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[肠道子宫内膜异位症——直肠定位病例。]

[BOWEL ENDOMETRIOSIS - CASE OF RECTAL LOCALISATION.].

作者信息

Tsankov Ts, Zlatkov V

出版信息

Akush Ginekol (Sofiia). 2016;55(4):56-58.

Abstract

Endometriosis is a relatively common disease which rarely involves the bowel, and even more rarely occurs with intestinal obstruction. Gastrointestinal tract is involved in 3 to 37% of women with endometriosis such as the frequency is highest in the rectum and the sigma (72%), small intestine (7%), cecum (3.6%) and others. Our case concerns 49 years old woman with a picture of secondary intestinal obsruction, deepening during the last 2-3 months. An anterior resection of the rectum with the closure of the rectal stump has been performed with temporary colostoma - due to the severely inflamed and distended colon as a result of stenosis about 1 cm in diameter involving the portion from the Bauhin's valve to the rectal ampula, caused by two fist-sized tumors in the intestinal wall - on the rear and rear-left side of the rectum. Distally, about 2-3 cm of the tumors, on the anterior wall of the rectum have been found two plaque-like lesions, additionally. The histological result showed that the wall of the colon is engaged by transmural endometriosis, involving the mucosa, muskularis propria and serosa. The case presented differential diagnostic difficulties to exclude malignancy. The benefits of surgical treatment of intestinal endometriosis despite the significant volume of conducted surgery should not be underestimated, as with medication, it significantly improves clinical symptoms and quality of life.

摘要

子宫内膜异位症是一种相对常见的疾病,很少累及肠道,更罕见的是伴有肠梗阻。3%至37%的子宫内膜异位症女性会累及胃肠道,其中直肠和乙状结肠的发生率最高(72%),小肠(7%)、盲肠(3.6%)等次之。我们的病例是一位49岁女性,有继发性肠梗阻症状,在过去2至3个月病情加重。由于直径约1厘米的狭窄累及从回盲瓣至直肠壶腹的部分,导致结肠严重炎症和扩张,在直肠后壁和左后壁有两个拳头大小的肿瘤,因此进行了直肠前切除术并封闭直肠残端,同时做了临时结肠造口术。此外,在直肠前壁距肿瘤远端约2至3厘米处发现了两个斑块状病变。组织学结果显示结肠壁受透壁性子宫内膜异位症侵犯,累及黏膜、固有肌层和浆膜。该病例在排除恶性肿瘤方面存在鉴别诊断困难。尽管手术量很大,但肠道子宫内膜异位症的手术治疗益处不应被低估,因为与药物治疗一样,它能显著改善临床症状和生活质量。

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