Endometriosis Division, Obstetrics and Gynecological Department - Sao Paulo University, Sao Paulo, Brazil
Obstetrics and Gynecology, Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy.
Hum Reprod Update. 2015 May-Jun;21(3):329-39. doi: 10.1093/humupd/dmv003. Epub 2015 Jan 24.
Deep endometriosis invading the bowel constitutes a major challenge for the gynecologist. In addition to the greater impact on pain, the high incidence of surgical morbidity involved with bowel endometriosis poses a therapeutic dilemma for the surgeon. Intestinal involvement by deep endometriotic nodules has been estimated to occur in 8-12% of women with endometriosis. Individual and clinical factors, pre-operative morphologic characteristics from imaging, surgical considerations and impact on quality of life are critical variables that should be considered in determining the best therapeutic strategy for a patient with deep endometriosis involving the sigmoid and/or the rectum. Pre-operative planning is fundamental for defining the optimal therapeutic strategy; patient counseling of treatment options, and when surgery is indicated, involvement of a multidisciplinary surgical team is required.
The PubMed and Cochrane database were searched for all original and review articles published in English, French and Italian, until June 2014. Search terms included 'deep endometriosis', 'surgical and clinical approach', 'bowel disease', 'quality of life', 'management of deep endometriosis'. Special attention was paid to articles comparing features of discoid and segmental resection.
The rationale for the best therapeutic options for patients with deep endometriosis has been shown and an evidence-based treatment algorithm for determining when and which surgical intervention may be required is proposed. In deciding the best treatment option for patients with deep endometriosis involving the sigmoid and rectum, it is important to understand how the different clinical factors and pre-operative morphologic imaging affect the algorithm. Surgery is not indicated in all patients with deep endometriosis, but, when surgery is chosen, a complete resection by the most appropriate surgical team is required in order to achieve the best patient outcome.
In women with deep endometriosis, surgery is the therapy of choice for symptomatic patients when deep lesions do not improve with a medical treatment.
深部子宫内膜异位症侵犯肠道对妇科医生来说是一个重大挑战。除了对疼痛的影响更大外，肠道子宫内膜异位症较高的手术发病率给外科医生带来了治疗上的困境。深部子宫内膜异位症结节的肠道累及估计发生在 8-12%的子宫内膜异位症患者中。个体和临床因素、术前影像学形态特征、手术考虑因素以及对生活质量的影响是决定涉及乙状结肠和/或直肠深部子宫内膜异位症患者最佳治疗策略的关键变量。术前规划对于确定最佳治疗策略至关重要；对治疗方案的选择进行患者咨询，当需要手术时，需要多学科手术团队的参与。
检索了 PubMed 和 Cochrane 数据库中所有发表于 2014 年 6 月之前的英文、法文和意大利文的原始研究和综述文章。检索词包括“深部子宫内膜异位症”、“手术和临床方法”、“肠道疾病”、“生活质量”、“深部子宫内膜异位症的管理”。特别关注了比较盘状和节段切除术特征的文章。
为深部子宫内膜异位症患者的最佳治疗选择提供了依据，并提出了一种基于证据的治疗算法，用于确定何时以及哪种手术干预可能是必要的。在决定涉及乙状结肠和直肠的深部子宫内膜异位症患者的最佳治疗方案时，了解不同的临床因素和术前形态影像学如何影响算法非常重要。并非所有深部子宫内膜异位症患者都需要手术，但当选择手术时，需要由最合适的手术团队进行彻底切除，以获得最佳的患者结局。
对于有症状的深部子宫内膜异位症患者，当深部病变不能通过药物治疗改善时，手术是首选治疗方法。
