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[肠道子宫内膜异位症致亚急性肠梗阻。三例经验]

[Intestinal endometriosis causing subacute ileus. Experience in three cases].

作者信息

Szendei Gyórgy, Máthé Zsolt, Hernádi Zsolt, Antal Péter, Dévényi Nóra

机构信息

Semmelweis Egyetem I. sz. Szülészeti és Nógyógyászati Klinika, 1088 Budapest, Baross u. 27.

出版信息

Magy Seb. 2002 Oct;55(5):307-12.

Abstract

We present three rare cases of intestinal endometriosis. The patients were treated at the Endometriosis Clinic of the 1st Dept. of Obstetrics and Gynecology of the Semmelweis University, Budapest. Their main symptom besides the classic symptoms of endometriosis (dysmenorrhea, dyspareunia, pelvic pain) was the catamenial haematochesia--a subacute obstruction which became more intensive in the perimenstrum and needed medical treatment but no surgical intervention. Because of the recurrent complaints, after detailed check-up and biopsy of the obstructing intestinal endometriosis, anterior resection of the rectum was performed with endocoagulation or extirpation of other endometriosis implants of the pelvis. Depending on the severity of pre or postoperative complaints patients underwent a GnRH-analogue therapy for six months. In one patient because of the patient's age, and extensive retrocervical-deep endometriosis causing serious dyspareunia--the resection was performed with additional hysterectomy and adnexectomy (TAH). Recently the patient is on monophasic hormone replacement therapy. In the two other patients after a second-look laparoscopy with testing the lumen of the tubes treatment was started for the induction--because of infertility. We give an overview of the frequency, incidence and possible pathomechanism of pelvic endometriosis. We describe the modern diagnostic and therapeutic tools of pelvic endometriosis.

摘要

我们报告三例罕见的肠道子宫内膜异位症病例。这些患者在布达佩斯塞梅尔韦什大学第一妇产科子宫内膜异位症诊所接受治疗。除了子宫内膜异位症的典型症状(痛经、性交困难、盆腔疼痛)外,她们的主要症状是经期便血——一种亚急性梗阻,在月经周期期间加重,需要药物治疗但无需手术干预。由于反复出现症状,在对梗阻性肠道子宫内膜异位症进行详细检查和活检后,对直肠进行了前切除术,并对盆腔内其他子宫内膜异位症植入物进行了内凝或切除。根据术前或术后症状的严重程度,患者接受了六个月的促性腺激素释放激素类似物治疗。在一名患者中,由于患者年龄以及广泛的宫颈后深部子宫内膜异位症导致严重的性交困难,手术切除时还进行了子宫切除术和附件切除术(全子宫双附件切除术)。最近,该患者正在接受单相激素替代治疗。在另外两名患者中,由于不孕,在进行二次腹腔镜检查并检测输卵管管腔后,开始进行诱导治疗。我们概述了盆腔子宫内膜异位症的发病率、发生率和可能的发病机制。我们描述了盆腔子宫内膜异位症的现代诊断和治疗方法。

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