Mereu Liliana, Ruffo Giacomo, Landi Stefano, Barbieri Fabrizio, Zaccoletti Riccardo, Fiaccavento Andrea, Stepniewska Ania, Pontrelli Giovanni, Minelli Luca
Department of Obstetrics and Gynecology, Ospedale Sacro Cuore, Negrar-Verona, Italy.
J Minim Invasive Gynecol. 2007 Jul-Aug;14(4):463-9. doi: 10.1016/j.jmig.2007.02.008.
Adequate surgical treatment of severe deep endometriosis requires complete excision of all implants, but the modality of bowel resection is still debated. We describe the results of our experience as a tertiary care endometriosis referral center in complete laparoscopic management of deep pelvic endometriosis with bowel involvement.
A prospective single-center study (Canadian Task Force classification II-1).
In Sacro Cuore General Hospital of Negrar, Italy.
One hundred ninety-two women treated with laparoscopic excision of deep endometriosis and segmental colorectal resections were evaluated.
From January 2003 through December 2005 we registered all consecutive patients laparoscopically treated for deep endometriosis who also were having segmental bowel resection.
Data analysis included age, weight, body mass index, history of endometriosis, preoperative symptoms, parity, infertility, operative procedures, operating time, conversion, intraoperative and postoperative morbidity, recovery of bladder and bowel function, and discharge from hospital. We report our results in terms of feasibility and short-term morbidity. Radicality was achieved in 91.5% of patients. Laparoconversion occurred in 5 cases (2.6%). Major complications that required repeat operation occurred in 20 cases (10.4%): Nine anastomosis leakages (4.7%), 3 uroperitoneum (1.6%), 4 hemoperitoneum (2.1%), 1 pelvic abscess (0.5%), 1 bowel perforation, 1 intestinal obstruction, and 1 sepsis. Minor complications occurred in 50 patients (26%).
Laparoscopic segmental colorectal resection for endometriosis is feasible and, in hospitals with necessary experience, can be proposed to selected patients who are informed of the risk of complications.
对重度深部子宫内膜异位症进行充分的手术治疗需要完全切除所有植入物，但肠道切除术的方式仍存在争议。我们描述了作为三级医疗子宫内膜异位症转诊中心，在完全腹腔镜治疗累及肠道的深部盆腔子宫内膜异位症方面的经验结果。
一项前瞻性单中心研究（加拿大工作组分类II-1）。
意大利内格拉尔的圣心综合医院。
对192例行腹腔镜深部子宫内膜异位症切除术和节段性结直肠切除术的女性进行了评估。
从2003年1月至2005年12月，我们记录了所有连续接受腹腔镜治疗深部子宫内膜异位症且同时行节段性肠道切除术的患者。
数据分析包括年龄、体重、体重指数、子宫内膜异位症病史、术前症状、产次、不孕情况、手术操作、手术时间、中转开腹、术中及术后发病率、膀胱和肠道功能恢复情况以及出院情况。我们从可行性和短期发病率方面报告了结果。91.5%的患者实现了根治性切除。5例（2.6%）发生了腹腔镜中转开腹。需要再次手术的主要并发症发生在20例（10.4%）：9例吻合口漏（4.7%）、3例尿腹（1.6%）、4例腹腔积血（2.1%）、1例盆腔脓肿（0.5%）、1例肠穿孔、1例肠梗阻和1例脓毒症。50例患者（26%）发生了轻微并发症。
腹腔镜节段性结直肠切除术治疗子宫内膜异位症是可行的，在有必要经验的医院，可以向了解并发症风险的选定患者推荐该手术。
