肠道子宫内膜异位症的临床特点及腹腔镜治疗21例分析

目的:探讨肠道子宫内膜异位症(bowel endometriosis,BE)的临床特点、诊断方法及腹腔镜手术治疗优势。方法:回顾性分析上海交通大学医学院附属仁济医院妇科肿瘤科自2014年2月—2018年1月收治的21例BE患者的临床表现、诊断方法及腹腔镜手术治疗优势及要点。结果:21例BE患者均有不同程度的肠道症状,如腹泻、便秘、排便痛等不适主诉。所有患者均接受腹腔镜手术治疗,其中7例(33.33%)行肠壁浆肌层病灶切除,14例(66.67%)行节段性肠切除吻合术。21例患者术后均无肠瘘、吻合口出血、吻合口瘘及吻合口狭窄等并发症。术后发生小肠梗阻1例(4.76%),尿潴留2例(9.52%),术后盆腔感染1例(4.76%)。术后患者痛经、性交痛、排便痛、下腹痛视觉模拟评分法(Visual Analogue Score,VAS)评分较术前均显著降低(P<0.05),腹泻、便秘等不适主诉均较术前有所缓解。结论:BE的临床表现不典型,诊断困难。腹腔镜手术能有效缓解相关疼痛症状,是首选的手术方式。

Clinical Characteristics and Laparoscopic Treatment of 21 Cases with Bowel Endometriosis

Objective：To explore the clinical manifestation, diagnosis and treatment of bowel endometriosis (BE). Methods：A total of 21 patients with BE from February 2014 to January 2018 were recruited. The clinical characters, diagnosis, treatment and outcomes of 21 cases were summarized and analyzed. Results：The intestinal manifestation in 21 patients included diarrhea, constipation, defecation pain, and so on. Seven patients (33.33%) underwent the laparoscopic superficial excision while the remaining 14 patients (66.67%) underwent the laparoscopic colorectal resection. There were no operative complications of intestinal fistulas, anastomotic bleeding, anastomotic fistulas and anastomotic stenosis. The other complications included small-bowel obstruction (1 case, 4.76%), urinary retentions (2 cases, 9.52%) and pelvic infection (1 case, 4.76%). The scores of visual analogue score (VAS) of dysmenorrheal, dyspareunia, defecation pain and hypogastralgia were significantly lowered (P＜0.05). The intestinal symptoms, such as diarrhea and constipation, were remitted. Conclusions：The clinical manifestation of BE is not typical, so the diagnosis of BE is difficult. Laparoscopic treatment of BE can effectively remitted the endometriosis-related symptoms, suggesting that the laparoscopy is the first choice of surgical treatment.