Endometriosis Centre Charité, Department of Gynaecology, Charité, Campus Virchow Clinic, Berlin, Germany (Drs. Abesadze, Sehouli, Mechsner, and Chiantera).
Endometriosis Centre Charité, Department of Gynaecology, Charité, Campus Virchow Clinic, Berlin, Germany (Drs. Abesadze, Sehouli, Mechsner, and Chiantera).
J Minim Invasive Gynecol. 2020 Jul-Aug;27(5):1103-1111. doi: 10.1016/j.jmig.2019.08.019. Epub 2019 Aug 23.
Beside the pain, there are 2 further problems in the management of endometriosis: the high recurrence rate (10% per year) and the high rate of impaired fertility. The objective of this study was to investigate the pathogenesis of these 2 factors.
This is a retrospective cohort study, and the aim is to evaluate the complete excision of endometriotic lesions, including the posterior compartment of the peritoneum, with regard to postoperative outcome, focusing on relieving pain, increasing fertility rate, and decreasing recurrence rate.
Charité-University Clinic, Department of Gynaecology, Endometriosis research Centre.
Fifty-four patients were enrolled in this study, with severe deep infiltrating endometriosis (scored by ENZIAN) and superficial endometriosis, as well as endometriomas (revised American Society for Reproductive Medicine [rASRM] I = 3; II = 15; III = 10; and IV = 26).
Posterior compartment peritonectomy (visible endometriotic lesions and inflamed altered peritoneum) was performed in all patients as part of a complex surgery: complete excision of endometriosis.
Postoperative outcomes were evaluated, based on the postoperative follow-up (up to 5 years) of 54 investigated patients. In 36 women (66%) preoperative complaints were eliminated. Furthermore, of 28 women seeking improved fertility, pregnancy was reported in 13 cases (46%). In 7 (54%) cases pregnancy occurred spontaneously, and in the remainder with assisted fertilization. In addition, long-term follow-up demonstrated a recurrence rate in 1.8% of patients.
Overall, the number of complaints was significantly reduced. Only in the case of reproductive-aged women with ongoing postoperative complaints was it important to preserve the uterus. Although this pilot study on systematic posterior peritonectomy showed improvement in recurrence and fertility rate, the main question remains: will this surgical technique achieve better results and outcomes in the future? This has to be addressed in a prospective randomized study.
除了疼痛，子宫内膜异位症的管理还存在另外两个问题：高复发率（每年 10%）和高生育力受损率。本研究的目的是探讨这两个因素的发病机制。
这是一项回顾性队列研究，目的是评估包括后腹膜在内的子宫内膜异位症病变的完全切除，术后结果主要关注缓解疼痛、提高生育力和降低复发率。
Charité-University Clinic，妇科，子宫内膜异位症研究中心。
本研究纳入 54 例患有严重深部浸润性子宫内膜异位症（ENZIAN 评分）和浅表子宫内膜异位症以及子宫内膜异位瘤（修订后的美国生殖医学学会 [rASRM] I=3；II=15；III=10；IV=26）的患者。
所有患者均行后腹膜切开术（可见子宫内膜异位症病变和炎症性改变的腹膜），作为复杂手术的一部分：子宫内膜异位症的完全切除。
根据 54 例接受调查的患者的术后随访（最长 5 年）评估术后结果。在 36 名女性（66%）中，术前症状得到消除。此外，在 28 名寻求改善生育力的女性中，13 例（46%）报告怀孕。7 例（54%）自然怀孕，其余通过辅助受精怀孕。此外，长期随访显示患者的复发率为 1.8%。
总体而言，投诉数量显著减少。只有在有持续性术后投诉的生殖年龄女性中，保留子宫才是重要的。虽然这项关于系统性后腹膜切开术的初步研究显示复发率和生育力提高，但主要问题仍然是：这种手术技术将来是否会取得更好的效果？这需要在一项前瞻性随机研究中解决。
