Expert Center in the Diagnosis and Multidisciplinary Management of Endometriosis, Rouen University Hospital, Rouen, France.
Department of Gynecology and Obstetrics, Nantes University Hospital, Nantes, France.
Fertil Steril. 2018 Jun;109(6):1079-1085.e1. doi: 10.1016/j.fertnstert.2018.02.124.
To report postoperative outcomes after surgery for deep endometriosis without involvement of the digestive or urinary tracts.
Retrospective 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): One hundred thirty consecutive patients whose follow-up ranged from 1 to 6 years.
INTERVENTION(S): Laparoscopic excision of deep endometriosis nodules.
MAIN OUTCOME MEASURE(S): Postoperative complications were recorded in the CIRENDO database and medical charts. Postoperative digestive function was assessed using standardized gastrointestinal questionnaires: the Gastrointestinal Quality of Life Index and the Knowles-Eccersley-Scott Symptom Questionnaire.
RESULT(S): Deep endometriosis nodules involved uterosacral ligaments, rectovaginal space, and vagina and spared the bowel, the bladder, and the ureters. Nodule size was <1 cm, 1-3 cm, and >3 cm in diameter in 20.8%, 64.6%, and 14.6% of cases, respectively. Clavien-Dindo 1, 2, and 3b complications occurred in 0.8%, 4.6%, and 5.4% of cases, respectively. Among Clavien-Dindo 3b complications, most involved pelvic hematoma. Gastrointestinal scores revealed significant improvement in digestive function or defecation pain at 1 and 3 years after surgery. The pregnancy rate was, respectively, 43.3% and 56.7% at 1 and 3 years postoperatively, among which 66.7% and 64.7% were spontaneous conceptions.
CONCLUSION(S): Our data suggest that surgery for deep endometriosis without involvement of the digestive or urinary tracts provides a low rate of postoperative complications and satisfactory fertility outcomes.
报告不涉及消化道或泌尿道的深部子宫内膜异位症手术后的结果。
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（CIRENDO）数据库中的数据进行回顾性研究。
大学三级转诊中心。
130 例连续患者，随访时间从 1 年到 6 年不等。
腹腔镜切除深部子宫内膜异位症结节。
CIRENDO 数据库和病历中记录了术后并发症。使用标准化胃肠道问卷：胃肠道生活质量指数和 Knowles-Eccersley-Scott 症状问卷评估术后消化功能。
深部子宫内膜异位症结节累及子宫骶韧带、直肠阴道间隙和阴道，未累及肠、膀胱和输尿管。结节大小分别为<1cm、1-3cm 和>3cm 的比例分别为 20.8%、64.6%和 14.6%。Clavien-Dindo 1、2 和 3b 并发症的发生率分别为 0.8%、4.6%和 5.4%。在 3b 级并发症中，大多数为盆腔血肿。术后 1 年和 3 年的胃肠道评分显示消化功能或排便疼痛显著改善。术后 1 年和 3 年的妊娠率分别为 43.3%和 56.7%，其中 66.7%和 64.7%为自然妊娠。
我们的数据表明，不涉及消化道或泌尿道的深部子宫内膜异位症手术可降低术后并发症发生率并获得满意的生育结局。
