直肠子宫内膜异位症多学科诊治1例报告并文献复习

Multidisciplinary management of rectal endometriosis: a case report and literature review

摘要:

深部浸润型子宫内膜异位症（DIE）是指子宫内膜异位病灶浸润腹膜下≥5 mm，常累及宫骶韧带、阴道直肠隔、阴道穹隆及直肠壁等部位，因临床表现缺乏特异性、影像学特征不典型而易误诊。本研究报告1例术前经内镜超声引导下细针穿刺活检（EUS-FNA）确诊的直肠DIE患者，结合文献回顾，总结其多学科团队（MDT）诊治经验。患者为35岁女性，因排便困难入院，经MRI及EUS-FNA确诊为直肠DIE。经结直肠肛门外科、妇科及泌尿外科联合讨论后实施腹腔镜直肠病变切除、乙状结肠-直肠吻合及预防性回肠造口术，术后病理证实切缘阴性，4个月后成功还纳造口。随访21个月，患者症状明显缓解，未见复发。结果提示，EUS-FNA在DIE的早期诊断中具有重要价值，而以结直肠肛门外科为主导、妇科与泌尿外科协同的MDT模式可显著提高手术安全性和根治性，对复杂盆腔内异症的精准诊治具有重要指导意义。

Abstract:

Deep infiltrating endometriosis (DIE) is defined as endometriotic lesions infiltrating ≥5 mm beneath the peritoneum, commonly affecting the uterosacral ligaments, rectovaginal septum, vaginal vault, and rectal wall. Due to nonspecific clinical manifestations and atypical imaging features, DIE is often misdiagnosed. This study reports a case of rectal DIE diagnosed preoperatively by endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) and summarizes the multidisciplinary treatment experience in conjunction with a literature review. A 35-year-old woman was admitted for defecation difficulty. MRI and EUS-FNA confirmed rectal DIE. After multidisciplinary team (MDT) evaluation involving colorectal, gynecologic, and urologic specialists, laparoscopic resection of the rectal lesion, sigmoid-rectal anastomosis, and protective ileostomy were performed. Pathology confirmed rectal DIE with negative margins. The stoma was successfully reversed 4 months later, and no recurrence was observed during 21 months of follow-up. These findings highlight the pivotal role of EUS-FNA in early diagnosis and demonstrate that an MDT approach led by colorectal surgeons can significantly enhance surgical safety and completeness, providing valuable guidance for the individualized management of complex pelvic endometriosis.