子宫切除术后15年并发阴道残端子宫内膜异位症一例

子宫内膜异位症（endometriosis,EMs）是女性常见的慢性炎症性疾病,指子宫内膜的腺体和间质出现在子宫腔以外的部位,常见于卵巢、盆腔腹膜表面或其他盆腔组织。报告1例子宫肌瘤行子宫切除术后15年发生阴道残端子宫内膜异位症的病例,患者48岁,因不规则阴道出血伴腹痛3年、加重2个月就诊,全腹增强CT发现左侧髂血管旁不规则软组织,多学科会诊后拟诊断为阴道残端病变行腹腔镜探查术,根据术中所见行左侧阴道残端肿物切除术,切除组织经石蜡切片病理检查证实为阴道残端EMs。结合此病例讨论并复习相关文献,为临床上子宫切除术后出现阴道出血病例提供了诊疗思路,旨在提高临床医生对手术后并发阴道残端EMs的认识。

Endometriosis of Vaginal Stump 15 Years after Hysterectomy: A Case Report

Endometriosis (EMs) is a common chronic inflammatory disease in women that refers to the presence of glands and stroma of the endometrium outside the uterine cavity, most commonly in the ovaries, pelvic peritoneal surfaces, or other pelvic tissues. We report a 48-year-old woman who developed vaginal stump endometriosis 15 years after hysterectomy for hysteromyoma. The patient was admitted to the hospital due to irregular vaginal bleeding accompanied by abdominal pain for 3 years and aggravation for 2 months. Enhanced CT of the whole abdomen found irregular soft tissue beside the left iliac vessels. After multidisciplinary consultation, the patient was diagnosed with vaginal stump disease and underwent laparoscopic exploration. Resection of the left vaginal stump mass was performed according to the intraoperative findings, and the excised tissue was confirmed to be EMs by paraffin section pathological examination. Combined with this case, we discussed and reviewed relevant literature to provide diagnosis and treatment ideas for clinical cases of vaginal bleeding after hysterectomy, so as to improve clinicians’ understanding of postoperative vaginal stump EMs.