Benbara A, Fortin A, Martin B, Palazzo L, Le Tohic A, Madelenat P, Yazbeck C
Service de gynécologie-obstétrique, hôpital Bichat Claude-Bernard, AP-HP, 46, rue Henri-Huchard, 75018 Paris, France.
Gynecol Obstet Fertil. 2008 Dec;36(12):1191-201. doi: 10.1016/j.gyobfe.2008.09.016. Epub 2008 Nov 18.
Indications of colorectal resection for endometriosis are controversial because of the risk of major complications. This study aims to evaluate the value of different diagnostic tests in decision-making, and to evaluate the surgical results and complications, as well as long-term functional results after surgery.
In the set of a retrospective case series, 50 patients who have been admitted for a colorectal resection because of deep endometriosis were included. Most of them have had an MRI and an endorectal ultrasonography. Specific questionnaires have been proposed in order to evaluate symptoms, sexuality (BISF-W) and quality of life (EHP-30).
For the diagnosis of rectal involvement, the sensitivity of MRI and endorectal ultrasonography were 55 and 100%, respectively. Forty-one colorectal amputations and nine partial colorectal resections have been done by 24 laparotomies, two laparoscopies and 24 laparoconversions. Major complications included six (12.5%) digestive fistulas, three (6%) anastomotic strictures, one ureterovaginal fistula and one ureteral stricture. Risk factors associated with digestive fistulas were the association of a vaginal opening (p=0.002) and an additional ileocaecal resection (p=0.007). The mean follow-up period was of 42 months. A significant improvement of dysmenorrhea (p<10(-4)), dyschesia (p<10(-4)), chronic pelvic pain (p<10(-4)), and of some digestive symptoms such as catamenial epreintes (p=0.002) and catamenial diarrheas (p=0.006), was noted. We noted postoperative 14 dysurias, six constipations and 12 rectal polykynesias. Four patients have had deep recurrent lesions. Twenty patients had a desire of pregnancy after the operation, 17 pregnancies were obtained (eight spontaneous and nine by ART) giving birth to 14 living children. Sexuality evaluation was below normal range. The quality of life was improved for most of the items. The global satisfaction was good (91%).
Colorectal resection for deep endometriosis improve significantly most of the pain symptoms, but the women should have detailed counselling about the risks of major complications and recurrence.
由于存在严重并发症风险，子宫内膜异位症行结直肠切除术的指征存在争议。本研究旨在评估不同诊断检查在决策中的价值，评估手术结果和并发症，以及术后的长期功能结果。
在一项回顾性病例系列研究中，纳入了50例因深部子宫内膜异位症而接受结直肠切除术的患者。他们中的大多数人接受了磁共振成像（MRI）和直肠内超声检查。为了评估症状、性功能（BISF-W）和生活质量（EHP-30），提出了特定的问卷。
对于直肠受累的诊断，MRI和直肠内超声检查的敏感性分别为55%和100%。通过24例开腹手术、2例腹腔镜手术和24例中转开腹手术完成了41例结直肠切除术和9例部分结直肠切除术。主要并发症包括6例（12.5%）消化瘘、3例（6%）吻合口狭窄、1例输尿管阴道瘘和1例输尿管狭窄。与消化瘘相关的危险因素是阴道开口合并（p=0.002）和额外的回盲部切除术（p=0.007）。平均随访期为42个月。痛经（p<10⁻⁴）、排便困难（p<10⁻⁴）、慢性盆腔疼痛（p<10⁻⁴）以及一些消化症状如经期便血（p=0.002）和经期腹泻（p=0.006）均有显著改善。术后我们记录到14例排尿困难、6例便秘和12例直肠坠胀感。4例患者出现深部复发病变。20例患者术后有妊娠意愿，获得17次妊娠（8次自然妊娠和9次辅助生殖技术妊娠），产下14名存活婴儿。性功能评估低于正常范围。大多数项目的生活质量得到改善。总体满意度良好（91%）。
深部子宫内膜异位症行结直肠切除术可显著改善大多数疼痛症状，但应向女性详细咨询严重并发症和复发的风险。
