[1]李末娟 熊丹① 黄懿 黄浩＊.女性生殖道畸形伴盆腔深部浸润型子宫内膜异位症23例临床分析[J].中国微创外科杂志,2018,18(11):989-992.
　Li Mojuan*,Xiong Dan,Huang Yi*,et al.Clinical Analysis of 23 Cases of Female Genital Tract Malformation Complicated With Deep Infiltrating Endometriosis[J].Chinese Journal of Minimally Invasive Surgery,2018,18(11):989-992.
点击复制

女性生殖道畸形伴盆腔深部浸润型子宫内膜异位症23例临床分析 ()
分享到：

《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
18
期数:
2018年11期
页码:
989-992
栏目:
临床研究
出版日期:
2018-11-20

文章信息/Info

Title:
Clinical Analysis of 23 Cases of Female Genital Tract Malformation Complicated With Deep Infiltrating Endometriosis
作者:
李末娟 熊丹① 黄懿 黄浩＊
（广东省佛山市南海区人民医院妇科，佛山528000）
Author(s):
Li Mojuan*;  Xiong Dan;  Huang Yi*;  et al.
*Department of Gynecology, Nanhai District People’s Hospital of Foshan, Foshan 528000, China
关键词:
女性生殖道畸形; 深部浸润型子宫内膜异位症
Keywords:
Female genital tract malformation; Deep infiltrating endometriosis
文献标志码:
A
摘要:
目的探讨女性生殖道畸形伴盆腔深部浸润型子宫内膜异位症（deep infiltrating endometriosis，DIE）的临床特点、诊断和治疗方法。方法对2005年6月~2017年11月经手术及病理确诊的23例女性生殖道畸形伴DIE的临床资料进行回顾性分析。21例行腹腔镜下DIE病灶切除及粘连松解术，其中13例术中同时行卵巢子宫内膜异位囊肿剥除术，3例行患侧附件切除术；2例行腹腔镜下DIE病灶及全子宫切除术。12例同时行宫腔镜检查，其中8例行宫腔镜下子宫中隔切除术，1例行宫腔镜下阴道斜隔切除术。结果本组诊断梗阻型生殖道畸形4例，非梗阻型19例。按Chapron提出的DIE解剖分型：Ⅱ型11例，Ⅲ型6例，Ⅱ型及Ⅲ型6例（以Ⅱ型为主）。7例DIE病灶不能完全切除者术后常规行3~6个月GnRHa治疗。23例随访6~150个月，平均47.7月。8例合并不孕者中3例活产，1例自然流产。术后疼痛缓解率83.3%（15/18）。2例分别于术后11及17个月异位症复发。结论梗阻型及非梗阻型生殖道畸形均有可能发生DIE，手术中应尽可能地去除DIE病灶，解除畸形，保护生育功能，药物可作为辅助治疗。
Abstract:
ObjectiveTo explore the clinical features, diagnosis, and treatment of female genital tract malformation with deep infiltrating endometriosis (DIE).MethodsA retrospective analysis was carried out on clinical data of 23 female cases of genital tract malformation with DIE confirmed by surgery and pathological examinations from June 2005 to November 2017. There were 21 cases of laparoscopic DIE lesions resection and adhesion release, 13 of which were combined with ovarian endometriosis cyst removal and 3 of which were combined with adnexectomy. There were 2 cases of laparoscopic surgery of DIE and total hysterectomy. Hysteroscopy was performed concurrently in 12 cases, 8 of which underwent septectomy and 1 of which underwent longitudinal vaginal septum resection.ResultsA total of 4 cases of obstructive and 19 cases of nonobstructive reproductive tract malformation were diagnosed. According to the Chapron’s anatomical type, there were 11 cases of type Ⅱ, 6 cases of type Ⅲ, and 6 cases of combination of type Ⅱ and type Ⅲ (based on type Ⅱ). Seven patients with DIE lesion not completely resected were treated with GnRHa treatment for 3-6 months after surgery. A total of 23 cases were followed up for 6-150 months (mean, 47.7 months). In 8 cases with infertility, there were 3 cases of live births and 1 case of spontaneous abortion. The postoperative pain relief rate was 83.3% (15/18). There were 2 cases of DIE recurrence at 11 months and 17 months after surgery.ConclusionsDIE may occur in both obstructive and nonobstructive reproductive tract malformations. The DIE lesion should be removed as much as possible during surgery to correct deformity and protect reproductive function. Medication can be used as an auxiliary treatment.

参考文献/References:

[1]叶明珠，郭红燕.深部浸润型子宫内膜异位症的诊断研究进展.实用妇产科杂志,2014,30(6):425-428.
[2]冯力民，主译.宫腔镜下的世界，从解剖到病理.北京：中国协和医科大学出版社，2018.88-107.
[3]蔡柏岑，彭超，孙笑,等．腹腔镜治疗深部浸润型子宫内膜异位症临床疗效6l例分析．中国妇产科临床杂志，2010,11(4):274-277.
[4]曾诚，徐嘉宁，周应芳，等.腹腔镜手术治疗阴道子宫内膜异位症43例疗效分析.中国微创外科杂志，2014，14(4):289-292.
[5]冷金花.深部浸润型子宫内膜异位症的诊治进展.中国实用妇科与产科杂志，2008,14(1):12-15.
[6]杨琳，张金玲，张琳，等.深部浸润型子宫内膜异位症38例临床病例分析.中外医学研究,2013,11(1):125-126.
[7]李卓莉，郝敏，赵卫红.腹腔镜手术联合促性腺激素释放激素激动剂治疗深部浸润型子宫内膜异位症的临床疗效分析.中华妇幼临床医学杂志（电子版）,2014,4(10):59-62.
[8]叶红,段华.青春期子宫内膜异位症13例临床分析.中国微创外科杂志,2013,13(11):999-1001.
[9]Chapron C,Chopin N,Borghese B,et al.Deeply infiltrating endometriosis:pathogenetic implications of the anatomical distribution.Hum Reprod,2006,21(7):1839-1845.
[10]谢辛，荀文丽，主编.妇产科学.第8版.北京：人民卫生出版社,2013.268-274.
[11]张焕晓,姚书忠.子宫内膜异位分型的思考、建议及意义.国际妇产科学杂志,2012,39(5):471-475.
[12]邓玉清，吴瑞芳.女性生殖道畸形合并子宫内膜异位症185例临床分析.中国微创外科杂志,2013,13(2):142-144.
[13]王芬，曹云霞.女性生殖道畸形与子宫内膜异位症.中国妇幼健康研究,2007,18(4):328-330.
[14]Millischer AE,Salomon LJ,Santulli P,et al.Fusion imaging for evaluation of deep infiltrating endometriosis: feasibility and preliminary results.Ultrasound Obstet Gynecol,2015,46(1):109-117.
[15]Seracchioli R,Mabrouk M,Manuzzi L,et al.Importance of retroperitoneal ureteral evaluation in cases of deep infiltrating endometriosis.J Minim Invasive Gynecol，2008，15(6)：435-439.
[16]Donnez J，Nisolle M，Suqifflet J．Ureteral endometriosis：a complication of rectovaginal endometriotic (adenomyotic) nodule.Fertil Steril，2002,77(1):32-37．
[17]冷金花，戴毅.合理利用能量器械,提高手术效果和安全性.中国实用妇科与产科杂志，2016,32(7):601-603.
[18]冷金花，戴毅.子宫内膜异位症诊治热点问题.中国实用妇科与产科杂志,2014,30(1):17-20.
[19]薛晴,曾诚,徐阳,等．不同类型内异症合并不孕患者保守性手术疗效分析．中华妇产科杂志,2013,48(1):16-19.

备注/Memo

备注/Memo:
＊通讯作者，Email：fshaos@163.com①（广东医科大学附属医院内一科，湛江524000）
更新日期/Last Update: 2019-03-01