De Nardi Paola, Osman Nadine, Ferrari Stefano, Carlucci Michele, Persico Paola, Staudacher Carlo
Department of Surgery, Scientific Institute S. Raffaele Hospital, Vita-Salute University San Raffaele, Milan, Italy.
Dis Colon Rectum. 2009 Mar;52(3):419-24. doi: 10.1007/DCR.0b013e318197d716.
Our study aimed to evaluate the feasibility and outcome of laparoscopic excision of deep pelvic endometriosis with extensive rectal involvement causing severe symptoms.
Ten patients, mean age 32 years (range, 27-43), with deep pelvic endometriosis and rectal wall involvement, requiring surgical resection, were studied since January 2004. Prior to surgery and 6 months postsurgery, patients completed a 100-point rank questionnaire on intensity of intestinal and extraintestinal symptoms. A laparoscopic approach was performed by a team of a gynecologist and colorectal surgeons.
At surgery, complete excision of infiltrating endometriosis was achieved, with 7 low rectal resections, 2 rectosigmoid resections, and 1 proctectomy with coloanal anastomosis. Additional procedures were: ureter resections (n = 2) with one reimplantation in the bladder, left ovariectomies (n = 2), ovarian endometrioma resections (n = 4), and laser ablation of superficial peritoneal lesions (n = 4). In four cases, a laparotomic conversion was needed. Mean follow-up was 27.6 months (range, 18-37). Neither intraoperative nor postoperative serious complications were observed. All the patients experienced significant improvement of intestinal and extraintestinal symptoms.
Laparoscopic resection of deep pelvic endometriosis with rectal involvement can be successful in improving digestive and gynecologic symptoms; however, this approach is challenging with a high rate of laparotomic conversion.
我们的研究旨在评估腹腔镜切除伴有广泛直肠受累并引起严重症状的深部盆腔子宫内膜异位症的可行性及治疗结果。
自2004年1月起，对10例平均年龄32岁（范围27 - 43岁）、患有深部盆腔子宫内膜异位症且直肠壁受累、需要手术切除的患者进行了研究。在手术前及术后6个月，患者完成了一份关于肠道和肠道外症状强度的100分等级问卷。由一名妇科医生和一名结直肠外科医生组成的团队实施腹腔镜手术。
手术中，浸润性子宫内膜异位症实现了完全切除，其中7例行低位直肠切除术，2例行直肠乙状结肠切除术，1例行直肠切除术并结肠肛管吻合术。额外的手术操作包括：输尿管切除术（n = 2），其中1例输尿管重新植入膀胱，左侧卵巢切除术（n = 2），卵巢子宫内膜瘤切除术（n = 4），以及浅表腹膜病变激光消融术（n = 4）。4例患者需要转为开腹手术。平均随访时间为27.6个月（范围18 - 37个月）。未观察到术中及术后严重并发症。所有患者的肠道和肠道外症状均有显著改善。
腹腔镜切除伴有直肠受累的深部盆腔子宫内膜异位症在改善消化和妇科症状方面可能成功；然而，这种方法具有挑战性，开腹手术转换率较高。
