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目的探讨腹腔镜手术治疗肠道子宫内膜异位症(bowel endometriosis,BE)的安全性和有效性。方法回顾性分析2008年6月至2012年5月中山大学附属第一医院妇产科行腹腔镜手术治疗并经病理证实的54例BE患者的临床资料。手术治疗的有效性通过患者的疼痛视觉模拟评分(visual analog scale,VAS)和症状改善的主观感觉(完全缓解、显著缓解、无缓解、加重)进行评价,并观察术后并发症及术后妊娠情况。结果 54例BE患者中15例患者行肠道表面病灶切除术,8例患者行病灶碟形切除术,31例进行腹腔镜节段性肠管切除及吻合术。术后患者各种疼痛症状的VAS评分显著下降(P<0.05)。术后并发症13例,发生率24.1%(13/54),包括直肠阴道瘘2例、尿潴留10例、盆腔脓肿1例。在术后随访超过6个月恢复正常月经的14例不孕且有生育要求的患者中,7例患者妊娠,术后妊娠率50.0%(7/14),其中6例自然受孕(2例足月经阴道分娩、1例足月剖宫产、1例现孕30周、1例孕20周因胎膜早破难免流产、1例孕8周因胚胎停育行清宫术),1例因双侧输卵管阻塞行体外受精-胚胎移植(IVF-ET)术,于孕足月剖宫产。结论腹腔镜手术能有效缓解BE患者的相关疼痛症状,改善术后妊娠情况,是治疗BE的首选手术方式。
Objective To investigate the safety and efficacy of laparoscopic surgery for bowel endometriosis (BE). Methods The clinical data of 54 patients with BE confirmed by laparoscopy and obstetrics and gynecology at the First Affiliated Hospital of Sun Yat-sen University from June 2008 to May 2012 were retrospectively analyzed. The effectiveness of the surgical treatment was assessed by the patient’s visual analog scale (VAS) and the subjective perception of symptom improvement (complete remission, significant remission, no remission, exacerbation) and postoperative complications and postoperative pregnancy Happening. Results Fifteen of 54 patients with BE were treated by enteral surface excision, 8 patients underwent disc resection and 31 underwent laparoscopic segmentectomy and anastomosis. The postoperative VAS score of various pain symptoms decreased significantly (P <0.05). Postoperative complications occurred in 13 cases with a rate of 24.1% (13/54), including 2 cases of rectovaginal fistula, 10 cases of urinary retention and 1 case of pelvic abscess. Of the 14 infertile women with fertility required to return to normal menstruation after more than 6 months of follow-up, 7 patients had pregnancy and postoperative pregnancy rates of 50.0% (7/14), of which 6 were spontaneous (2 Menstruation vaginal delivery, 1 case of full-term cesarean section, 1 case of 30 weeks pregnant, 1 case of 20 weeks premature rupture of membranes due to unavoidable abortion, 1 case of pregnancy due to embryo 8 weeks curettage surgery), 1 case due to double Side tubal obstruction in vitro fertilization - embryo transfer (IVF-ET) surgery, full-term cesarean section in pregnancy. Conclusions Laparoscopic surgery can effectively relieve the pain related symptoms and improve postoperative pregnancy in patients with BE. It is the first choice for the treatment of BE.