Canis M, Botchorishvili R, Slim K, Pezet D, Pouly J L, Wattiez A, Pomel C, Masson F N, Mage G, Chipponi J, Bruhat M A
Service de Gynécologie-Obstétrique et Reproduction Humaine, Polyclinique, CHU de Clermont-Ferrand.
J Gynecol Obstet Biol Reprod (Paris). 1996;25(7):699-709.
Colo-rectal endometriosis requiring colon resection are reported in 8 patients to illustrated the diagnostic and therapeutic problems encountered in the management of this uncommon localisation. Pericatamenial or catamenial bowel symptoms associated with pelvic genital involvement were encountered in all cases. Clinical examination, barium enema and colonoscopy are essential to guide surgical management looking for multiple localisations. However their diagnostic value is low as endometriosis rarely involves the mucosa. Endosonography appears to be very promising in evaluating the depth of infiltration of the bowel. The treatment of bowel endometriosis is controversial and varies greatly according to the patient's complaints and clinical data. The indications and limits of all treatment modalities including abstention, medical, and surgical treatment are discussed. From the cases reported we conclude that symptomatic bowel endometriosis should be fully excised whenever possible, and the surgical procedure should be adapted to the depth of infiltration. A full thickness excision or bowel resection is mandatory in patients with deep muscularis involvement. These procedures, which are often difficult due to extensive fibrosis and adhesions, may be achieved by laparoscopy in selected patients.
本文报告了8例需要进行结肠切除的结直肠子宫内膜异位症患者，以说明在处理这种罕见定位时遇到的诊断和治疗问题。所有病例均出现与盆腔生殖器受累相关的经前期或经期肠道症状。临床检查、钡剂灌肠和结肠镜检查对于指导寻找多处病变的手术治疗至关重要。然而，它们的诊断价值较低，因为子宫内膜异位症很少累及黏膜。内镜超声在评估肠道浸润深度方面似乎非常有前景。肠道子宫内膜异位症的治疗存在争议，并且根据患者的主诉和临床数据有很大差异。本文讨论了包括观察、药物和手术治疗在内的所有治疗方式的适应证和局限性。从报告的病例中我们得出结论，有症状的肠道子宫内膜异位症应尽可能完全切除，手术方式应根据浸润深度进行调整。对于肌层深部受累的患者，必须进行全层切除或肠切除。由于广泛的纤维化和粘连，这些手术通常很困难，在选定的患者中可通过腹腔镜完成。
