宫内膜异位症 子宫腺肌病 诊断 病理 

分 类 号：R711.71[医药卫生—妇产科学]