摘要
目的探讨腹腔镜下对子宫内膜异位直肠患者行经阴道拖出的中低位直肠切除的手术方式、安全性及疗效。方法回顾性分析自2010年5月至2012年12月中山大学附属第一医院诊断为子宫内膜异位症并中低位直肠子宫内膜异位的患者共48例，在腹腔镜辅助下经阴道拖出直肠并手术切除病灶，总结经自然腔道直肠切除的手术方法、手术后近远期并发症，分析其临床疗效。结果所有患者在腹腔镜辅助下行子宫内膜异位直肠的经阴道拖出的中低位直肠切除术，患者中位年龄34．4（22。43）岁；内膜异位直肠位于腹膜返折及以下29例，无一例中转手术及行预防性造口，吻合口瘘发生率为2．1％（1例），直肠平均手术时间78（62—180）min；患者术后平均住院时间7．5d，术后相比术前消化道、妇科各种症状都得到明显改善[肠道出血0比18（37．5％），痛经1（2．1％）比48（100．0％），均P〉0．05]，但便秘症状无明显改善[6（12．5％）比5（10．4％），P〉0．05]。结论腹腔镜下经阴道的子宫内膜异位中低位直肠的切除术疗效好，较安全，值得推广。
Objective To explore the efficacies and safety of laparoscopic-assisted rectal resection and transvaginal removal for middle or low rectal endometriosis. Methods A total of 48 patients with middle or low rectal endometriosis undergoing laparoscopic-assisted transvaginal resection from May 2010 to December 2012 at First Affiliated Hospital, Sun Yat-sen University were enrolled. Postoperative short and long-term complications and clinical effieacies were retrospectively analyzed. Results All cases underwent laparoscopic-assisted transvaginal rectal resection successfully. Neither conversion into laparotomy nor preventive eolostomy was needed. Their average age was 34. 4 （ 22 - 43 ） years. The locations were above peritoneal reflection （ n = 19 ） and below （ n = 29 ）. The incidence of anastomotic leakage was 2. 1% （ n = 1 ）. The mean operative duration was 78 （62 - 180） min and the length of hospital stay 7. 5 days. Compared with preoperative period, their postoperative digestive and gynecological symptoms improved significantly （intestinal bleeding 0 vs 18 （37.5%）, dysmenorrhea 1 （2. 1% ） vs 48 （100. 0% ） all P 〈 O. 05 ）. However, there was no change of constipation symptoms （ 6 （ 12. 5% ） vs 5 （ 10.4% ）, P 〉 0. 05 ） . Conclusion Laparoscopic-assisted transvaginal resection for middle or low rectal endometriosis was efficacious, safe and worth Dopularizinz.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2014年第2期131-133,共3页
National Medical Journal of China
基金
广东省科技计划项目（20118031800240、20128031800389）
