Ferrero Simone, Camerini Giovanni, Leone Roberti Maggiore Umberto, Venturini Pier L, Biscaldi Ennio, Remorgida Valentino
Simone Ferrero, Umberto Leone Roberti Maggiore, Pier L Venturini, Valentino Remorgida, Department of Obstetrics and Gynecology, San Martino Hospital and University of Genoa, Largo R. Benzi 1, 16132 Genoa, Italy.
Giovanni Camerini, Department of Surgery, San Martino Hospital and University of Genoa, Largo R. Benzi 1, 16132 Genoa, Italy.
World J Gastrointest Surg. 2011 Mar 27;3(3):31-38. doi: 10.4240/wjgs.v3.i3.31.
Bowel endometriosis affects between 3.8% and 37% of women with endometriosis. The evaluation of symptoms and clinical examination are inadequate for an accurate diagnosis of intestinal endometriosis. Transvaginal ultrasonography is the first line investigation in patients with suspected bowel endometriosis and allows accurate determination of the presence of the disease. Radiological techniques (such as magnetic resonance imaging and multidetector computerized tomography enteroclysis) are useful for estimating the extent of bowel endometriosis. Hormonal therapies (progestins, gonadotropin releasing hormone analogues and aromatase inhibitors) significantly improve pain and intestinal symptoms in patients with bowel stenosis less than 60% and who do not wish to conceive. However, hormonal therapies may not prevent the progression of bowel endometriosis and, therefore, patients receiving long-term treatment should be periodically monitored. Surgical excision of bowel endometriosis should be offered to symptomatic patients with bowel stenosis greater than 60%. Intestinal endometriotic nodules may be excised by nodulectomy or segmental resection. Both surgical procedures improve pain, intestinal symptoms and fertility. Nodulectomy may be associated with a lower rate of complications.
肠道子宫内膜异位症在患有子宫内膜异位症的女性中占比为3.8%至37%。症状评估和临床检查不足以准确诊断肠道子宫内膜异位症。经阴道超声检查是疑似肠道子宫内膜异位症患者的一线检查方法，可准确确定疾病的存在。放射学技术（如磁共振成像和多排螺旋计算机断层扫描小肠造影）有助于评估肠道子宫内膜异位症的范围。激素疗法（孕激素、促性腺激素释放激素类似物和芳香化酶抑制剂）可显著改善肠道狭窄小于60%且不想怀孕的患者的疼痛和肠道症状。然而，激素疗法可能无法阻止肠道子宫内膜异位症的进展，因此，接受长期治疗的患者应定期监测。对于肠道狭窄大于60%的有症状患者，应进行肠道子宫内膜异位症的手术切除。肠道子宫内膜异位结节可通过结节切除术或节段性切除术切除。这两种手术都可改善疼痛、肠道症状和生育能力。结节切除术的并发症发生率可能较低。
