复发性子宫内膜异位症再手术11例临床分析

目的 探讨子宫内膜异位症术后复发再手术的可行性，再手术治疗的适应证、手术方法和减少术后复发的措施。方法 选择2001年1月1日～2006年6月30日收治的11例子宫内膜异位症患者术后复发再手术的病例，分析复发原因，再手术方式、术后用药情况、术后随访情况。结果 11例患者均进行了二次手术，7例为腹腔镜手术，其中1例中转开腹；4例开腹手术。11例手术中分离粘连中肠管损伤1例进行修补，肠管浆肌层异位病灶切除并缝合3例，输尿管病灶切除并膀胱植入1例，膀胱异位病灶切除修补1例，经阴道腹部联合切除后穹隆异位灶2例。结论 第1次手术的彻底性以及术后的正规用药是减少复发的因素。二次手术应慎重选择手术途径与方式，充分做好术前准备，二次手术应该进行病灶的减灭术，术后正规用药可防止再复发。

Analysis of second operation for recurrent endometriosis in 11 cases

Objective To investigate the feasibility of second operation in patients with recurrent endometrosis,the indication and method of second operation,and how to reduce the possibility of endometrosis recurrence after sugery.Methods Eleven cases of recurrent endometriosis for second operation were reviewed in our hospital.The causes of recurrence,the surgical procedures,the postoperative medical treatment as well as the follow-up information were analyzed.Results All patients underwent second operation.7 patients were laparoscopy(1 case turned to be laparotomy during operation).Intestinal damage was found in one case.Endometriosis lesions were found on intestinal serous membrane and removed in 3 cases.Endometriosis lesion was also found on ureter and bladder in 1 case.Conclusions Endometriosis is a benign but troublesome gynaecological condition because of its high risk of recurrence.An extensive first surgery and proper medical postoperative treatment are difficult to reduce the recurrent rate.To perform a second operation for recurrent endometriosis,surgical procedures should be determined with caution,and sufficient pre-operative preparation is demanded.A radical second surgery with regular postoperative medical treatment is the key point to prevent recurrence.