Roman Horace, Moatassim-Drissa Salwa, Marty Noemie, Milles Mathilde, Vallée Aurélie, Desnyder Eulalie, Stochino Loi Emanuela, Abo Carole
Expert Center for Diagnosis and Management of Endometriosis, Department of Gynecology and Obstetrics, Rouen University Hospital, Rouen, France; Research Group EA 4308 Spermatogenesis and Male Gamete Quality, IHU Rouen Normandy, IFRMP23, Reproductive Biology Laboratory, Rouen University Hospital, Rouen, France.
Expert Center for Diagnosis and Management of Endometriosis, Department of Gynecology and Obstetrics, Rouen University Hospital, Rouen, France.
Fertil Steril. 2016 Nov;106(6):1438-1445.e2. doi: 10.1016/j.fertnstert.2016.07.1097. Epub 2016 Aug 23.
To report postoperative outcomes after rectal shaving for deep endometriosis infiltrating the rectum.
Retrospective study using data prospectively recorded in the CIRENDO database.
University tertiary referral center.
PATIENT(S): One hundred and twenty-two consecutive patients whose follow-up observation ranged from 1 to 6 years.
INTERVENTION(S): Rectal shaving performed using ultrasound scalpel or scissors and plasma energy in 68 and 54 women, respectively.
MAIN OUTCOME MEASURE(S): Postoperative digestive function assessed using standardized gastrointestinal questionnaires: the Gastrointestinal Quality of Life Index (GIQLI) and the Knowles-Eccersley-Scott-Symptom Questionnaire (KESS).
RESULT(S): Nodules were between 1 and 3 cm, <1 cm, and >3 cm in diameter, in 73.7%, 11.5%, and 14.8% of cases, respectively. They were located on the middle (49.2%) and upper rectum (50.8%). Clavien-Dindo 3a, 3b, 4a, and 4b complications occurred in 0.8%, 5.7%, 1.6%, and 0.8% of cases, respectively. Excepting two rectal fistulas (1.6%), the majority of complications were not related to rectal shaving itself. Gastrointestinal scores revealed statistically significant improvement in digestive function and pelvic pain at 1 and 3 years after rectal shaving, but not constipation. Rectal recurrences occurred in 4% of patients, 2.4% of whom had segmental resection, 0.8% shaving, and 0.8% disc excision. Three years postoperatively, the pregnancy rate was 65.4% among patients with pregnancy intention, 59% of whom conceived spontaneously.
CONCLUSION(S): Our data suggest that rectal shaving is a valuable treatment for deep endometriosis infiltrating the rectum, providing a low rate of postoperative complications, good improvement in digestive function, and satisfactory fertility outcomes.
报告直肠深部浸润性子宫内膜异位症行直肠削除术后的结局。
利用前瞻性记录在CIRENDO数据库中的数据进行回顾性研究。
大学三级转诊中心。
122例连续患者，随访观察时间为1至6年。
分别对68例和54例女性使用超声刀或剪刀及等离子能量进行直肠削除。
使用标准化胃肠道问卷评估术后消化功能：胃肠道生活质量指数（GIQLI）和诺尔斯-埃克斯利-斯科特症状问卷（KESS）。
结节直径在1至3厘米、小于1厘米和大于3厘米的病例分别占73.7%、11.5%和14.8%。它们位于直肠中部（49.2%）和上部（50.8%）。Clavien-Dindo 3a、3b、4a和4b级并发症分别发生在0.8%、5.7%、1.6%和0.8%的病例中。除两例直肠瘘（1.6%）外，大多数并发症与直肠削除本身无关。胃肠道评分显示，直肠削除术后1年和3年消化功能和盆腔疼痛有统计学意义的改善，但便秘无改善。4%的患者出现直肠复发，其中2.4%接受节段性切除，0.8%接受削除，0.8%接受盘状切除。术后三年，有妊娠意愿的患者妊娠率为65.4%，其中59%为自然受孕。
我们的数据表明，直肠削除是治疗直肠深部浸润性子宫内膜异位症的一种有价值的方法，术后并发症发生率低，消化功能有良好改善，生育结局令人满意。
