Department of Obstetrics and Gynecology, Gynecologic Oncology and Minimally Invasive Pelvic Surgery, International School of Surgical Anatomy, "Sacro Cuore-Don Calabria" Hospital, Negrar, Verona, Italy.
Department of Obstetrics and Gynecology, Gynecologic Oncology and Minimally Invasive Pelvic Surgery, International School of Surgical Anatomy, "Sacro Cuore-Don Calabria" Hospital, Negrar, Verona, Italy; Department of Medical, Surgery and Health Sciences, University of Trieste, Trieste, Italy.
J Minim Invasive Gynecol. 2019 Jan;26(1):78-86. doi: 10.1016/j.jmig.2018.03.031. Epub 2018 Apr 12.
To investigate the efficacy of laparoscopic ureteroneocystostomy in patients with deep infiltrating endometriosis (DIE) with ureteral, parametrial, and bowel involvement.
Prospective study (Canadian Task Force classification II-2).
Tertiary referral center for endometriosis care.
One hundred sixty patients with DIE underwent laparoscopic radical eradication and ureteroneocystostomy between January 2009 and December 2016.
Laparoscopic nerve-sparing radical treatment with ureteroneocystostomy, parametrectomy, and, if necessary, segmental bowel resection.
Surgical eradication was radical, and ureteral endometriosis was histologically confirmed in all patients (45.6% intrinsic and 54.4% extrinsic). In 58.7% of patients ureteroneocystostomy was performed with the psoas hitch technique. Bowel resection was performed in 121 patients (75.6%), and 115 of them had a concomitant ileostomy (71.9%). Unilateral parametrectomy was performed on the left side in 61.9% of patients and on the right side in 30% of patients, respectively, whereas bilateral parametrectomy was completed in 33 patients (20.6%). Postoperative complications were infrequent: 7 patients underwent reoperation (4.4%), 8 patients experienced fever (5%), 4 patients required blood transfusion (2.5%), 3 patients had intestinal fistulas (1.9%), and 24 patients experienced impaired bladder voiding (15%) after 6 months. Mean follow-up time was 20.5 months (range, 1-60). The study reported good clinical and surgical results, with a regression of symptoms (p < .001) and recurrence of parametrial endometriosis of 1.2% that required opposite-side ureteroneocystostomy.
This is the largest documented series of patients with DIE undergoing laparoscopic radical eradication and ureteroneocystostomy. The collected data show that in patients with ureteral endometriosis, this technique is feasible, effective, and safe and provides good results in terms of relapses and symptoms' control.
探讨腹腔镜输尿管-膀胱吻合术治疗合并输尿管、宫旁和肠道受累的深部浸润型子宫内膜异位症（DIE）的疗效。
前瞻性研究（加拿大任务组分类 II-2）。
子宫内膜异位症治疗的三级转诊中心。
2009 年 1 月至 2016 年 12 月期间，160 例 DIE 患者接受腹腔镜下根治性切除术和输尿管-膀胱吻合术。
腹腔镜下保留神经的根治性治疗，包括输尿管-膀胱吻合术、宫旁切除术，如果必要，还包括肠段切除术。
所有患者均行根治性手术，且输尿管子宫内膜异位症均经组织学证实（45.6%为内在型，54.4%为外在型）。在 58.7%的患者中，采用腰大肌悬带技术进行输尿管-膀胱吻合术。121 例患者（75.6%）行肠切除术，其中 115 例患者同时行回肠造口术（71.9%）。左侧单侧宫旁切除术在 61.9%的患者中进行，右侧单侧宫旁切除术在 30%的患者中进行，而双侧宫旁切除术在 33 例患者（20.6%）中进行。术后并发症少见：7 例患者（4.4%）需要再次手术，8 例患者（5%）发热，4 例患者（2.5%）需要输血，3 例患者（1.9%）发生肠瘘，24 例患者（15%）在术后 6 个月出现膀胱排空障碍。平均随访时间为 20.5 个月（范围：1-60）。研究报告了良好的临床和手术结果，症状缓解（p < .001），宫旁子宫内膜异位症复发率为 1.2%，需要对侧输尿管-膀胱吻合术。
这是最大的一组接受腹腔镜下根治性切除术和输尿管-膀胱吻合术的 DIE 患者系列研究。收集的数据表明，对于输尿管子宫内膜异位症患者，该技术是可行、有效和安全的，并且在复发和症状控制方面提供了良好的结果。
