Daraï E, Bazot M, Rouzier R, Coutant C, Ballester M
Service de gynécologie-obstétrique, université Pierre-et-Marie-Curie-Paris-6, hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France.
Gynecol Obstet Fertil. 2008 Dec;36(12):1214-7. doi: 10.1016/j.gyobfe.2008.09.010. Epub 2008 Nov 13.
Endometriosis is a common gynaecological condition affecting 10 to 15% of the female population. Deep infiltrating endometriosis (DIE) is diagnosed in 20% of women with endometriosis. Moreover, bowel endometriosis is found in five to 12% of patients with endometriosis. Colorectum represents 90% of all bowel locations. For women with infertility associated with colorectal endometriosis, no predictive criteria of fertility outcome are available. In a literature review, the pregnancy rate after colorectal resection reached 63%. These results, particularly high, raise the issue on legitimacy of colorectal resection in infertile women. Recent studies suggest that predictive criteria of success after colorectal resection are; a young age; a low American Society of Reproductive Medicine (ASRM) score and the laparoscopic route. In contrast, the presence of adenomyosis appears a negative predictive factor of fertility outcome. Despite encouraging results on the fertility of colorectal resection for endometriosis, only studies comparing the results of assisted reproductive therapy to those of surgery are required to identify good candidates for surgery.
子宫内膜异位症是一种常见的妇科疾病,影响着10%至15%的女性人群。20%的子宫内膜异位症女性被诊断为深部浸润性子宫内膜异位症(DIE)。此外,5%至12%的子宫内膜异位症患者存在肠道子宫内膜异位症。结肠直肠占所有肠道发病部位的90%。对于患有与结肠直肠子宫内膜异位症相关不孕症的女性,目前尚无生育结局的预测标准。在一项文献综述中,结肠直肠切除术后的妊娠率达到了63%。这些结果,尤其是较高的结果,引发了关于不育女性进行结肠直肠切除术合理性的问题。最近的研究表明,结肠直肠切除术后成功的预测标准是:年龄较轻;美国生殖医学学会(ASRM)评分较低以及采用腹腔镜手术途径。相比之下,子宫腺肌病的存在似乎是生育结局的一个负面预测因素。尽管结肠直肠切除治疗子宫内膜异位症对生育有令人鼓舞的结果,但仍需要进行将辅助生殖治疗结果与手术结果进行比较的研究,以确定手术的合适候选者。