Marty Noémie, Touleimat Salma, Moatassim-Drissa Salwa, Millochau Jenny Claude, Vallee Aurélie, Stochino Loi Emanuela, Desnyder Eulalie, Roman Horace
Expert Center in the Diagnosis and Multidisciplinary Management of Endometriosis, Rouen University Hospital, Rouen, France.
Expert Center in the Diagnosis and Multidisciplinary Management of Endometriosis, Rouen University Hospital, Rouen, France.
J Minim Invasive Gynecol. 2017 Nov-Dec;24(7):1121-1127. doi: 10.1016/j.jmig.2017.06.019. Epub 2017 Jun 30.
To evaluate postoperative complications, digestive function and fertility outcomes in patients managed by rectal shaving using plasma energy in deep infiltrating endometriosis of the rectum.
A single-center retrospective cohort study using data recorded prospectively.
Canadian Task Force classification II-2.
Department of Gynecology and Obstetrics of Rouen University Hospital (France).
One hundred and ten patients treated between December 2012 and December 2016.
Laparoscopic rectal shaving using plasma energy.
Clinical history, baseline symptoms, preoperative assessment, intraoperative findings, and postoperative outcomes were recorded prospectively. Follow-up evaluations were performed at 1 year and 3 years. Mean age of patients was 37 ± 6.4 years. Most patients had rectal nodules infiltrating either the mid or upper rectum and measuring <3 cm long. No intraoperative complications were recorded. One patient with multiple previous surgical procedures presented with a postoperative rectovaginal fistula (0.9%), and 1 patient presented with a postoperative rectouterine fistula treated exclusively with antibiotics (0.9%). Two patients (1.8%) had bladder atony necessitating ≥3 weeks of daily self-catheterization. Four patients (3.6%) had Clavien-Dindo grade I complications, 12 (10.9%) had grade II complications, 1 (0.9%) had a grade IIIa complication, 5 (4.5%) had grade IIIb complications, and 1 (0.9%) had a grade 4a complication. The vast majority of patients (n = 103 patients; 93.6%) were free of serious complications. Significant improvements in constipation and gastrointestinal quality of life were recorded at 1 year and 3 years postoperatively. Thirty-two patients attempted pregnancy after surgery (29.1%), and 17 of them conceived (53.1%).
Rectal shaving using plasma energy allows for a low rate of postoperative complications with good digestive function and fertility outcomes and appears to be suitable in selected women with symptomatic rectal endometriosis.
评估采用等离子体能量直肠削切术治疗直肠深部浸润性子宫内膜异位症患者的术后并发症、消化功能及生育结局。
一项单中心回顾性队列研究，使用前瞻性记录的数据。
加拿大工作组分类II-2。
鲁昂大学医院妇产科（法国）。
2012年12月至2016年12月期间接受治疗的110例患者。
采用等离子体能量进行腹腔镜直肠削切术。
前瞻性记录临床病史、基线症状、术前评估、术中发现及术后结局。在术后1年和3年进行随访评估。患者的平均年龄为37±6.4岁。大多数患者的直肠结节浸润直肠中上部，长度<3 cm。未记录到术中并发症。1例既往有多次手术史的患者出现术后直肠阴道瘘（0.9%），1例患者出现术后直肠子宫瘘，仅用抗生素治疗（0.9%）。2例患者（1.8%）出现膀胱无张力，需要每天自行导尿≥3周。4例患者（3.6%）出现Clavien-Dindo I级并发症，12例（10.9%）出现II级并发症，1例（0.9%）出现IIIa级并发症，5例（4.5%）出现IIIb级并发症，1例（0.9%）出现4a级并发症。绝大多数患者（n = 103例；93.6%）未出现严重并发症。术后1年和3年记录到便秘及胃肠道生活质量有显著改善。32例患者术后尝试妊娠（29.1%），其中17例受孕（成功率53.1%）。
采用等离子体能量直肠削切术术后并发症发生率低，消化功能及生育结局良好，似乎适用于有症状的直肠子宫内膜异位症的特定女性患者。
