Marpeau O, Thomassin I, Barranger E, Detchev R, Bazot M, Daraï E
Service de Gynécologie-Obstétrique, France.
J Gynecol Obstet Biol Reprod (Paris). 2004 Nov;33(7):600-6. doi: 10.1016/s0368-2315(04)96600-8.
Colorectal endometriosis is source of chronic pelvic pain greatly affecting quality-of-life. Colorectal resection is indicated after failure of medical treatment. Few data are available on complications and functional results after laparoscopic colorectal resection for endometriosis. Therefore, the aims of this prospective study were to evaluate the feasibility, peri-operative complications and functional results of laparoscopic colorectal resection for endometriosis.
From March 2001 to March 2003, 32 consecutive women with clinically-suspected colorectal endometriosis confirmed by MR imaging and rectal endoscopic sonography were included in this prospective study.
Conversion to open surgery was required for four of the 32 women (12.5%). Mean operating time was 6 hours (range 4 to 13). Associated surgical procedures were: adhesiolysis (n=24), ureteral lysis (n=19), ovarian cystectomy (n=11), and hysterectomy (n=4). Mean blood loss was 2.4 g/dl (range: 0 to 8.6). Blood transfusion was required in 6 women including two who underwent laparoconversion. Two rectovaginal fistulae (6.3%) occurred requiring a colostomy. Urinary retention was noted in 6 women (15.6%).
Laparoscopic colorectal resection for endometriosis is feasible and is associated with a significant improvement of symptoms. However, the benefit of this procedure has to be weighed against the high morbidity.
结直肠子宫内膜异位症是慢性盆腔疼痛的根源，严重影响生活质量。药物治疗失败后需行结直肠切除术。关于腹腔镜结直肠切除术治疗子宫内膜异位症后的并发症和功能结果的资料较少。因此，本前瞻性研究的目的是评估腹腔镜结直肠切除术治疗子宫内膜异位症的可行性、围手术期并发症和功能结果。
2001年3月至2003年3月，32例经磁共振成像和直肠内镜超声检查确诊为临床疑似结直肠子宫内膜异位症的连续女性纳入本前瞻性研究。
32例患者中有4例（12.5%）需转为开腹手术。平均手术时间为6小时（范围4至13小时）。相关手术操作包括：粘连松解术（n = 24）、输尿管松解术（n = 19）、卵巢囊肿切除术（n = 11）和子宫切除术（n = 4）。平均失血量为2.4 g/dl（范围：0至8.6）。6例患者需要输血，其中2例接受了中转开腹手术。发生了2例直肠阴道瘘（6.3%），需要行结肠造口术。6例患者（15.6%）出现尿潴留。
腹腔镜结直肠切除术治疗子宫内膜异位症是可行的，且症状有显著改善。然而，该手术的益处必须与高发病率相权衡。
