Belghiti Jérémie, Ballester Marcos, Zilberman Sonia, Thomin Anne, Zacharopoulou Chrysoula, Bazot Marc, Thomassin-Naggara Isabelle, Daraï Emile
Departments of Obstetrics and Gynecology, GRC 6-UPMC, Centre Expert En Endometriose (C3E), UMRS938, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris, Université-Pierre-et-Marie-Curie-Paris VI, Paris, France.
Department of Radiology, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris, Université-Pierre-et-Marie-Curie-Paris VI, Paris, France.
J Minim Invasive Gynecol. 2014 May-Jun;21(3):472-9. doi: 10.1016/j.jmig.2013.12.094. Epub 2013 Dec 28.
To evaluate the role of protective defunctioning stoma (PDS) on the occurrence of digestive tract complications after colorectal resection to treat endometriosis.
Prospective cohort study (Canadian Task Force classification II-2).
University hospital.
All patients undergoing segmental colorectal resection to treat colorectal endometriosis with and without PDS between 2003 and 2011 at Tenon University Hospital, Paris, France.
Patients were assessed at 1, 6, and 12 months postoperatively and each year thereafter. Median follow-up was 60 months. Of 198 patients included for analysis, 53 (27%) had PDS. Overall, 15 (7.5%) digestive tract complications occurred: 9 (4.5%) rectovaginal fistulas and 6 (3%) anastomotic leakages. All rectovaginal fistulas occurred in patients with a low colorectal anastomosis (p < .001) and 88% (8 of 9) in patients with a partial colpectomy (p < .001). PDS was associated with a decrease in the number of rectovaginal fistulas in women undergoing partial colpectomy and low colorectal resection from 27% to 15%, without reaching significance (p = .4). No anastomotic leakage occurred in patients with PDS.
Our results support that PDS can be omitted in patients with mid-colorectal anastomosis without partial colpectomy. In patients requiring partial colpectomy or partial colpectomy plus low colorectal anastomosis, PDS remains questionable.
评估预防性去功能造口（PDS）在结直肠切除术后治疗子宫内膜异位症时对消化道并发症发生情况的作用。
前瞻性队列研究（加拿大工作组分类II-2）。
大学医院。
2003年至2011年期间在法国巴黎Tenon大学医院接受节段性结直肠切除术治疗结直肠子宫内膜异位症的所有患者，分为有PDS组和无PDS组。
在术后1、6和12个月以及此后每年对患者进行评估。中位随访时间为60个月。纳入分析的198例患者中，53例（27%）有PDS。总体而言，发生了15例（7.5%）消化道并发症：9例（4.5%）直肠阴道瘘和6例（3%）吻合口漏。所有直肠阴道瘘均发生在低位结直肠吻合患者中（p<0.001），88%（9例中的8例）发生在部分阴道切除术患者中（p<0.001）。PDS与接受部分阴道切除术和低位结直肠切除术的女性直肠阴道瘘数量从27%降至15%相关，但未达到显著差异（p=0.4）。有PDS的患者未发生吻合口漏。
我们的结果支持，对于无部分阴道切除术的中位结直肠吻合患者可省略PDS。对于需要部分阴道切除术或部分阴道切除术加低位结直肠吻合的患者，PDS的作用仍存在疑问。
