Clinical Analysis And Literature Review Of Perianal Endometriosis

Objective:To retrospectively analyze the etiology,pathogenesis,clinical features,treatment and prognosis of perianal endometriosis to explore the diagnosis and treatment of perianal endometriosis,in order to provide a reference for clinical practice.Methods:Firstly we collect informations from 17 cases of perianal endometriosis who were hospitalized in anorectal department of Nanjing Traditional Chinese Medicine Hospital fom January 2006 to January 2016 January,and follow-up.Then is to search for literatures about perianal endometriosis which were published in the years from January 2000 to December 2016.According the inclusion and exclusion criteria to complete the screening,remove the repeated reports,and then further analysis of the data in the literature to determine whether the literature is included.Data mainly for the general situation of the case,clinical features,treatment and follow-up prognosis.All data were descriptive and analyed?Results:Firstly,11 cases were diagnosed as perianal endometriosis before the surgey,6 cases were diagnosed as perianal abscess and anal fistula,but finally turn out to be the perianal endometriosis.Eleven patients'lesions did not involve the anal sphincter,so resection was performed.No recurrence was observed after operation.Six patients had anal sphincter damaged(4cases of fistula),two cases which did not form the fistula cut the lesion completely(including some anal sphincter),take contraceptives for three months after the operation,no recurrence;4 patients with anal fistula just remove the lesion possibly without damage the anal function;Perianal endometriosis were confirmed after the surgey,they accepted gonadotropin-releasing hormone(GnRH)treatment for three months,3 cases of recurrence after treatment,1 case refused to re-surgery and decided to take contraceptive to relieve symptoms,the remainin cases take operation agian,and take GnRH for three months,no recurrence.Secondly,we take 67 articles which include 767 patients,95.7%of the patients had typical clinical symptoms,but 4.3%was not.Only 8.5%(65/767)of the patients had serum CA-125.The average diameter of the lesion was 2.64 � 0.97cm.All patients underwent surgical treatment.The lesion which involved with anal sphincter account for18.1%(138/767),the cure rate was 85.9%(659/767),the lose ratio of follow-up was 1.7%(13/767),the recurrence rate was 6.0%(46/767).40.4%patients use medicaine therapy.Conclusion:1 The clinical incidence of perianal endometriosis is low,may be associated with episiotomy(or laceration)when have vaginal delivery,intrauterine and/or perineal surgery and poor healing of lateral incision and so on.The Other relevant factors may be age,postpartum menstrual after delivery and postpartum breastfeeding time.2 Patients who have typical symptoms are easy to diagnose,if they are not,they need combine examinations such as Pelvic ultrasound?MRI or Aspiration cytology.3 The main treatment of perianal endometriosis is surgical resection of the lesionin,when lesions involving the anal sphincter need combine drug therapy,such as hormone therapy,traditional Chinese medicine and Chinese medicine retain enema.4 The recurrence of perianal may be related with misdiagnosis,and the incomplete resection,it is important to assess the patient's anal function before surgery again and avoid the fecal incontinence.