Expert Center in the Diagnosis and Multidisciplinary Management of Endometriosis, Rouen University Hospital, Rouen, France.
Department of Surgery, Rouen University Hospital, Rouen, France.
Fertil Steril. 2018 Jan;109(1):172-178.e1. doi: 10.1016/j.fertnstert.2017.10.001.
To assess the postoperative complications related to three surgical procedures used in colorectal endometriosis: rectal shaving, disc excision, and segmental resection.
Retrospective comparative study using data prospectively recorded in the North-West Inter Regional Female Cohort for Patients with Endometriosis (CIRENDO) database.
University tertiary referral center.
PATIENT(S): A total of 364 consecutive patients with deep endometriosis infiltrating the rectosigmoid, were stratified into three arms according to the technique used.
INTERVENTION(S): All patients had a laparoscopic surgical procedure to treat bowel endometriosis: rectal shaving (145 patients), disc excision (80 patients), or segmental colorectal resection (139 patients).
MAIN OUTCOME MEASURE(S): Postoperative complication rate was assessed using Clavien-Dindo classification.
RESULT(S): Clavien 3b postoperative complications were recorded in 43 patients (11.8%), two thirds of whom were managed by segmental colorectal resection (P<.001). Fourteen cases of rectovaginal fistula (3.8%) were reported: three in the shaving arm (2.1%), three in the disc excision arm (3.7%), and eight in the segmental colorectal resection arm (5.8%) (P=.13). Twenty-four cases (6.6%) of pelvic abscess were recorded in patients free of fistula or leakage. One year after the surgery pregnancy rate (PRs) and delivery rate were comparable between patients with or without severe complications who intended to get pregnant. Three years postoperatively, the PR in infertile patients was 66.7%, with spontaneous conception in 50% of cases.
CONCLUSION(S): Our data suggest that using a strategy prioritizing shaving, whenever it is possible, could be related to a reduction in severe complication rates. However, prudence is required before concluding that extensive disease should not be treated by segmental resection because of the risk of complications.
评估直肠刮除术、病灶切除术和节段切除术 3 种结直肠子宫内膜异位症手术相关的术后并发症。
使用前瞻性记录在西北区域女性子宫内膜异位症患者队列研究（CIRENDO）数据库中的数据进行回顾性比较研究。
大学三级转诊中心。
共纳入 364 例直肠乙状结肠深部浸润型子宫内膜异位症患者，根据手术方式分为 3 组。
所有患者均接受腹腔镜手术治疗肠道子宫内膜异位症：直肠刮除术（145 例）、病灶切除术（80 例）或节段性结直肠切除术（139 例）。
采用 Clavien-Dindo 分级评估术后并发症发生率。
3 组术后均出现 43 例（11.8%）Clavien 3b 级并发症，其中 2/3 例为节段性结直肠切除术患者（P<.001）。共报道 14 例直肠阴道瘘（3.8%），其中 3 例在刮除术组（2.1%），3 例在病灶切除术组（3.7%），8 例在节段性结直肠切除术组（5.8%）（P=.13）。无瘘或漏的患者中，共记录 24 例（6.6%）盆腔脓肿。术后 1 年，有生育计划的严重并发症患者和无严重并发症患者的妊娠率（PR）和分娩率相当。术后 3 年，不孕患者的 PR 为 66.7%，其中 50%为自然受孕。
我们的数据表明，尽可能优先采用直肠刮除术的策略可能与降低严重并发症发生率有关。然而，在得出广泛病变不应因并发症风险而采用节段切除术的结论之前，需要谨慎。
