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部分结肠切除术是子宫内膜异位症行结直肠切除术发生泌尿科并发症的一个危险因素。

Partial colpectomy is a risk factor for urologic complications of colorectal resection for endometriosis.

机构信息

Service de Gynécologie-Obstétrique, Hôpital Tenon, Paris, France.

出版信息

J Minim Invasive Gynecol. 2013 Jan-Feb;20(1):49-55. doi: 10.1016/j.jmig.2012.08.775. Epub 2012 Nov 4.

Abstract

STUDY OBJECTIVE

To evaluate urologic complications after colorectal resection for endometriosis.

DESIGN

Cohort study (Canadian Task Force classification II-2).

SETTING

Tertiary referral university hospital and expert center in endometriosis.

PATIENTS

One hundred sixty-six women with colorectal endometriosis proven by transvaginal sonography and magnetic resonance imaging.

INTERVENTION

Open or laparoscopic colorectal resection for endometriosis.

MEASUREMENTS AND MAIN RESULTS

Forty-four patients (26.5%) experienced at least 1 urologic complication, including infection. Eight patients (4.8%) experienced postoperative symptomatic hydronephrosis requiring ureteral stent in 3 cases, a percutaneous nephrostomy in 1 case, and expectant management for the last 4. Urologic fistulas occurred in 5 patients (3%). Postoperative voiding dysfunction requiring self-catheterization was observed in 48 patients (28.9%). With univariate analysis, a relationship was found between voiding dysfunction and partial colpectomy (p = .001) and American Society of Reproductive Medicine total score (p = .02), and between the occurrence of urinary fistula and the use of prophylactic ureteral catheterization (p = .015) and parametrectomy (p = .02). A relationship was found between postoperative symptomatic hydronephrosis and the use of prophylactic ureteral catheterization (p = .003).

CONCLUSION

Colorectal resection for endometriosis can lead to urologic complications, particularly for patients requiring partial colpectomy, of which patients need to be informed.

摘要

研究目的

评估子宫内膜异位症直肠结肠切除术的泌尿系统并发症。

设计

队列研究(加拿大任务组分类 II-2)。

地点

三级转诊大学医院和子宫内膜异位症专家中心。

患者

166 例经阴道超声和磁共振成像证实为直肠子宫内膜异位症的女性。

干预措施

开腹或腹腔镜直肠结肠切除术治疗子宫内膜异位症。

测量和主要结果

44 例(26.5%)至少发生 1 种泌尿系统并发症,包括感染。8 例(4.8%)患者术后出现症状性肾盂积水,3 例需要输尿管支架置入,1 例需要经皮肾造瘘术,4 例患者采取保守治疗。5 例(3%)发生泌尿系统瘘。48 例(28.9%)患者术后出现排尿功能障碍,需要自行导尿。单因素分析发现,排尿功能障碍与部分结肠切除术(p =.001)和美国生殖医学协会总评分(p =.02)有关,而尿瘘的发生与预防性输尿管置管(p =.015)和宫旁切除术(p =.02)有关。术后症状性肾盂积水与预防性输尿管置管(p =.003)有关。

结论

直肠结肠切除术治疗子宫内膜异位症可导致泌尿系统并发症,特别是对于需要部分结肠切除术的患者,需要告知患者这些风险。

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