Rausei Stefano, Sambucci Daniele, Spampatti Sebastiano, Cassinotti Elisa, Dionigi Gianlorenzo, David Giulia, Ghezzi Fabio, Uccella Stefano, Boni Luigi
Minimally Invasive Research Center, University of Insubria, Via Guicciardini 9, 21100, Varese, Italy.
Department of Obstetrics and Gynecology, University of Insubria, Varese, Italy.
Surg Endosc. 2015 Oct;29(10):2904-9. doi: 10.1007/s00464-014-4018-4. Epub 2014 Dec 9.
The short-term results of a retrospective consecutive series of multidisciplinary laparoscopic approach to deep infiltrating endometriosis with intestinal involvement requiring segmental bowel resection procedures are presented.
Patients with radiologically or intraoperative-confirmed endometriosis, who underwent a combined laparoscopic segmental bowel resection by a team of gynecologists and colorectal surgeons, were retrospectively reviewed. The postoperative data were collected in a specific database and analyzed for short-term (30 days) postoperative outcomes with the comparison between two specimen's extraction methods.
Forty-one patients (median age of 36 years, range 25-44) have been operated by a combined team of gynecologist and colorectal surgeons. The median operative time was 247.5 min (range 155-375), and median estimated blood loss was 300 ml (range 100-1300). In 20 patients, the surgical specimens were extracted transvaginally, while in 21 cases, a sovrapubic transverse Pfannenstiel minilaparotomy was used. No intraoperative complications or conversion to laparotomy were reported. An acceptable cumulative rate of postoperative morbidity was observed (6/41, 15 %), without any postoperative deaths. Comparing the two subgroups of patients with different modalities of specimen retrieval, postoperative pain (assessed by visual analog scale) was significantly reduced in the transvaginal extraction group (median: 1 and range: 0-2 vs median: 3, 5 and range: 1-6; p = 0.002), without any statistically significant differences in terms of complications.
Laparoscopic bowel segmental resection combined with gynecologic surgery for deep infiltrating endometriosis with intestinal involvement is a valid treatment option with a low rate of postoperative complications. Transvaginal specimen extraction allows the same results of minilaparotomic incision, minimizing surgical trauma and warranting a clear benefit in terms of reduction of postoperative pain.
本文介绍了一系列对累及肠道、需行节段性肠切除的深部浸润性子宫内膜异位症患者采用多学科腹腔镜方法进行治疗的短期结果。
对经放射学检查或术中确诊为子宫内膜异位症、由妇科医生和结直肠外科医生团队联合进行腹腔镜节段性肠切除的患者进行回顾性研究。术后数据收集于特定数据库，并分析短期（30天）术后结果，同时比较两种标本取出方法。
41例患者（中位年龄36岁，范围25 - 44岁）接受了妇科医生和结直肠外科医生联合团队的手术。中位手术时间为247.5分钟（范围155 - 375分钟），中位估计失血量为300毫升（范围100 - 1300毫升）。20例患者经阴道取出手术标本，21例采用耻骨上横向Pfannenstiel小切口剖腹术。未报告术中并发症或中转开腹情况。观察到术后发病率累积率可接受（6/41，15%），无术后死亡病例。比较不同标本取出方式的两组患者，经阴道取出组术后疼痛（采用视觉模拟评分法评估）明显减轻（中位值：1，范围：0 - 2 对比中位值：3.5，范围：1 - 6；p = 0.002），并发症方面无统计学显著差异。
对于累及肠道的深部浸润性子宫内膜异位症，腹腔镜肠段切除联合妇科手术是一种有效的治疗选择，术后并发症发生率低。经阴道取出标本与小切口剖腹术效果相同，可最大程度减少手术创伤，并在减轻术后疼痛方面有明显益处。
