Chapron C, Jacob S, Dubuisson J B, Vieira M, Liaras E, Fauconnier A
Hôpitaux de Paris (AP-HP), Service de Chirurgie Gynécologique, Clinique Universitaire Baudelocque, C.H.U. Cochin Saint Vincent de Paul, Paris, France.
Acta Obstet Gynecol Scand. 2001 Apr;80(4):349-54.
Two aims: 1) To assess the results of laparoscopically assisted vaginal management of deep endometriosis infiltrating the rectovaginal septum (RVS); 2) to pinpoint the differences between this procedure and that used for deep endometriotic lesions located on the uterosacral ligaments (USL).
Descriptive retrospective study. Twenty-nine consecutive patients operated for deep endometriosis infiltrating the RVS were included in this series.
One patient only (3.5%) presented a major complication of the recto-vaginal fistula type. After a one step reoperation under anesthesia, the post operative history was uncomplicated and no sequelae are to be deplored. With respect to dysmenorrhea (DM), deep dyspareunia (DP) and chronic pelvic pain (CPP), there was an improvement in respectively 91.7% (22 patients), 100% (24 patients) and 92.9% (13 patients) of cases. For each of these 3 symptoms the median score according to the visual analog scale was significantly lower after the operation (for DM: 7.6+/-2.0 versus 1.7+/-2.6; for DP 7.5+/-1.9 versus 0.5+/-1.1; for CPP 5.9+/-2.8 versus 1.4+/-3.2) (p<0.0001).
These results demonstrate that provided the surgeon is highly skilled in laparoscopy, operative laparoscopy is efficient for the treatment of patients presenting painful symptoms related to deep endometriotic infiltrating the RVS. From the technical point of view the rectum must be freed, leaving the deep endometriotic nodule attached to the posterior wall of the vagina. Resection of the whole lesion requires the posterior wall of the vagina to be resected, whereas ureterolysis is often unnecessary. So for lesions located on the RVS the vagina is opened systematically, unlike the situation when resecting deep endometriotic lesions infiltrating the USL. Deep pelvic endometriosis is not synonymous with endometriosis of the RVS. Lesions truly infiltrating the RVS represent only a small proportion of all deep endometriosis lesions.
两个目标：1）评估腹腔镜辅助下对浸润直肠阴道隔（RVS）的深部子宫内膜异位症进行阴道处理的结果；2）明确该手术与用于子宫骶韧带（USL）上深部子宫内膜异位症病变的手术之间的差异。
描述性回顾性研究。本系列纳入了连续29例因浸润RVS的深部子宫内膜异位症而接受手术的患者。
仅1例患者（3.5%）出现直肠阴道瘘型的主要并发症。在麻醉下进行一步再次手术后，术后病程顺利，无后遗症。关于痛经（DM）、深部性交困难（DP）和慢性盆腔疼痛（CPP），分别有91.7%（22例患者）、100%（24例患者）和92.9%（13例患者）的病例有所改善。对于这3种症状中的每一种，根据视觉模拟量表的中位评分在术后均显著降低（DM：7.6±2.0对1.7±2.6；DP：7.5±1.9对0.5±1.1；CPP：5.9±2.8对1.4±3.2）（p<0.0001）。
这些结果表明，只要外科医生具备高超的腹腔镜技术，手术腹腔镜对于治疗出现与浸润RVS的深部子宫内膜异位症相关疼痛症状的患者是有效的。从技术角度来看，必须游离直肠，使深部子宫内膜异位结节附着于阴道后壁。切除整个病变需要切除阴道后壁，而输尿管松解术通常不必要。因此，对于位于RVS的病变，与切除浸润USL的深部子宫内膜异位症病变的情况不同，通常要打开阴道。深部盆腔子宫内膜异位症并非RVS子宫内膜异位症的同义词。真正浸润RVS的病变仅占所有深部子宫内膜异位症病变的一小部分。
