Diguisto C, Hébert T, Paternotte J, Kellal I, Marret H, Ouldamer L, Body G
Service de gynécologie, obstétrique et médicine fœtale, centre hospitalo-universitaire de Tours, 2, boulevard Tonnellé, 37044 Tours cedex 9, France; Université François-Rabelais, 10, boulevard Tonnellé, BP 3223, 37032 Tours cedex 1, France.
Service de gynécologie, obstétrique et médicine fœtale, centre hospitalo-universitaire de Tours, 2, boulevard Tonnellé, 37044 Tours cedex 9, France.
Gynecol Obstet Fertil. 2015 Apr;43(4):266-70. doi: 10.1016/j.gyobfe.2015.02.006. Epub 2015 Mar 23.
To compare perioperative complications of two surgical methods for digestive endometriosis management: "shaving" and colorectal resection in robotic-assisted laparoscopy.
Twenty-eight women underwent robotic-assisted laparoscopy for digestive endometriosis, confirmed histologically. Six women had a digestive resection and twenty-one women had a shaving procedure. Short-term and long-term results and complications were compared between the two groups.
Operative time was significantly shorter (P=0.0002) and estimated blood loss was significantly lower (200 ml vs 560 ml, P=0.04) in the shaving procedure group in comparison with the resection group. We observed one conversion to laparotomy in the resection group and one case of bladder injury in the shaving group. Length of hospital stay was longer (P=0.0001) in the resection group than in the shaving group. At the two-month re-evaluation, there was no significant difference between the two groups for the number of women in full remission for pelvic pain, urinary or gastrointestinal symptoms or dyspareunia. Two women of the resection group reported functional gastrointestinal signs that persisted 24 months after the intervention.
Both immediate and delayed operative morbidity are more frequent in case of resection. Surgery for deep infiltrating endometriosis, even if operated with robotic assisted laparoscopy, is associated with significant morbidity.
比较机器人辅助腹腔镜下两种治疗消化道子宫内膜异位症的手术方法（“削除术”和结肠切除术）的围手术期并发症。
28名经组织学确诊为消化道子宫内膜异位症的女性接受了机器人辅助腹腔镜手术。6名女性接受了消化道切除术，21名女性接受了削除术。比较两组的短期和长期结果及并发症。
与切除组相比，削除术组的手术时间明显更短（P = 0.0002），估计失血量明显更低（200毫升对560毫升，P = 0.04）。我们观察到切除组有1例转为开腹手术，削除组有1例膀胱损伤。切除组的住院时间比削除组长（P = 0.0001）。在两个月的复查中，两组在盆腔疼痛、泌尿系统或胃肠道症状或性交困难完全缓解的女性人数方面没有显著差异。切除组有两名女性报告了干预后持续24个月的功能性胃肠道症状。
切除术后即时和延迟手术发病率更高。深部浸润性子宫内膜异位症的手术，即使是在机器人辅助腹腔镜下进行，也会有显著的发病率。
