Roman H
Expert Center in the Diagnosis and Multidisciplinary Management of Endometriosis, Department of gynecology and obstetrics, Rouen university hospital, 1, rue de Germont, 76031 Rouen, France; Research Group EA 4308 'Spermatogenesis and Male Gamete Quality', IHU Rouen Normandy, IFRMP23, Reproductive Biology Laboratory, Rouen University Hospital, Rouen, France.
J Gynecol Obstet Hum Reprod. 2017 Feb;46(2):159-165. doi: 10.1016/j.jogoh.2016.09.004. Epub 2017 Jan 30.
To perform a survey on the characteristics of the surgical management of patients with deep infiltrating endometriosis of the rectum and the sigmoid colon (DIERS) in France in 2015.
Case-series study enrolling patients with DIERS involving muscularis, submucosa or mucosa, operated on from January 1st to December 31st 2015, in 56 healthcare facilities in France. Surgeons filled in questionnaires concerning the number of patients, deep endometriosis localizations, surgical route and techniques used on digestive tract, associated surgical procedures and major complications. Data were pooled in a single database.
A total of 1135 patients from 56 healthcare facilities were enrolled in the series (33 university hospitals, 4 general hospitals and 19 private hospitals). Deep endometriosis infiltrated only the rectum in 56.8% of cases, the rectum and the sigmoid colon in 36.3% and only the sigmoid colon in 6.9%. Associated localizations involved the cecum in 6.6% of cases, small bowel in 4.7%, bladder in 9%, and were responsible for stenosis of the ureters in 13.4% and for hydronephrosis in 6.8%. Surgery was performed using conventional laparoscopy in 82.2% of cases, robotic-assisted laparoscopy in 9.7% and open surgery in 8.1%. Rectal shaving was carried out in 48.1% of cases, disc excision in 7.3%, colorectal segmental resection in 40.4% and sigmoid colon segmental resection in 6.4% (2 different procedures could be associated in the same patient). Ureter resection was carried out in only 4% of cases, representing 29.6% of cases with stenosis of the ureters. Bladder resection was carried out in 6.9%. Vaginal resection and hysterectomy were performed in 33 and 14.7% of cases respectively, while temporary stoma was used in 19.1%. Anastomotic leakage occurred in 0.8% of cases, pelvic abscess in 3.4%, rectovaginal fistula in 2.7%, ureter fistula in 0.7%, while 8.6% of patients either required catheterization after recovery or had a post-voiding bladder volume superior to 100mL. According to the surgical procedure used, the risk of rectovaginal fistula was 1.3, 3.6 and 3.9% after shaving, disc excision and segmental resection respectively. Intensive care was required in 1.1% and blood transfusion in 2.2%. One patient died (0.1%) after rectal shaving.
Our 2015 survey of a large number of patients managed for DIERS in France confirms that DIERS is far from being a rare disease. Even in the setting of complex procedures requiring multidisciplinary teams, a laparoscopic approach can achieve successful surgical treatment in 9 out of 10 patients with an acceptable risk of major postoperative complications.
对2015年法国直肠和乙状结肠深部浸润性子宫内膜异位症（DIERS）患者的手术治疗特点进行一项调查。
病例系列研究，纳入2015年1月1日至12月31日在法国56家医疗机构接受手术治疗的累及肌层、黏膜下层或黏膜的DIERS患者。外科医生填写有关患者数量、深部子宫内膜异位症的部位、消化道手术途径及技术、相关手术操作和主要并发症的问卷。数据汇总至单一数据库。
该系列研究共纳入来自56家医疗机构的1135例患者（33家大学医院、4家综合医院和19家私立医院）。深部子宫内膜异位症仅累及直肠的病例占56.8%，累及直肠和乙状结肠的占36.3%，仅累及乙状结肠的占6.9%。相关部位累及盲肠的病例占6.6%，小肠占4.7%，膀胱占9%，导致输尿管狭窄的占13.4%，肾积水的占6.8%。82.2%的病例采用传统腹腔镜手术，9.7%采用机器人辅助腹腔镜手术，8.1%采用开放手术。48.1%的病例进行了直肠剥除术，7.3%进行了盘状切除术，40.4%进行了结直肠节段切除术，6.4%进行了乙状结肠节段切除术（同一患者可能采用2种不同手术方式）。仅4%的病例进行了输尿管切除术，占输尿管狭窄病例的29.6%。6.9%的病例进行了膀胱切除术。33%和14.7%的病例分别进行了阴道切除术和子宫切除术，19.1%的病例使用了临时造口。吻合口漏发生率为0.8%，盆腔脓肿为3.4%，直肠阴道瘘为2.7%，输尿管瘘为0.7%，8.6%的患者恢复后需要导尿或残余尿量超过100mL。根据所采用的手术方式，直肠剥除术、盘状切除术和节段切除术后直肠阴道瘘的风险分别为1.3%、3.6%和3.9%。1.1%的患者需要重症监护，2.2%的患者需要输血。1例患者在直肠剥除术后死亡（0.1%）。
我们2015年对法国大量DIERS患者的调查证实，DIERS远非罕见疾病。即使在需要多学科团队参与的复杂手术中，腹腔镜手术方法也能使十分之九的患者获得成功的手术治疗，且术后主要并发症风险可接受。
