Bray-Beraldo Fernando, Pereira Ana Maria Gomes, Gazzo Cláudia, Santos Marcelo Protásio, Lopes Reginaldo Guedes Coelho
Gastroenterology Surgery Service, Hospital do Servidor Público Estadual, São Paulo, SP, Brazil.
Ginecology Service, Hospital do Servidor Público Estadual, São Paulo, SP, Brazil.
Rev Bras Ginecol Obstet. 2018 Jul;40(7):390-396. doi: 10.1055/s-0038-1660827. Epub 2018 Jun 27.
To outline the demographic and clinical characteristics of patients with deep intestinal endometriosis submitted to surgical treatment at a tertiary referral center with a multidisciplinary team, and correlate those characteristics with the surgical procedures performed and operative complications.
A prospective cohort from February 2012 to November 2016 of 32 women with deep intestinal endometriosis operations. The variables analyzed were: age; obesity; preoperative symptoms (dysmenorrhea, dyspareunia, acyclic pain, dyschezia, infertility, urinary symptoms, constipation and intestinal bleeding); previous surgery for endometriosis; Enzian classification; size of the intestinal lesion; and surgical complications.
The mean age was 37.75 (±5.72) years. A total of 7 patients (22%) had a prior history of endometriosis. The mean of the largest diameter of the intestinal lesions identified intraoperatively was of 28.12 mm (±14.29 mm). In the Enzian classification, there was a predominance of lesions of the rectum and sigmoid, comprising 30 cases (94%). There were no statistically significant associations between the predictor variables and the outcome complications, even after the multiple logistic regression analysis. Regarding the size of the lesion, there was also no significant correlation with the outcome complications ( = 0.18; 95% confidence interval [95%CI]:0.94-1.44); however, there was a positive association between grade 3 of the Enzia classification and the more extensive surgical techniques: segmental intestinal resection and rectosigmoidectomy, with a prevalence risk of 4.4 ( < 0.001; 95%CI:1.60-12.09).
The studied sample consisted of highly symptomatic women. A high prevalence of deep infiltrative endometriosis lesions was found located in the rectum and sigmoid region, and their size correlated directly with the extent of the surgical resection performed.
概述在一家拥有多学科团队的三级转诊中心接受手术治疗的深部肠道子宫内膜异位症患者的人口统计学和临床特征，并将这些特征与所实施的手术程序及手术并发症相关联。
对2012年2月至2016年11月期间32例接受深部肠道子宫内膜异位症手术的女性进行前瞻性队列研究。分析的变量包括：年龄；肥胖；术前症状（痛经、性交困难、非周期性疼痛、排便困难、不孕、泌尿系统症状、便秘和肠道出血）；既往子宫内膜异位症手术史；恩齐安分类；肠道病变大小；以及手术并发症。
平均年龄为37.75（±5.72）岁。共有7例患者（22%）有子宫内膜异位症病史。术中确定的肠道病变最大直径平均值为28.12毫米（±14.29毫米）。在恩齐安分类中，直肠和乙状结肠病变占主导，共30例（94%）。即使经过多因素逻辑回归分析，预测变量与结局并发症之间也没有统计学上的显著关联。关于病变大小，与结局并发症也没有显著相关性（=0.18；95%置信区间[95%CI]：0.94 - 1.44）；然而，恩齐安分类3级与更广泛的手术技术（节段性肠切除和直肠乙状结肠切除术）之间存在正相关，患病率风险为4.4（<0.001；95%CI：1.60 - 12.09）。
所研究的样本由症状严重的女性组成。发现深部浸润性子宫内膜异位症病变在直肠和乙状结肠区域的患病率很高，其大小与所进行的手术切除范围直接相关。
