Liang Yan, Zhang Duo, Jiang Ling, Liu Yuan, Zhang Jian
Department of Obstetrics and Gynecology, International Peace Maternity and Child Health Hospital, Shanghai 200030, China.
Department of Radiology, International Peace Maternity and Child Health Hospital, Shanghai 200030, China.
World J Clin Cases. 2021 Feb 16;9(5):1037-1047. doi: 10.12998/wjcc.v9.i5.1037.
The prevalence of perineal endometriosis (PEM) is low among women with endometriosis (EM) treated by surgery. It manifests as hard or cystic nodules with pain in the perineal wounds and surrounding areas. Implantation theory is regarded as the main pathogenesis of PEM. There are few clinical studies on the incidence and clinical characteristics of PEM. This study aims to summarize the clinical data of 14 PEM cases and analyze the factors that may be related to the incubation period and pain.
To analyze the medical history, clinical manifestations, diagnosis, treatment and treatment effect of PEM.
The present study is a case series. We collected the clinical data and follow-up data of 14 patients with PEM who visited The International Peace Maternal and Child Health Hospital Affiliated to Shanghai Jiaotong University from January 2009 to December 2019. Paired test and Pearson correlation analysis were used for statistical analysis. < 0.05 was considered statistically significant.
The 14 patients included had a history of vaginal delivery. All patients underwent PEM lesion resection. Three patients were treated by levator ani muscle repair at the same time and 1 patient underwent extensive PEM lesion resection and anal sphincter repair. Body mass index (BMI) at delivery and BMI within 1 mo after delivery were negatively correlated with the latent period, respectively ( = 0.53/0.86, < 0.05). The average visual analog scale score in lesions at the third month after surgery was 0.57 ± 1.28 for all patients, which was significantly lower than that prior to surgery ( < 0.05). One patient relapsed during the sixth month after surgery, and to date, no recurrence occurred after the second surgery.
The higher the BMI during delivery and within 1 mo after delivery, the shorter the incubation period of PEM. It is very important to evaluate the location of lesions before surgery. Surgical resection of the lesion is the best treatment for PEM and results in significant alleviation of symptoms. Therefore, following the diagnosis of PEM, immediate surgery is recommended.
在接受手术治疗的子宫内膜异位症（EM）女性中，会阴子宫内膜异位症（PEM）的患病率较低。它表现为会阴伤口及周围区域的硬结或囊性结节，并伴有疼痛。植入理论被认为是PEM的主要发病机制。关于PEM的发病率和临床特征的临床研究较少。本研究旨在总结14例PEM病例的临床资料，并分析可能与潜伏期和疼痛相关的因素。
分析PEM的病史、临床表现、诊断、治疗及治疗效果。
本研究为病例系列研究。收集了2009年1月至2019年12月期间就诊于上海交通大学附属国际和平妇幼保健院的14例PEM患者的临床资料和随访数据。采用配对检验和Pearson相关分析进行统计学分析。P<0.05被认为具有统计学意义。
纳入的14例患者均有阴道分娩史。所有患者均接受了PEM病灶切除术。3例患者同时行肛提肌修复术，1例患者行广泛性PEM病灶切除术及肛门括约肌修补术。分娩时的体重指数（BMI）和产后1个月内的BMI分别与潜伏期呈负相关（r=0.53/0.86，P<0.05）。所有患者术后第3个月病灶处的视觉模拟评分平均为0.57±1.28，显著低于术前（P<0.05）。1例患者术后第6个月复发，至第二次手术后至今未再复发。
分娩时及产后1个月内BMI越高，PEM的潜伏期越短。术前评估病灶位置非常重要。手术切除病灶是PEM的最佳治疗方法，可显著缓解症状。因此，诊断PEM后，建议立即手术。
