Department of Urology, Nippon Medical School, Tokyo, Japan.
Department of Urology, Nippon Medical School, Tokyo, Japan,
Urol Int. 2020;104(7-8):546-550. doi: 10.1159/000503795. Epub 2020 Mar 19.
Bladder endometriosis (BE) is rare. Deep invasive endometriosis is difficult to control with medications alone; such cases need surgical treatment. Good results of laparoscopic partial cystectomy with a transurethral (TU) resectoscope by the see-through technique for patients with BE are reported.
From January 2008 to February 2016, 12 cases of symptomatic BE were seen in our institution. The chief complaints of 9 cases were micturition pain during menstruation. Preoperative cystoscopy showed a bladder mass with blueberry spots. All surgeries were performed under general anesthesia. Laparoscopic surgery was performed with a fan of 4 ports in the lower abdomen. First, the uterus and bilateral ovaries were checked. Then, the TU resectoscope was inserted. When the affected bladder wall was identified, it was again observed with the laparoscopic light source off, which made it possible to observe the twilight leaking inside from the bladder. This twilight came from the light source of the TU resectoscope via the unaffected bladder wall. In contrast, the thickness of the affected wall prevented the light from inside the bladder from passing through it. We call this the "see-through technique." The tumor was then safely dissected with both laparoscopic and TU resection procedures. Finally, the bladder was sutured by laparoscopic procedures using absorbable sterile surgical suture. The urethral catheter was removed after cystography 7 days after the operation.
The surgical margins of all cases were negative. There has been no recurrence of BE so far in any patients. There were no major adverse events perioperatively and the urinary symptoms improved in all cases.
By laparoscopic partial cystectomy assisted with a TU resectoscope and see-through technique, the edge of BE could be easily and precisely identified. These procedures are effective and safe for BE surgical treatment.
膀胱子宫内膜异位症（BE）较为罕见。深部侵袭性子宫内膜异位症单用药物难以控制，需要手术治疗。有报道称，采用经尿道（TU）电切镜直视下经腹腔镜部分膀胱切除术治疗 BE 效果良好。
自 2008 年 1 月至 2016 年 2 月，我院收治 12 例有症状的 BE 患者。9 例的主要症状为经期排尿痛。术前膀胱镜检查显示膀胱内有带蓝莓斑点的肿块。所有手术均在全身麻醉下进行。腹腔镜手术在下腹部采用 4 孔扇形法。首先检查子宫和双侧卵巢。然后插入 TU 电切镜。当发现受影响的膀胱壁时，关闭腹腔镜光源再次观察，此时可以观察到从膀胱内部漏出的暮光。这种暮光来自 TU 电切镜的光源，通过未受影响的膀胱壁。相比之下，受累壁的厚度阻止了来自膀胱内部的光通过。我们称之为“直视技术”。然后，通过腹腔镜和 TU 切除程序安全地切除肿瘤。最后，通过腹腔镜程序使用可吸收无菌手术缝线缝合膀胱。术后 7 天行膀胱造影后拔除尿道导管。
所有病例的手术切缘均为阴性。迄今为止，没有任何患者出现 BE 复发。围手术期无重大不良事件，所有患者的尿路症状均得到改善。
通过腹腔镜辅助 TU 电切镜和直视技术，可轻松、准确地识别 BE 的边缘。这些方法对于 BE 的手术治疗是有效且安全的。
