Perineal endometriosis with anal sphincter involvement - Report of a case
Perineal endometriosis with anal sphincter involvement - Report of a case
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DOI：
10.1007/bf02236565
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发表时间：
2000-08-01
影响因子：
3.9
通讯作者：
Hull, T
中科院分区：
文献类型：
--
作者：
Dougherty, LS;Hull, T
引言：会阴子宫内膜异位症累及肛门括约肌是一种罕见的发生。广泛切除是治愈会阴子宫内膜异位症的最佳方法，但当累及肛门括约肌时可能引起失禁。相反，狭窄切除可能导致不完全切除，复发率增加，需要额外的治疗。广泛切除与初级括约肌成形术和狭窄切除手术技术进行审查。方法：回顾性分析1例会阴子宫内膜异位症伴肛门括约肌受累的病例及文献报道。根据切除类型（宽或窄切除）和结局对患者进行比较。研究结果：自1957年以来，有7例会阴子宫内膜异位症伴肛门括约肌受累的报道，本文作者增加了1例，共8例。平均年龄为33岁（范围：22-47岁）。手术治疗包括广泛切除并一期括约肌成形术（2例）、狭窄切除（4例）和不完全切除（1例）。1例在随后的妊娠后自发消退。窄切除组有2例复发，宽切除组无复发。所有手术均未报告并发症。结论：虽然随访时间不一，人数较少，但对于会阴子宫内膜异位症伴肛门括约肌受累的患者，广泛切除并一期括约肌成形术似乎是治愈的最佳机会，并具有良好的功能结果。特别是在年轻患者中，应考虑是否需要长期后续激素治疗或因症状复发而再次切除。相比之下，接近绝经期的患者（子宫内膜异位症趋于消退时）可以通过狭窄切除术进行最佳治疗，以避免显著的肛门括约肌切除的风险。
INTRODUCTION: Perineal endometriosis with anal sphincter involvement is an infrequent occurrence. Wide excision is the best chance of cure of perineal endometriosis but may cause incontinence when the anal sphincter is involved. Conversely, narrow excision may result in incomplete removal, with increased recurrence rates and need of additional therapy. Wide excision with primary sphincteroplasty and narrow excision surgical techniques are reviewed. METHODS: One case report of perineal endometriosis with anal sphincter involvement and previously reported cases were reviewed. Patients were compared based on type of resection (wide or narrow excision) and outcome. RESULTS: Since 1957 there have been seven reported cases of perineal endometriosis with anal sphincter involvement, with the present authors adding one additional case for a total of eight. The mean age was 33 (range, 22–47) years. Surgical treatment included wide excision with primary sphincteroplasty (2 cases), narrow excision (4 cases), and incomplete excision (1 case). One case spontaneously regressed after a subsequent pregnancy. There were two recurrences in the narrow excision group and no recurrences in the wide excision group. There were no complications reported for any of the procedures. CONCLUSIONS: Although follow-up time was variable and the numbers small, wide excision with primary sphincteroplasty for patients with perineal endometriosis with anal sphincter involvement seems to be the best chance of cure with good functional results. It should be considered particularly in younger patients to obviate the need of long-term subsequent hormonal therapy or re-excision for symptomatic recurrences. In contrast, patients closer to menopause (when endometriosis tends to regress) may be treated optimally by narrow excision to avoid the risks of significant anal sphincter resection.