Fleisch Markus C, Xafis Dimitris, De Bruyne Filip, Hucke Juergen, Bender Hans Georg, Dall Peter
Department of Obstetrics and Gynecology, Heinrich-Heine-University, Moorenstr. 5, D-40225 Duesseldorf, Germany.
Eur J Obstet Gynecol Reprod Biol. 2005 Dec 1;123(2):224-9. doi: 10.1016/j.ejogrb.2005.04.007. Epub 2005 Aug 15.
With the present study we wanted to evaluate the effect of a radical resection of bowel and bladder endometriosis with respect to relief of pain symptoms and long-term effects.
Retrospectively we analyzed 23 patients undergoing bowel or bladder resection for infiltrating endometriosis between 1995 and 2004. Chart review was performed and data were analyzed with respect to pain symptoms, fertility, type of surgery, operative morbidity and mortality. At 1, 3 and 5 years of follow-up patients were asked to evaluate their symptoms based on a visual analogue pain scale (0: no pain, 10: most severe pain). Results were compared using the Student's t-test.
Leading symptoms were chronic pelvic pain (17/23, 73.9%), dysmenorrhea (11/23, 47.8%), dyspareunia (6/23, 26.1%), infertility (4/23, 17.4%) and dyschezia (4/23, 17.4%). Three patients (13%) had abdominal hysterectomy, 5 (21.7%) LSO (n = 2) or BSO (n = 3), 18 (78.3%) anterior rectal resection, 4 (17.4%) sigmoid resection, 2 (8.6%) segmental bladder resection and one patient (4.3%) cecal resection. Major complications requiring re-operation occurred in three patients (2x postoperative bleeding, 1x anastomosis break-down). During follow-up (mean 40.5 months) 21 of the 23 patients (91.3%) had a persistent improvement of symptoms, 8 of the 23 (34.8%) had recurrent symptoms with a mean symptom-free interval of 40.4 months after surgery (24-60 months). No patient developed dyspareunia or dyschezia during follow-up. Overall cure rate was 73.9%. Four patients became pregnant (23%). Average pain scores increased during follow-up period but still remained significantly below the initial score (p < 0.001).
Radical surgery for deep endometriosis with bowel or bladder involvement leads to a reliable and persistent relief of pain symptoms. Especially deep dyspareunia and dyschezia might be eliminated by this procedure.
通过本研究，我们旨在评估肠道和膀胱子宫内膜异位症根治性切除术对缓解疼痛症状及长期效果的影响。
我们回顾性分析了1995年至2004年间因浸润性子宫内膜异位症接受肠道或膀胱切除术的23例患者。进行病历审查，并就疼痛症状、生育能力、手术类型、手术发病率和死亡率进行数据分析。在随访1年、3年和5年时，要求患者根据视觉模拟疼痛量表（0：无疼痛，10：最严重疼痛）评估其症状。使用学生t检验比较结果。
主要症状为慢性盆腔疼痛（17/23，73.9%）、痛经（11/23，47.8%）、性交困难（6/23，26.1%）、不孕（4/23，17.4%）和排便困难（4/23，17.4%）。3例患者（13%）接受了腹式子宫切除术，5例（21.7%）接受了腹腔镜下全子宫及双侧附件切除术（LSO，n = 2）或双侧附件切除术（BSO，n = 3），18例（78.3%）接受了直肠前切除术，4例（17.4%）接受了乙状结肠切除术，2例（8.6%）接受了膀胱部分切除术，1例患者（4.3%）接受了盲肠切除术。3例患者（2例术后出血，1例吻合口破裂）发生了需要再次手术的严重并发症。在随访期间（平均40.5个月），23例患者中有21例（91.3%）症状持续改善，23例中有8例（34.8%）出现复发症状，术后平均无症状间隔为40.4个月（24 - 60个月）。随访期间无患者出现性交困难或排便困难。总体治愈率为73.9%。4例患者怀孕（23%）。随访期间平均疼痛评分有所增加，但仍显著低于初始评分（p < 0.001）。
对于累及肠道或膀胱的深部子宫内膜异位症，根治性手术可可靠且持久地缓解疼痛症状。尤其是深部性交困难和排便困难可能通过该手术消除。
