Nezhat C, Nezhat F, Pennington E
Department of Obstetrics and Gynecology, Mercer University School of Medicine, Macon, Georgia.
Br J Obstet Gynaecol. 1992 Aug;99(8):664-7. doi: 10.1111/j.1471-0528.1992.tb13851.x.
To present the technique and results of videolaparoscopy and the CO2 laser as a treatment for deep, infiltrative endometriosis of the rectovaginal septum, uterosacral ligaments, pouch of Douglas and anterior wall of the rectosigmoid colon.
Observational study with 1-5 year follow up.
Sub-specialty practice: Endometriosis clinic and centre for special pelvic surgery.
185 women, aged 25-41 years. All had pelvic endometriosis and were referred because of the failure of previous medical and/or surgical treatment.
Vaporization and excision of endometriotic implants and nodules, ureterolysis, ureteric stents, laparoscopic anterior rectal wall resection and reanastomosis, presacral neurectomy, laparoscopic hysterectomy, salpingo-oophorectomy and appendicectomy using the CO2 laser.
174 patients were followed for 1-5 years after surgery by office visit questionnaire or telephone interview. Eleven were lost to follow-up.
175 patients were discharged within 24 h. Nine with bowel perforations and one with a partial bowel resection were discharged 2-4 days postoperatively. Two patients required ureteric stents, which were removed 6 weeks postoperatively without sequelae. 162 women reported moderate to complete pain relief (145 after one procedure, 13 after two and four after three). 12 reported persistent or worse pain following the surgery. Seven eventually underwent total hysterectomy, four had bowel resections and one had a salpingo-oophorectomy. Of 61 with infertility, 25 achieved pregnancy. Postoperative complications included shoulder pain, anterior abdominal wall ecchymosis, urine retention and dyschezia for one to two weeks.
Our experience suggests that rectosigmoid colon and infiltrative rectovaginal septum endometriosis can be effectively treated via videolaparoscopy in the hands of experienced endoscopic gynaecologists.
介绍视频腹腔镜及二氧化碳激光治疗直肠阴道隔、子宫骶韧带、Douglas窝和直肠乙状结肠前壁深部浸润性子宫内膜异位症的技术及结果。
随访1 - 5年的观察性研究。
专科实践：子宫内膜异位症诊所及特殊盆腔手术中心。
185名年龄在25 - 41岁的女性。所有患者均患有盆腔子宫内膜异位症，因先前药物和/或手术治疗失败而转诊。
使用二氧化碳激光汽化和切除子宫内膜异位植入物及结节、输尿管松解术、输尿管支架置入、腹腔镜直肠前壁切除术及吻合术、骶前神经切除术、腹腔镜子宫切除术、输卵管卵巢切除术及阑尾切除术。
174例患者术后通过门诊问卷或电话访谈进行了1 - 5年的随访。11例失访。
175例患者在24小时内出院。9例肠穿孔患者和1例部分肠切除术患者术后2 - 4天出院。2例患者需要输尿管支架，术后6周取出，无后遗症。162名女性报告疼痛中度至完全缓解（145例一次手术后缓解，13例二次手术后缓解，4例三次手术后缓解）。12例报告术后疼痛持续或加重。7例最终接受了全子宫切除术，4例接受了肠切除术，1例接受了输卵管卵巢切除术。61例不孕患者中，25例成功怀孕。术后并发症包括肩部疼痛、前腹壁瘀斑、尿潴留和排便困难，持续一至两周。
我们的经验表明，在经验丰富的内镜妇科医生手中，通过视频腹腔镜可以有效治疗直肠乙状结肠和浸润性直肠阴道隔子宫内膜异位症。
