肛周子宫内膜异位症的流行病学、诊断和治疗

M. Kołodziejczak, I. Sudoł-Szopińska, M. Siergiej
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摘要

子宫内膜异位症是指子宫外存在子宫内膜。这种疾病通常影响育龄妇女。子宫内膜异位症的病灶大多(95%)位于腹腔(宫颈、阴道穹窿、外阴、膀胱、腹股沟区),很少发现超出腹腔。偶尔会在会阴组织中发现子宫内膜异位症,通常在会阴切口疤痕处,而在肛肠区域则极为罕见。子宫内膜异位症通常发生在激素活动期间。该病可能无症状或表现为性交困难、盆腔疼痛综合征、生育问题、月经紊乱和月经过多。肛门直肠子宫内膜异位症的诊断是通过彻底的访谈和额外的检查来确定的,包括经直肠和经阴道超声或可选的磁共振成像。最终的诊断是在组织病理学检查中确定的,通常是术中收集的样本。此外,应进行内窥镜检查(至少直肠镜检查)以排除其他病理病变。治疗包括药物治疗和手术。在年轻患者,在激素活动期间,广泛切除与原发性括约肌重建似乎是最理想的选择。在接近更年期的老年患者中,保守治疗是一种更好的解决方案,因为子宫内膜异位症在绝经后消退和疾病症状消退。在这些病例中,保守治疗有助于避免医源性括约肌损伤和大便失禁。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Endometriosis of the perianal region – epidemiology, diagnosis and treatment
Endometriosis is the presence of the uterine endometrium beyond the uterus. The disease usually affects women of childbearing age. Foci of endometriosis are mostly (in 95% of cases) located in the peritoneal cavity (cervix uteri, vaginal vault, vulva, urinary bladder, inguinofemoral region) and only rarely found beyond it. Occasionally, endometriosis is found in the perineal tissues, usually in the episiotomy scar, and, exceptionally rarely, in the anorectal region. Endometriosis usually develops in the period of hormonal activity. The disease may be asymptomatic or manifest with dyspareunia, pelvic pain syndrome, fertility problems, menstrual disorders and heavy menstruation. The diagnosis of anorectal endometriosis is established through a thorough interview and additional tests, including transrectal and transvaginal ultrasound or optionally magnetic resonance imaging. The final diagnosis is determined in a histopathological examination, usually of samples collected intraoperatively. Also, an endoscopic examination should be performed (at least rectoscopy) to rule out other pathological lesions. Treatment includes pharmacotherapy and surgery. In young patients, in the period of hormonal activity, extensive resection with primary sphincter reconstruction seems to be the most optimal option. In older patients, nearing menopause, conservative treatment is a better solution as endometriosis regresses and disease symptoms subside after menopause. In these cases, conservative treatment helps avoid iatrogenic sphincter injury and faecal incontinence.
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