Hidaka Takao, Nakashima Akitoshi, Hashimoto Yoshiko, Saito Shigeru
Department of Obstetrics and Gynecology, Faculty of Medicine, University of Toyama, Toyama, Japan.
Minim Invasive Ther Allied Technol. 2012 Sep;21(5):355-61. doi: 10.3109/13645706.2011.617758.
Deep endometriosis is associated with severe painful symptoms that sometimes impair the quality of life in women of reproductive age. Medical therapy does not provide for adequate pain relief, and an effective management option to reduce pelvic pain appears to be complete laparoscopic removal of as many endometriotic lesions as possible. In this study, we investigated the usefulness and risks of radical laparoscopic removal of deep endometriosis for patients diagnosed as stage III/IV endometriosis during laparoscopic surgery. Forty-seven consecutive patients undergoing conservative laparoscopic surgery alone (adhesiotomy and cystectomy of ovarian endometriosis but not removal of deep endometriotic lesion; non-DEL removal group) and 151 consecutive patients undergoing radical laparoscopic removal of deep endometriotic lesions combined with conservative surgery (DEL removal group) were compared. As a result, significant improvements in pain were obtained in both groups, however, the degree of improvement was significantly higher and the rate of recurrence was significantly lower in the DEL removal group. The addition of radical removal of deep endometriotic lesions to conservative laparoscopic surgery markedly reduces the severity of dysmenorrhea and the rate of recurrent pelvic pain. Although the surgical procedure is technically demanding, the levels of peri-operative complications and morbidity are acceptable.
深部子宫内膜异位症与严重的疼痛症状相关，有时会损害育龄期女性的生活质量。药物治疗无法提供充分的疼痛缓解，而一种有效的减轻盆腔疼痛的管理选择似乎是通过腹腔镜尽可能彻底地切除子宫内膜异位病变。在本研究中，我们调查了对于在腹腔镜手术中被诊断为III/IV期子宫内膜异位症的患者，根治性腹腔镜切除深部子宫内膜异位症的有效性和风险。比较了47例仅接受保守性腹腔镜手术的连续患者（粘连松解术和卵巢子宫内膜异位症囊肿切除术，但不切除深部子宫内膜异位病变；非深部子宫内膜异位病变切除组）和151例接受深部子宫内膜异位病变根治性腹腔镜切除联合保守手术的连续患者（深部子宫内膜异位病变切除组）。结果，两组患者的疼痛均有显著改善，然而，深部子宫内膜异位病变切除组的改善程度显著更高，复发率显著更低。在保守性腹腔镜手术中增加深部子宫内膜异位病变的根治性切除可显著降低痛经的严重程度和复发性盆腔疼痛的发生率。尽管该手术操作在技术上要求较高，但围手术期并发症和发病率水平是可接受的。
