Tóm tắt
Đặt vấn đề: Lạc nội mạc tử cung tầng sinh môn (LNMTCTSM) ảnh hưởng nhiều đến cuộc sống người bệnh do những cơn đau vùng đáy chậu mãn tính liên quan đến chu kỳ kinh nguyệt. Trên thế giới nghiên cứu LNMTCTSM chủ yếu ở dạng báo cáo ca bệnh hoặc chùm ca bệnh. Tại Việt Nam, chưa có nghiên cứu nào đánh giá kết quả điều trị phẫu thuật đối với căn bệnh này.
Đối tượng và phương pháp nghiên cứu: Nghiên cứu mô tả, hồi cứu nhằm đánh giá kết quả điều trị phẫu thuật lạc nội mạc tử cung tầng sinh môn của 16 nữ người bệnh tại bệnh viện Việt Đức giai đoạn 2019-2020.
Kết quả:16 người bệnh đều có tiền sử sinh thường có cắt khâu tầng sinh môn. Thời gian ủ bệnh trung bình 50,6 ± 44,8 tháng. 7 người bệnh có xâm lấn cơ thắt hậu môn cần phải tạo hình cơ thắt. Thời gian nằm viện trung bình 8 ± 2,6 ngày. Thời gian theo dõi trung bình 17,43 tháng. 14/16 (87,5%) người bệnh có kết quả tốt. 2 người bệnh (12,5%) có biểu hiện đau tái phát sau phẫu thuật.
Kết luận: Điều trị LNMTCTSM bằng phẫu thuật, đặc biệt ở những người bệnh có xâm lấn cơ vòng mang lại kết quả tốt.
Từ khóa: Lạc nội mạc tử cung tầng sinh môn, đau tầng sinh môn mãn tính, rạch tầng sinh môn, cơ thắt hậu môn.
Tài liệu tham khảo
- Zhu, L., et al., Presentation and management of perineal endometriosis. International Journal of Gynecology & Obstetrics, 2009. 105(3): p. 230-232.
- Lê Tư Hoàng and Nguyễn Sỹ Lánh, Lạc nội mạc tử cung vào sẹo cắt tầng sinh môn. Y học thực hành, 2005. 510(4): p. 64-66.
- Chen, N., et al., The clinical features and management of perineal endometriosis with anal sphincter involvement: a clinical analysis of 31 cases. Human reproduction, 2012. 27(6): p. 1624-1627.
- Li, J., et al., Diagnosis and treatment of perineal endometriosis: review of 17 cases. Archives of gynecology and obstetrics, 2015. 292(6): p. 1295.
- Liang, Y., et al., Clinical characteristics of perineal endometriosis: A case series. World Journal of Clinical Cases, 2021. 9(5): p. 1037.
- Laadioui, M., et al., L’endométriose périnéale profonde sur cicatrice dépisiotomie: à propos d’un cas rare. The Pan African Medical Journal, 2013. 16.
- Dugarte, C.G.T., et al., Perineal endometrioma with anal sphincter involvement. Case report. Revista Mexicana de Coloproctología Enfermedades del Ano, Recto y Colon, 2011. 17(1): p. 25-29.
- Jayanthan, S.S., G. Shashikala, and N. Arathi, Perineal scar endometriosis. The Indian Journal of Radiology & Imaging, 2019. 29(4): p. 457.
- Matalliotakis, M., et al., Abdominal and perineal scar endometriosis: Retrospective study on 40 cases. European Journal of Obstetrics & Gynecology and Reproductive Biology, 2020. 252: p. 225-227.
- Liu, Y., et al., Characteristics and long-term outcomes of perineal endometriosis: A retrospective study. Medicine, 2020. 99(23).
- Bazot M. BC, C.A., Uzan S., Darạ E, Imagerie par résonance magnétique et endométriose. EMC-Gynécologie, 2007. 149(30): p. 1-9.
- Fitzpatrick, M., et al., A randomized clinical trial comparing primary overlap with approximation repair of third-degree obstetric tears. American journal of obstetrics and gynecology, 2000. 183(5): p. 1220-1224.
- Hitti, I.F., S.S. Glasberg, and S. Lubicz, Clear cell carcinoma arising in extraovarian endometriosis: report of three cases and review of the literature. Gynecologic oncology, 1990. 39(3): p. 314-320.
- Chene, G., et al., Malignant degeneration of perineal endometriosis in episiotomy scar, case report and review of the literature. International journal of gynecological cancer: official journal of the International Gynecological Cancer Society, 2007. 17(3): p. 709.
- Xu, S., W. Wang, and L.P. Sun, Comparison of clear cell carcinoma and benign endometriosis in episiotomy scar-two cases report and literature review. BMC women’s health, 2020. 20(1): p. 1-6.
Abstract
Introduction: Perineal endometriosis (PEM) greatly affects patients quality of life, especially chronic pelvic pain associated with menstruation. Around the world, there are many studies on endometriosis, but PEM is less mentioned. In Vietnam, there is no study that evaluates the results of surgical treatment for this disease.
Patients and methods:This was a descriptive, retrospective study of 16 patients operated for PEM at Viet Duc Hospital during the period 2019 – 2020.
Results: All 16 patients had a history of vaginal delivery and episiotomy. The mean incubation time was 50.6 ± 44.8 months. Among 16 patients operated for a complete resection of PEM mass, 7 patients presented with anal sphincter invasion requiring anal sphincter repair. The mean length of hospital stay was 8 ± 2.6 days. The average duration of follow-up was 17.43 months. 14/16 (87.5%) patients had good results. 2 patients (12.5%) had recurrence of the painful mass after surgery.
Conclusion: Surgical treatment of PEM, especially in patients with sphincter invasion, provided good results.
Keywords: Perineal endometriosis; Chronic perineal pain; Episiotomy; Anal sphincter.
References
- Zhu, L., et al., Presentation and management of perineal endometriosis. International Journal of Gynecology & Obstetrics, 2009. 105(3): p. 230-232.
- Le Tu Hoang and Nguyen Sy Lanh, perineal endometriosis at the perinal scar. Journal of practical medicine, 2005. 510(4): p. 64-66.
- Chen, N., et al., The clinical features and management of perineal endometriosis with anal sphincter involvement: a clinical analysis of 31 cases. Human reproduction, 2012. 27(6): p. 1624-1627.
- Li, J., et al., Diagnosis and treatment of perineal endometriosis: review of 17 cases. Archives of gynecology and obstetrics, 2015. 292(6): p. 1295.
- Liang, Y., et al., Clinical characteristics of perineal endometriosis: A case series. World Journal of Clinical Cases, 2021. 9(5): p. 1037.
- Laadioui, M., et al., L’endométriose périnéale profonde sur cicatrice dépisiotomie: à propos d’un cas rare. The Pan African Medical Journal, 2013. 16.
- Dugarte, C.G.T., et al., Perineal endometrioma with anal sphincter involvement. Case report. Revista Mexicana de Coloproctología Enfermedades del Ano, Recto y Colon, 2011. 17(1): p. 25-29.
- Jayanthan, S.S., G. Shashikala, and N. Arathi, Perineal scar endometriosis. The Indian Journal of Radiology & Imaging, 2019. 29(4): p. 457.
- Matalliotakis, M., et al., Abdominal and perineal scar endometriosis: Retrospective study on 40 cases. European Journal of Obstetrics & Gynecology and Reproductive Biology, 2020. 252: p. 225-227.
- Liu, Y., et al., Characteristics and long-term outcomes of perineal endometriosis: A retrospective study. Medicine, 2020. 99(23).
- Bazot M. BC, C.A., Uzan S., Darạ E, Imagerie par résonance magnétique et endométriose. EMC-Gynécologie, 2007. 149(30): p. 1-9.
- Fitzpatrick, M., et al., A randomized clinical trial comparing primary overlap with approximation repair of third-degree obstetric tears. American journal of obstetrics and gynecology, 2000. 183(5): p. 1220-1224.
- Hitti, I.F., S.S. Glasberg, and S. Lubicz, Clear cell carcinoma arising in extraovarian endometriosis: report of three cases and review of the literature. Gynecologic oncology, 1990. 39(3): p. 314-320.
- Chene, G., et al., Malignant degeneration of perineal endometriosis in episiotomy scar, case report and review of the literature. International journal of gynecological cancer: official journal of the International Gynecological Cancer Society, 2007. 17(3): p. 709.
- Xu, S., W. Wang, and L.P. Sun, Comparison of clear cell carcinoma and benign endometriosis in episiotomy scar-two cases report and literature review. BMC women’s health, 2020. 20(1): p. 1-6.