Endoscopica Malzoni, Center for Advanced Endoscopic Gynecologic Surgery, Avellino, Italy.
Endoscopica Malzoni, Center for Advanced Endoscopic Gynecologic Surgery, Avellino, Italy.
J Minim Invasive Gynecol. 2018 Nov-Dec;25(7):1231-1240. doi: 10.1016/j.jmig.2018.03.003. Epub 2018 Mar 12.
To assess the sensitivity and accuracy of combined transvaginal/ transabdominal ultrasonography (TV/TA US) for evaluation of deep infiltrating bowel endometriosis nodules measured after surgery.
Prospective study (Canadian Task Force classification II.1).
A center for advanced endoscopic gynecologic surgery.
All women undergoing laparoscopic surgery and scheduled for segmental resection for clinically suspected bowel endometriosis between January 2014 and December 2016.
In all women with clinically suspected bowel endometriosis, a US scan was performed before surgery to detect and measure the 3 diameters of bowel endometriotic lesions: longitudinal, anteroposterior, and transverse. These diameters were compared with those obtained by direct measurement on a fresh specimen. The sensitivity and specificity values of US evaluation were calculated, with 95% confidence intervals.
The sensitivity and specificity of TV/TA US in the 328 patients of this study were 100% when rectal endometriotic lesions were investigated. The specificity was 100%, whereas the sensitivity decreased to 91.4% when sigmoid lesions were investigated. Bowel muscularis infiltration was histologically confirmed in all cases in which endometriotic lesions were detected by US (284 of 284; 100%). All missed sigmoid lesions (12 of 296) were located >25 cm from the anal verge. The mean diameters of endometriotic nodules calculated by US evaluation and by direct measurement on the fresh specimen were 43.19 × 19.87 × 10.79 mm and 42.76 × 19.64 × 10.62 mm, respectively, with no statistically significant differences between the 2 methods.
We believe that US can be considered an accurate diagnostic technique for the evaluation of deep infiltrating bowel endometriosis when performed by a dedicated experienced sonographer in a specialized center.
评估经阴道/经腹超声（TV/TA US）联合用于评估手术后测量的深部浸润性肠子宫内膜异位症结节的敏感性和准确性。
前瞻性研究（加拿大任务组分类 II.1）。
先进内镜妇科手术中心。
所有 2014 年 1 月至 2016 年 12 月间因临床疑似肠子宫内膜异位症而行腹腔镜手术并计划行节段切除术的女性。
所有临床疑似肠子宫内膜异位症的女性在术前均行 US 扫描，以检测和测量肠子宫内膜异位症病变的 3 个直径：纵向、前后和横向。这些直径与新鲜标本上直接测量的直径进行比较。计算 US 评估的灵敏度和特异性值，置信区间为 95%。
在这项研究的 328 名患者中，直肠子宫内膜异位症病变的 TV/TA US 敏感性和特异性均为 100%。特异性为 100%，而当检测到乙状结肠病变时，敏感性下降至 91.4%。所有通过 US 检测到的子宫内膜异位症病变（284 例中的 284 例；100%）均证实存在肠肌层浸润。所有漏诊的乙状结肠病变（296 例中的 12 例）均位于距肛门 25cm 以外。US 评估和新鲜标本直接测量计算的子宫内膜异位症结节的平均直径分别为 43.19×19.87×10.79mm 和 42.76×19.64×10.62mm，两种方法之间无统计学差异。
我们认为，在专门中心由经验丰富的超声医师进行操作时，US 可作为评估深部浸润性肠子宫内膜异位症的一种准确诊断技术。
