Bachmann Robert, Bachmann Cornelia, Lange Jessica, Krämer Bernhard, Brucker Sara Y, Wallwiener Diethelm, Königsrainer Alfred, Zdichavsky Marty
Department of General, Visceral and Transplant Surgery, University Hospital Tübingen, Tübingen, Germany,
Arch Gynecol Obstet. 2014 Nov;290(5):919-24. doi: 10.1007/s00404-014-3257-x. Epub 2014 May 4.
Endometriosis as a benign disease appears frequently in premenopausal women with highly variable symptoms. In advanced stages bowel involvement is common. In symptomatic disease the adequate treatment requires complete resection of all residues. Indications of colorectal resection for endometriosis remain controversial because of the risk of major complications. The purpose of this study was to show the feasibility of planned complete laparoscopic management of symptomatic deep pelvic endometriosis with bowel involvement performing segmental colorectal resection in a center of excellence.
Between 2007 and 2012 all patients treated for symptomatic colorectal endometriosis in our institution were included and retrospectively evaluated. Laparoscopic excision of all visible disease was planned. Data analysis included age, previous history of endometriosis, intraoperative findings, operative procedure and intra- and postoperative complications.
In this time period 35 patients with bowel infiltrating endometriosis were treated. Affected locations were the rectovaginal space in 31 patients (89 %), the rectum in 32 patients (91 %), the sigmoid colon in 10 patients (29 %), the coecum in 2 patients (5.7 %), the appendix in 3 patients (8.6 %) and the terminal ileum in 1 patient (2.9 %). In the majority of patients (85.7 %) the resection was achieved laparoscopically, in 3 patients a conversion to laparotomy was necessary and in 2 patients a primary laparotomia was performed. Complications occurred in 2 cases with anastomotic leakage in 1 patient (2.8 %) and a rectovaginal fistula in another patient. Radical resection was achieved in almost all patients (97 %).
A well-trained interdisciplinary team can perform treatment of deep infiltrating endometriosis laparoscopically with low incidence of major complications as anastomotic leakage or rectovaginal fistula. Criteria of complete endometriosis restoration of the rectum can be achieved by total or subtotal rectal excision.
子宫内膜异位症作为一种良性疾病，常见于绝经前女性，症状高度多变。在疾病晚期，肠道受累较为常见。对于有症状的疾病，充分治疗需要完全切除所有病灶。由于存在严重并发症的风险，子宫内膜异位症行结直肠切除术的指征仍存在争议。本研究的目的是在一家卓越中心展示计划性完全腹腔镜治疗有症状的深部盆腔子宫内膜异位症伴肠道受累并进行节段性结直肠切除的可行性。
纳入2007年至2012年间在我院接受有症状的结直肠子宫内膜异位症治疗的所有患者，并进行回顾性评估。计划对所有可见病灶进行腹腔镜切除。数据分析包括年龄、既往子宫内膜异位症病史、术中发现、手术操作以及术中和术后并发症。
在此期间，35例肠道浸润性子宫内膜异位症患者接受了治疗。受累部位为直肠阴道间隙31例（89%）、直肠32例（91%）、乙状结肠10例（29%）、盲肠2例（5.7%）、阑尾3例（8.6%）、回肠末端1例（2.9%）。大多数患者（85.7%）通过腹腔镜完成切除，3例患者需要中转开腹，2例患者进行了一期开腹手术。2例发生并发症，1例患者出现吻合口漏（2.8%），另1例患者出现直肠阴道瘘。几乎所有患者（97%）都实现了根治性切除。
一个训练有素的多学科团队可以通过腹腔镜治疗深部浸润性子宫内膜异位症，吻合口漏或直肠阴道瘘等严重并发症的发生率较低。通过直肠全切除或次全切除可实现直肠子宫内膜异位症的完全恢复标准。
