【摘要】：目的:回顧性分析肛周子宮內(nèi)膜異位癥的病因病機(jī)、發(fā)病特點(diǎn)、鑒別診斷、治療方法及預(yù)后等相關(guān)因素,以探討肛周子宮內(nèi)膜異位癥的診治方法,以期為臨床提供參考。方法:收集南京市中醫(yī)院2006年1月至2016年1月肛腸外科診治的17例肛周內(nèi)異癥患者的病例資料并進(jìn)行隨訪;計(jì)算機(jī)檢索有關(guān)肛周異位癥的文獻(xiàn),發(fā)表年限為2000年1月～2016年12月。通過納入和排除標(biāo)準(zhǔn)然完成初篩,去除重復(fù)報(bào)道,然后進(jìn)一步分析文獻(xiàn)中的數(shù)據(jù),決定文獻(xiàn)是否納入。數(shù)據(jù)資料主要為病例的一般情況、臨床特點(diǎn)、治療及隨訪預(yù)后。所有數(shù)據(jù)均采用描述性匯總分析。結(jié)果:11例術(shù)前臨床診斷為肛周內(nèi)異癥,6例分別診斷為肛周膿腫和肛瘺,術(shù)后病理均證實(shí)為肛周內(nèi)異癥。術(shù)前11例病灶未累及肛門括約肌者予以手術(shù)全切除,術(shù)后隨訪未復(fù)發(fā);6例病灶累及肛門括約肌(其中4例合并肛瘺),未合并肛瘺的2例患者予以完全切除病灶(包括部分括約肌),術(shù)后繼續(xù)口服避孕藥3月,隨訪未復(fù)發(fā);4例合并肛瘺患者在保護(hù)肛門功能的情況下盡量切除病灶,病理診斷為肛周內(nèi)異癥后予以促性腺激素釋放激素(GnRH-a)治療3月,停藥后3例病灶復(fù)發(fā),1例拒絕再次手術(shù)予以口服避孕藥控制癥狀,2例予以再次手術(shù)切除病灶,術(shù)后繼續(xù)予GnRH治療3月,隨訪未見復(fù)發(fā)。研究中共納入67篇相關(guān)文獻(xiàn),共767例患者,95.7%的患者臨床癥狀典型,4.3%的患者臨床癥狀不典型;文獻(xiàn)中僅有8.5%(65/767)患者行血清CA-125檢查;手術(shù)或超聲下發(fā)現(xiàn)59.2%的病灶表現(xiàn)為單發(fā),9.7%表現(xiàn)多發(fā),病灶平均直徑為2.64cm±0.97cm;所有患者均采用手術(shù)治療,其中病灶涉及肛門括約肌者占18.1%(138/767),手術(shù)治愈率為85.9%(659/767),失訪率為1.7%(13/767),術(shù)后復(fù)發(fā)率約為6.0%(46/767),40.4%(310/767)患者接受藥物治療。結(jié)論:1、肛周內(nèi)異癥臨床發(fā)病率低,可能與經(jīng)陰道分娩時(shí)會(huì)陰側(cè)切(或者撕裂傷)、產(chǎn)時(shí)合并宮腔和(或)會(huì)陰部手術(shù)操作以及側(cè)切口愈合不良等因素有關(guān)。其他相關(guān)因素可能有年齡、產(chǎn)后月經(jīng)復(fù)潮時(shí)間以及產(chǎn)后母乳喂養(yǎng)時(shí)間等。2、肛周內(nèi)異癥癥狀典型者易確診,癥狀不典型者易需結(jié)合其他輔助檢查,如盆腔超聲、MRI或穿刺細(xì)胞學(xué)等檢查,有助于明確診斷。3、肛周內(nèi)異癥目前主要治療方式是手術(shù)完全切除,病灶累及肛門括約肌多術(shù)前或術(shù)后聯(lián)合藥物治療,藥物治療主要為雌孕激素治療,其他還有中藥口服或保留灌腸、針刺療法等方法。4、肛周內(nèi)異癥的復(fù)發(fā)可能與術(shù)前診斷不明確有關(guān),以致病灶切除不完全,復(fù)發(fā)再次手術(shù)時(shí)注意評(píng)估患者的肛門功能,避免出現(xiàn)大便失禁。
[Abstract]:Objective: to analyze the etiology, pathogenesis, characteristics, differential diagnosis, treatment and prognosis of perianal endometriosis, so as to explore the diagnosis and treatment of perianal endometriosis. Methods: from January 2006 to January 2016, 17 patients with perianal heterosis were collected and followed up in Nanjing Hospital of traditional Chinese Medicine from January 2006 to January 2016. The publication period is from January 2000 to December 2016. Through the inclusion and exclusion of the criteria to complete the initial screening, remove repeated reports, and then further analysis of the data in the literature to determine whether the literature included. The data were mainly general case, clinical features, treatment and follow-up prognosis. All data were analyzed by descriptive summary. Results: 11 cases were diagnosed as perianal heterosis, 6 cases as perianal abscess and anal fistula. Total resection of anal sphincter was performed in 11 patients who had no involvement of anal sphincter before operation. 6 patients with anal sphincter involved anal sphincter (4 patients with anal fistula), 2 patients without anal fistula underwent complete resection (including partial sphincter), and continued to take contraceptive orally for 3 months after operation. 4 patients with anal fistula were treated with gonadotropin releasing hormone (GnRH-a) for 3 months. After stopping the treatment, 3 cases recurred, 1 case refused to take contraceptive to control the symptoms again, 2 cases were resected again. The patients were treated with GnRH for 3 months. No recurrence was found in the follow-up. A total of 67 related articles were included in the study, including 767 patients, 95.7% of them had typical clinical symptoms, 4.3% of them had atypical clinical symptoms, only 8.5% (65 / 767) of the patients had CA-125 examination in serum. Under surgery or ultrasound, 59.2% of the lesions showed single lesions, 9.7% showed multiple lesions, and the mean diameter of lesions was 2.64cm 鹵0.97 cm. All the patients were treated by operation. Among them, 18.1% (13.8 / 767) of the lesions involved anal sphincter, 85.9% (65.9 / 767) of the patients were cured, 1.7% (13 / 767) of the patients were lost, the recurrence rate was about 6.0% (46767), and 40.4% (310 / 767) patients received drug treatment. Conclusion: 1. The clinical incidence of perianal heterosis is low, which may be related to lateral perineal incision (or laceration) during vaginal delivery, intrauterine and / or perineal operation during labor, and poor healing of lateral incision. Other related factors may include age, postpartum menstrual regurgitation and postpartum breast-feeding time, etc. 2. Those with typical symptoms within anus are easy to be diagnosed, and those with atypical symptoms need to be combined with other auxiliary examinations. For example, pelvic ultrasound, MRI or puncture cytology are helpful in the diagnosis of perianal heterosis. At present, the main treatment for perianal heterosis is complete resection of the tumor and the involvement of the anal sphincter before or after the operation. Drug therapy is mainly estrogen and progesterone therapy, other methods include oral or reserved enema of Chinese medicine, acupuncture therapy and so on. 4. The recurrence of perianal heterosis may be related to the unclear diagnosis before operation, resulting in incomplete excision of the lesion. Care should be taken to evaluate anus function during recurrent reoperation to avoid fecal incontinence.
【學(xué)位授予單位】：南京中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R657.1

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