Cosma Stefano, Ceccaroni Marcello, Benedetto Chiara
Department of Gynecology and Obstetrics, Sant'Anna Hospital, University of Turin, Turin, Italy.
Department of Gynecology and Obstetrics, Gynecologic Oncology Division, International School of Surgical Anatomy, European Gynecology Endoscopy School, Sacred Heart Hospital, Negrar, Verona, Italy.
Wideochir Inne Tech Maloinwazyjne. 2014 Sep;9(3):463-7. doi: 10.5114/wiitm.2014.41617. Epub 2014 Mar 25.
Bowel endometriosis affects 3-37% of patients with endometriosis, involving more frequently the rectum and the rectosigmoid junction. Severe endometriosis with bowel involvement is often refractory to standard medical therapy. For these reasons, surgery for bowel treatment is frequently needed. We report the case of a 36-year-old woman with deep endometriosis of the pelvis, triple segmental bowel involvement (recto-sigma, ileum-cecum, transverse colon) and massive endometriotic ascites with secondary Glisson's capsule inflammation, refractory to medical therapy. A laparoscopic triple segmental bowel resection and complete fertility sparing excision of pelvic endometriotic lesions was performed. At 48 months of follow-up, the woman was asymptomatic, with no evidence of recurrence of disease or ascites. Laparoscopic segmental bowel resection, including multiple section, is feasible in selected symptomatic patients with consequent improved quality of life, morbidity rates similar to those achieved by laparotomy and with a less detrimental effect on fertility.
肠道子宫内膜异位症在子宫内膜异位症患者中的发生率为3% - 37%，更常累及直肠和直肠乙状结肠交界处。伴有肠道受累的重度子宫内膜异位症通常对标准药物治疗无效。因此，常需要进行肠道手术治疗。我们报告一例36岁女性患者，患有盆腔深部子宫内膜异位症，累及肠道三个节段（直肠乙状结肠、回盲部、横结肠），并有大量子宫内膜异位性腹水伴继发性肝门部炎症，药物治疗无效。实施了腹腔镜下肠道三个节段切除术，并完整保留生育功能切除盆腔子宫内膜异位病灶。随访48个月时，该女性无症状，无疾病复发或腹水的迹象。对于有症状的特定患者，腹腔镜下节段性肠道切除术，包括多节段切除，是可行的，可改善生活质量，发病率与开腹手术相似，且对生育的不良影响较小。
