Coronado C, Franklin R R, Lotze E C, Bailey H R, Valdés C T
Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas.
Fertil Steril. 1990 Mar;53(3):411-6. doi: 10.1016/s0015-0282(16)53332-9.
The approach to the treatment of bowel endometriosis has varied greatly. In this paper we present 77 consecutive patients with deep colorectal endometriosis treated with a full-thickness resection. Gynecologic procedures included conservative laparotomies for preserving fertility (39 patients); hysterectomy with bilateral salpingo-oophorectomy (29 patients); bilateral salpingo-oophorectomy (2 patients); left salpingo-oophorectomy (1 patient) and resection of pelvic endometriosis in patients with previous ablative surgery (6 patients). A low anterior bowel resection was performed in 68 patients (88.3%); a disc excision of the anterior rectal wall in 5 (6.5%); sigmoid resection in 3 (3.9%), and partial cecal resection in 1 (1.3%). The postoperative febrile morbidity was 10.4%, with no apparent anastomotic leaks. Of 33 patients who attempted to conceive postoperatively, 13 achieved a term pregnancy (39.4%). Complete relief of pelvic symptoms was obtained in 38 patients (49.4%); improvement in 30 (39%); no improvement in 8 (10.4%); and worsening of symptoms in 1 (1.2%). There has been no recurrence of symptomatic bowel endometriosis during 1 to 9 years of follow-up. Full-thickness resection of the colon for the treatment of deep bowel endometriosis is a safe procedure with low morbidity, good postoperative relief of symptoms, and favorable pregnancy rates.
肠道子宫内膜异位症的治疗方法差异很大。在本文中，我们介绍了77例连续接受全层切除治疗的深部结直肠子宫内膜异位症患者。妇科手术包括保留生育功能的保守性剖腹手术（39例）；子宫切除术加双侧输卵管卵巢切除术（29例）；双侧输卵管卵巢切除术（2例）；左侧输卵管卵巢切除术（1例）以及对既往已接受消融手术的患者进行盆腔子宫内膜异位症切除术（6例）。68例患者（88.3%）进行了低位前肠切除术；5例（6.5%）进行了直肠前壁盘状切除术；3例（3.9%）进行了乙状结肠切除术；1例（1.3%）进行了部分盲肠切除术。术后发热发病率为10.4%，未出现明显的吻合口漏。在33例术后尝试怀孕的患者中，13例成功足月妊娠（39.4%）。38例患者（49.4%）盆腔症状完全缓解；30例（39%）有所改善；8例（10.4%）无改善；1例（1.2%）症状恶化。在1至9年的随访期间，未出现有症状的肠道子宫内膜异位症复发。全层结肠切除术治疗深部肠道子宫内膜异位症是一种安全的手术，发病率低，术后症状缓解良好，妊娠率理想。
