Department of Surgery, Ospedale Sacro Cuore, Via Sempreboni, 5, 37024 Negrar, VR, Italy.
Surg Endosc. 2011 Apr;25(4):1257-62. doi: 10.1007/s00464-010-1354-x. Epub 2010 Sep 17.
Ileocecal endometriosis is a very rare entity, and its diagnosis is usually made during surgery for other endometriosis sites or, rarely, because of direct complications of ileal involvement. This study was designed to analyze perioperative and long-term outcomes after bowel resection for ileocecal endometriosis.
All patients who underwent surgery for ileocecal endometriosis between October 2004 and January 2008 were prospectively collected and analyzed.
Thirty-one women (median age, 34 (range, 25-40) years) were identified. Ileocecal endometriosis was diagnosed during surgery in all patients, and it was associated with colorectal endometriosis in 29 patients (94%). All patients underwent laparoscopic ileocecal resection with no laparotomic conversion. Rectosigmoid or rectal resections was associated in 28 patients (90%) and nodulectomy for sigmoid endometriosis in 1 patient. Median duration of surgery was 301 (range, 90-480) min. Other associated surgical procedures included total hysterectomy (n = 3, 14%), ureterolysis (n = 7, 23%), excision of vesical (n = 4, 13%), vaginal (n = 8, 26%), and parametrial (n = 3, 14%) nodules. There was no mortality. Four patients (13%) required blood transfusions and one a reoperation for bleeding. In a patient who performed ureterolysis, a ureteral fistula occurred. The median hospital stay was 7 (range, 5-18) days. Long-term (>12 months) follow-up data were available for 18 patients. After a median follow-up of 27 months, in 12 of 18 patients (67%) defecation after surgery was normal. Only one patient developed recurrence, which is under medical treatment.
Laparoscopic ileocecal resection is safe and feasible and should be considered as part of surgery for endometriosis with radical intent.
回盲部子宫内膜异位症是一种非常罕见的疾病，其诊断通常是在手术治疗其他部位的子宫内膜异位症时做出的，或者很少是因为回肠受累的直接并发症。本研究旨在分析因回盲部子宫内膜异位症行肠切除术的围手术期和长期结局。
2004 年 10 月至 2008 年 1 月期间所有接受手术治疗的回盲部子宫内膜异位症患者均被前瞻性收集和分析。
共确定 31 名女性（中位年龄 34 岁（范围 25-40 岁））。所有患者均在手术中诊断为回盲部子宫内膜异位症，其中 29 名患者（94%）与结直肠子宫内膜异位症相关。所有患者均行腹腔镜回盲部切除术，无剖腹手术转换。28 名患者（90%）行直肠乙状结肠切除术，1 名患者行乙状结肠结节切除术。手术时间中位数为 301 分钟（范围 90-480 分钟）。其他相关手术包括全子宫切除术（n=3，14%）、输尿管松解术（n=7，23%）、膀胱（n=4，13%）、阴道（n=8，26%）和宫旁（n=3，14%）结节切除术。无死亡病例。4 名患者（13%）需要输血，1 名患者因出血行再次手术。在 1 名行输尿管松解术的患者中，发生输尿管瘘。中位住院时间为 7 天（范围 5-18 天）。18 名患者中有 18 名获得了长期（>12 个月）随访数据。在 18 名患者的中位随访 27 个月后，12 名患者（67%）术后排便正常。仅 1 名患者复发，正在接受治疗。
腹腔镜回盲部切除术安全可行，应作为根治性子宫内膜异位症手术的一部分考虑。
