| Objective:To retrospective analyze the etiological risk factors, clinical feature, treatment and prognosis in patients with perineal endometriosis (PEMs) and to explore the diagnosis and surgical treatment for PEMs in the aim of improving future prognosis.Methods:Primary Part:The research collected the clinical data of patient with PEMs in Qilu hospital of Shandong University from Jan 2006 to Dec 2014 and 11 cases was found followed with a follow-up investigation. A statistics was done to analyze the general conditions, clinical characteristics, therapeutic method and follow-up prognosis of the patients.Second Part:Search the article on PEMs in database including Pubmed, CNKI, Wangfang, Weipu with the publication years ranging from 2000 to 2014. After a primary screening depending on the titles and abstracts, we further evaluated the clinical data to select the article which met the criteria and read through the article to exclude the duplicate ones. We analyzed the data on general conditions, clinical feature, treatment and prognosis and used the case summary analysis to study the feature of PEMs and discuss the risk factors of PEMs in etiology, recurrence and prognosis.Results:First part result:All of the 11 patients were reproductive women with a mean age of 33.1 years old (range,23～43).10 patients had a history of episiotomy and 1 patient had no history of operation or trauma in perineum. The 10 patients has a mean latent period of 22.8 months(range,0-60), a mean breastfeeding time of 12.7 months(range,1.5-48) and a mean menses-return time of 7.9 months(range,2-12). Statistics analysis found no relationship among them. The diagnosis rate was 42.9% of serum CA125 but was 100% in imaging examination. Drug treatment was used in part of patients before and after surgery(54.5%,18.2%). The mean maximum lesion diameter was 3.3cm(range,1.5～6) and no potent relationship was found with disease course.2 cases of recurrence was found and its relationship with menses-return time was proved(P<0.05).Second part result:A total of 43 articles was included and found a mean age of 30.4 years old. Non-incisional PEMs accounted for 1.4% while 98.6% was incisional PEMs with a history of episiotomy(83.4%) or peirneal laceration(16.6%). Other factors included: poor healing(18.4%), artificial placental separation(29.1%), uterine curettage(23.9%). Mean latent time was 37.7months.97.2% patients had a classical symptom and other symptoms included:dyspareunia(11.1%), perianal pain(7.5%), ulceration(2.5%), local cyanosis(18.2%), atypical symptoms(2.8%).1.2% of patients suffered from dysmenorrhea. Only 15.0% of patients had a high level of serum CA125. And 17.3% of presurgery diagnosis was uncertain. PEMs lesions could be single(79.7%) or multiple(20.3%) and had a mean diameter of 2.4cm. Surgery was the first choice and the recurrent rate was 1.8%.Conclusion:1. PEMs has a low incidence rate and multiple relative factors including episiotomy, perineal laceration, operation during delivery, poor wound healing. Influential factors include patient age, breastfeeding time, menses-return time.2. Incisional PEMs has classical symptoms and is easy to diagnose. Non-incisional PEMs is rare and may be atypical which is difficult to identify. Pathological examination can help from differentiating.3. Serum CA125 has less diagnostic values but ultrasound examination in perineum works effectively. Pelvic ultrasound examination can find concurrent pelvic EMs. MRI or CT can help evaluate PEMs with large deep lesions or sever involvement of anal sphincter.4. Therapeutic plans should be made under a comprehensive consideration depending on patient age, operation contradictions, size of lesion et al. Surgery is the priority and a relative radical excision including surrounding fiber connective tissue is needed. Partial excision and repair of anal sphincter should be done in patients with anal sphincter involvement.5.Pseudomenopausal therapy can shrink the lesion and contribute to complete excision. Local treatment can help relieve symptoms on the condition of biopsy diagnose.6. Recurrence relates to misdiagnosis and lesion residual in surgery.7. Prevention of incisional PEMs depends on enhanced sense of isolation. |
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