Ceccaroni Marcello, Roviglione Giovanni, Rosenberg Piergiorgio, Pesci Anna, Clarizia Roberto, Bruni Francesco, Zardini Claudio, Ruffo Giacomo, Placci Angelo, Crippa Stefano, Minelli Luca
Gynecologic Oncology Division, International School of Surgical Anatomy, Sacred Heart Hospital, Negrar, Verona, Italy ; Department of Obstetrics and Gynecology, European Gynaecology Endoscopy School, Sacred Heart Hospital, Negrar, Verona, Italy.
Wideochir Inne Tech Maloinwazyjne. 2012 Jun;7(2):122-31. doi: 10.5114/wiitm.2011.26758. Epub 2012 Jan 26.
Diaphragmatic endometriosis is a rare entity, often asymptomatic, which has been described only in small series. It is almost always associated with severe pelvic involvement. The most plausible theory about this condition is based on retrograde menstruation and subsequent transportation of viable cells in peritoneal fluid from the pelvis up the right gutter to the right hemidiaphragm, thus demonstrating its asymmetric distribution on the diaphragm. Pre-operative diagnosis is poorly supported by imaging techniques. In most cases, it is an incidental finding because the lesions may hide behind the right hepatic lobe. In that case it cannot be easily demonstrated with a laparoscope from an umbilical port. Symptomatic diaphragmatic endometriosis is associated with deep lesions which can involve the entire thickness of the diaphragm. In these cases, treatment is more difficult with possible incomplete pain relief and a considerable possibility of recurrence. In this subset, abdominal surgery is recommended. Surgical treatment must be individualized on the basis of the patient's age, fertility desires, type and location of disease and symptoms. We report the surgical treatment of a patient with synchronous pericardial, pleural and diaphragmatic endometriosis associated with pelvic peritoneal and bowel involvement. A review of the literature regarding pericardial and diaphragmatic endometriosis focusing on anatomical and surgical aspects of its management is undertaken.
膈子宫内膜异位症是一种罕见的病症，通常无症状，仅在少数病例系列中有过描述。它几乎总是与严重的盆腔受累相关。关于这种病症最合理的理论基于逆行月经以及随后存活细胞通过腹膜液从盆腔沿右侧沟向上传输至右半膈，从而显示出其在膈上的不对称分布。术前诊断在影像学技术上缺乏有力支持。在大多数情况下，它是偶然发现的，因为病变可能隐藏在右肝叶后方。在这种情况下，通过脐部端口用腹腔镜不易显示。有症状的膈子宫内膜异位症与深部病变相关，这些病变可累及膈的全层。在这些病例中，治疗较为困难，可能无法完全缓解疼痛且复发可能性很大。在这一亚组中，建议进行腹部手术。手术治疗必须根据患者的年龄、生育意愿、疾病类型和位置以及症状进行个体化。我们报告了一例同步发生心包、胸膜和膈子宫内膜异位症并伴有盆腔腹膜和肠道受累患者的手术治疗情况。同时对有关心包和膈子宫内膜异位症的文献进行综述，重点关注其治疗的解剖学和手术方面。
