Godlewski G, Rouanet J P, Mares P, Maubon A, Louis J F, Delbos O
Département de Chirurgie Digestive, C.H.R.U. de Nîmes, Hôpital Caremeau.
J Chir (Paris). 1991 Oct;128(10):409-14.
Seven cases of pelvic endometriosis of the urinary or digestive tracts are reported: 4 cases of vesical endometriosis, 1 case of ureteral involvement, 1 rectal case and 1 sigmoid location. The authors point out the difficulty of the clinical preoperative diagnosis--in despite of cyclic troubles--and underline the interest of complementary explorations performed at the time of periods: ultrasound, cystoscopy, rectosigmoïdoscopy and coelioscopy. The MR imaging, showing high intensity a T1-weighted images and prominent high intensity on T2-weighted images, is very suggestive of an endometrial lesions. A joint medical and surgical treatment is required. Endoscopic excision, endoprothetic tube, excision-suture, resection-anastomosis and a complementary medical treatment using Danazol, Decapeptyl or progestational agents have to be proposed. Per-operative microscopy is advised as routine procedure in order to avoid excessive surgery.
本文报告了7例发生于泌尿生殖道的盆腔子宫内膜异位症病例：4例膀胱子宫内膜异位症，1例输尿管受累，1例直肠及1例乙状结肠部位的病例。作者指出尽管存在周期性症状，但临床术前诊断仍存在困难，并强调了在经期进行辅助检查的重要性：超声、膀胱镜检查、直肠乙状结肠镜检查及腹腔镜检查。磁共振成像显示在T1加权像上呈高强度信号，在T2加权像上呈明显高强度信号，强烈提示为子宫内膜病变。需要联合药物和手术治疗。建议采用内镜切除、内置假体管、切除缝合、切除吻合术，并辅以使用达那唑、戈舍瑞林或孕激素类药物的药物治疗。建议术中常规进行显微镜检查以避免过度手术。
