腸管子宮内膜症の病態

Clinicopathological Aspect of Endometriosis of the Intestine

要旨　子宮内膜組織が異所性に腸管壁に増殖したものが腸管子宮内膜症である．本症が全子宮内膜症に占める率はそれほど多くないが，腸管の中では直腸・S状結腸に発生するものが大部分である．消化管症状を訴える性成熟期後期の女性においては注意を要する疾患で，月経・妊娠歴など婦人科的問診が大切である．診断面でもX線・内視鏡的検査において，悪性腫瘍，炎症性腸疾患などとの鑑別が困難なことがある．また，本症の癌化例があることにも注意を要する．治療としては病巣部の腸管切除が多く行われるが，子宮全摘・両側附属器摘除も同時に行う根治手術については，患者の年齢，妊娠の希望の有無など諸要因を考慮して選択を行わなければならない．

　Endometriosis is defined as the location of endometrial tissue in areas other than its normal location in the uterus. In some cases, endometrioma develop in the wall of the intestine. The intestine was involved in 13％ of cases of endometriosis (Masson 1945). The common sites of the intestinal endometriosis are the rectosigmoid, rectum and sigmoid colon.

　A history of sterility or decreased reproductive capacity, dysmenorrhea, menstrual irregularities and dyspareunia are common symptoms as well as bowel dysfunctions, such as rectal pain, irregular bowel habit and rectal bleeding. Bowel dysfunctions are aggravated at the time of menses. Also we should keep in mind intestinal endometriosis as an underlying disease of intestinal obstruction.

　This disease presents difficulty for correct diagnosis. From findings on endoscopic and x-ray examination, intestinal endometriosis is often misdiagnosed as carcinoma or inflammatory disease, especially as a constricting lesion.

　In addition, it is difficult to make a diagnosis of intestinal endometriosis by endoscopic biopsy, because the mucosal surface remains intact in most cases with this disorder.

　Treatment should be influenced by the age of the patient and whether future pregnancies are desired. Intestinal endometriosis may be treated by resection of the involved intestine preserving ovary and uterus in patients less than 40 years of age. In some cases, pre-and post-operative adjuvant hormonal therapy is useful for control of the disease.

　It is an important fact that there are several reports of intestinal endometriosis having transformed into carcinoma or sarcoma.