Finan M A, Kwark J A, Joseph G F, Kline R C
Department of Obstetrics and Gynecology, Ochsner Clinic, USA.
J La State Med Soc. 1997 Jan;149(1):32-5.
Twenty-seven patients who underwent laparotomy after a prior hysterectomy for endometriosis were studied. The mean interval from index surgery to repeat surgery was 7.8 years. Abdominal/pelvic pain was the most common presenting complaint, followed by the objective finding of a pelvic mass. Six patients were taking estrogen replacement therapy. Physical findings suggested a pelvic mass or nodularity in 15 patients. Extensive pelvic adhesions with dense involvement of the ovaries was common. Surgery in 2 patients was complicated by an enterotomy, with 4 patients requiring a bowel resection and anastomosis. Postoperatively, 5 patients developed fever, 3 a postoperative ileus, 1 a wound breakdown, and 1 a small bowel obstruction. The mean hospital stay was 5 days. We conclude that in patients who have undergone a hysterectomy as treatment for endometriosis, subsequent surgery to remove the ovaries involved with recurrent endometriosis carries considerable morbidity. In light of readily available estrogen replacement therapy, conservation of the ovaries in patients who are undergoing a hysterectomy for endometriosis should be applied with caution.
对27例因子宫内膜异位症先行子宫切除术后又接受剖腹手术的患者进行了研究。从初次手术到再次手术的平均间隔时间为7.8年。腹部/盆腔疼痛是最常见的就诊主诉，其次是盆腔肿块这一客观发现。6例患者正在接受雌激素替代治疗。体格检查发现15例患者有盆腔肿块或结节。广泛的盆腔粘连伴卵巢严重受累很常见。2例患者手术时并发肠切开术，4例患者需要进行肠切除和吻合术。术后，5例患者出现发热，3例出现术后肠梗阻，1例伤口裂开，1例小肠梗阻。平均住院时间为5天。我们得出结论，对于因子宫内膜异位症接受子宫切除术的患者，后续手术切除与复发性子宫内膜异位症相关的卵巢会带来相当大的发病率。鉴于雌激素替代治疗容易获得，对于因子宫内膜异位症接受子宫切除术的患者，保留卵巢应谨慎应用。
