Keckstein J, Ulrich U, Kandolf O, Wiesinger H, Wustlich M
Abteilung für Gynäkologie und Geburtshilfe, Landeskrankenhaus Villach, Kärnten.
Zentralbl Gynakol. 2003 Jul-Aug;125(7-8):259-66. doi: 10.1055/s-2003-42281.
Patients with severe endometriosis involving the rectovaginal septum and bowel makes surgery necessary. The laparoscopic approach offers the possibility to perform the complete resection with minimal invasive techniques. Small lesions can be removed by full-thickness-resection. Large nodules make a segmental resection necessary. Deep lesions are resected with stapling devices. Nodules in the sigmoid ore removed by laparoscopic assisted hand-sewn anastomosis.
Between 3/96 and 7/03 142 patients with severe endometriosis involving the bowel have been treated laparoscopically. The pre-operative complains have been reduced as following: dyschezio: 88%, dyspareunia 87%, chronic pelvic pain 96%, disturbance of sexuality 75%. The complication rate was minimal: leakage of the anastomosis n=4 (2.8%), paraproctial abscess 2 (1.4%), blood transfusion 1 (0,7 %), severe stenosis of the anastomosis 6 (4.2%).
Laparoscopic approach is a safe and effective technique to treat deep infiltrating endometriosis with bowel involvement. The hormonal treatment of bowel endometriosis is used in patients with minimal symptoms. The postoperative treatment becomes necessary in incomplete operations or in patients with severe adenomyosis and infertility.
患有累及直肠阴道隔和肠道的重度子宫内膜异位症的患者需要进行手术。腹腔镜手术方法提供了使用微创技术进行完整切除的可能性。小病灶可通过全层切除去除。大结节则需要进行节段性切除。深部病灶用吻合器切除。乙状结肠中的结节通过腹腔镜辅助手工缝合吻合术切除。
在1996年3月至2003年7月期间，142例患有累及肠道的重度子宫内膜异位症的患者接受了腹腔镜治疗。术前症状减轻情况如下：排便困难：88%，性交困难87%，慢性盆腔疼痛96%，性功能障碍75%。并发症发生率极低：吻合口漏4例（2.8%），直肠旁脓肿2例（1.4%），输血1例（0.7%），吻合口严重狭窄6例（4.2%）。
腹腔镜手术方法是治疗累及肠道的深部浸润性子宫内膜异位症的一种安全有效的技术。肠道子宫内膜异位症的激素治疗用于症状轻微的患者。在手术不完整或患有重度子宫腺肌病及不孕症的患者中，术后治疗是必要的。
