摘要
目的:探讨直肠阴道隔子宫内膜异位症(EMT)的临床特征及腹腔镜对其的诊治价值。方法:回顾分析6年内经腹腔镜手术病理检查证实的直肠阴道隔EMT11例的临床资料。结果:11例直肠阴道隔EMT患者中9例有痛经,6例有肠道症状。病灶位于直肠阴道隔内,直径10～70mm,实性、质硬、界限不清、活动度差、有明显触痛。术前经阴道活检病理检查确诊2例,高度疑诊7例,误诊2例。11例均经腹腔镜手术确诊而行EMT病灶切除术,7例术前、9例术后辅以激素治疗。平均随访44.7个月,11例症状均缓解;1例卵巢EMT复发;1例原发不孕术后妊娠。手术前后生活质量评分、疼痛评分比较,差异均有统计学意义(P<0.05)。术中直肠浆肌层损伤3例,术后2例发热,1例直肠阴道瘘,1例大便不成形。结论:直肠阴道隔EMT以各种盆腔痛及肠道症状为主;病灶位于直肠阴道隔内,有明显的触痛。术前结合病史、妇科检查及辅助检查可能诊断。腹腔镜手术有助于直肠阴道隔EMT的确诊,并能够较完整切除病灶;于术前后辅以激素治疗,能取得较好的疗效。
Objective：To evaluate the clinical characteristics of rectovaginal septum endometriosis（EMT） and the value of laparoscopy for its diagnosis and treatment. Methods：The clinical data of 11 rectovaginal septum EMT patients who were treated with laparoscope and confirmed by histology in past 6 years were ret- rospectively analyzed. Results ：9 patients presented with dysmenorrhea and 6 cases presented with bowel symptoms. The lesions with obvious tenderness located in the rectovaginal septum, ranging from 10 to 70 mm in diameter,solid, hard, and unmoved. Preoperative diagnosis of 2 cases depended on the vaginal biopsy and 7 cases were highly suspected diagnosis, as well as 2 cases were misdiagnosed. All cases were confirmed by laparoscopy and underwent laparoscopic resection of EMT lesion,of which 7 and 9 patients were underwent preoperative and postoperative hormonotherapy, respectively. During the followed-up, 11 cases（100%） a- chieved symptom remission, and 1 case got recurrence of ovarian EMT cyst. 1 infertile case got pregnany 6 months later. Significant differences in the quality of life scores and the visual analogue scale were observed before surgery to after surgery（ P 〈0.05）. The rectal seromuscular layer was injured in 3 cases in surgery, and postoperative fever was observed in 2 cases, and rectovaginal leakage and the stool shapeless was ob- served in 1 case, respectively. Conclusions：Rectovaginal septum EMT clinically presented with various pelvic pain and bowel symptoms, the lesions located in the rectovaginal septum with tenderness. Preoperative diag- nosis depends on the meaical history,gynecological examination and laboratory examinations. Laparoscopic surgery can remove all visible lesions, and postoperative hormonotherapy has some values in improvement of the postoperative prognosis.
出处
《实用妇产科杂志》
CAS
CSCD
北大核心
2013年第3期214-217,共4页
Journal of Practical Obstetrics and Gynecology
