Ferrero Simone, Camerini Giovanni, Menada Mario Valenzano, Biscaldi Ennio, Ragni Nicola, Remorgida Valentino
Department of Obstetrics and Gynecology, San Martino Hospital and University of Genoa, Largo R. Benzi 1, 16132 Genoa, Italy.
J Reprod Med. 2009 Jun;54(6):366-72.
To determine whether the presence of uterine adenomyosis may impair the amelioration of pain symptoms after laparoscopic excision of pelvic endometriosis combined with colorectal resection.
This prospective study included 50 women with bowel endometriosis with or without uterine adenomyosis. Presence of uterine adenomyosis was investigated by magnetic resonance imaging. Patients underwent excision of pelvic endometriosis and colorectal resection; some patients with focal adenomyosis underwent uterine surgery. Pain symptoms and gastrointestinal complaints were evaluated before surgery and at 6, 12 and 18 months' follow-up.
At 6-month follow-up, dysmenorrhea significantly improved in women without uterine adenomyosis and in those with adenomyosis that was excised at surgery; this improvement persisted at 18 months' followup. No significant improvement in dysmenorrhea was observed in women with adenomyosis not excised at surgery. Deep dyspareunia and chronic pelvic pain significantly improved at follow-up in all study groups. Most of gastrointestinal symptoms improved or disappeared at 6 months' follow-up; the improvement in gastrointestinal function persisted at 18 months' follow-up.
Excision of pelvic endometriosis combined with bowel resection significantly improves chronic pelvic pain, dyspareunia and gastrointestinal symptoms; however, the presence of uterine adenomyosis may determine persistence of dysmenorrhea.
确定子宫腺肌病的存在是否会影响腹腔镜下盆腔子宫内膜异位症切除联合结直肠切除术后疼痛症状的改善。
这项前瞻性研究纳入了50例患有或未患有子宫腺肌病的肠道子宫内膜异位症女性。通过磁共振成像检查子宫腺肌病的存在情况。患者接受盆腔子宫内膜异位症切除和结直肠切除术；一些患有局灶性腺肌病的患者接受了子宫手术。在手术前以及随访6、12和18个月时评估疼痛症状和胃肠道不适情况。
在6个月的随访中，没有子宫腺肌病的女性以及手术中切除了腺肌病的女性痛经明显改善；这种改善在18个月的随访中持续存在。在手术中未切除腺肌病的女性中，未观察到痛经有明显改善。所有研究组在随访时深部性交痛和慢性盆腔疼痛均明显改善。大多数胃肠道症状在6个月的随访时有所改善或消失；胃肠功能的改善在18个月的随访中持续存在。
盆腔子宫内膜异位症切除联合肠切除术可显著改善慢性盆腔疼痛、性交痛和胃肠道症状；然而，子宫腺肌病的存在可能决定痛经的持续存在。
