Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA, USA.
Acta Obstet Gynecol Scand. 2020 Mar;99(3):317-323. doi: 10.1111/aogs.13762. Epub 2019 Nov 25.
Patients with advanced endometriosis may be at an increased risk of surgical complications following laparoscopic treatment of endometriosis; however, this relationship has not been examined. We sought to identify predictors of major complications following laparoscopic treatment of endometriosis.
A retrospective cohort study of women who underwent laparoscopic treatment of suspected endometriosis between 2009 and 2016 within the Division of Minimally Invasive Gynecologic Surgery at Brigham and Women's Hospital, Boston, MA, USA. Predictors of major perioperative complications were assessed by comparing the characteristics of women who had any major intraoperative or postoperative complication with those of women who had no complication.
A total of 397 women underwent laparoscopic treatment of suspected endometriosis including excision of superficial endometriosis (55.4%), excision of deep-infiltrating endometriosis (24.9%), fulguration of endometriosis (38.3%), hysterectomy (23.2%), ovarian cystectomy (35.5%), salpingectomy (18.6%), oophorectomy (15.1%), and bowel resection (1.0%). Women were followed for 60 days following surgery, over which time 18 women (4.5%) had a major perioperative complication. Patient characteristics and preoperative imaging were similar between women with and without complications. Women with advanced endometriosis, including stage III or IV endometriosis, deep-infiltrating endometriosis, or rectovaginal disease, were more likely to have a complication, though this did not reach statistical significance (77.8% of women with a complication versus 56.7% of women without a complication had advanced endometriosis, P = 0.077). Women who had a complication were more likely to have undergone adhesiolysis or ureterolysis (88.9% of women with a complication versus 52.5% without a complication underwent adhesiolysis, P = 0.002; and 61.1% of women with a complication versus 28.8% without a complication underwent ureterolysis, P = 0.003). The total number of procedures was greater for women who had a complication (4.3 ± 1.2 vs 3.2 ± 1.5, P = 0.003). All other procedure characteristics were similar between women with and without complications.
Complications following laparoscopic treatment of suspected endometriosis could not be predicted by preoperative patient characteristics or surgical findings of advanced endometriosis. Adhesiolysis, ureterolysis, and an increased number of total procedures may be predictive of perioperative complications, suggesting that surgical complexity as measured by the procedures performed, rather than the disease severity, may increase the risk of a complication compared with women who do not undergo these procedures.
患有晚期子宫内膜异位症的患者在接受腹腔镜子宫内膜异位症治疗后可能会面临更高的手术并发症风险；然而，这一关系尚未得到研究。我们试图确定腹腔镜子宫内膜异位症治疗后发生主要并发症的预测因素。
这是一项在美国马萨诸塞州波士顿布莱根妇女医院微创妇科手术科对 2009 年至 2016 年期间接受疑似子宫内膜异位症腹腔镜治疗的女性进行的回顾性队列研究。通过比较有任何主要术中或术后并发症的女性与无并发症的女性的特征，评估主要围手术期并发症的预测因素。
共有 397 名女性接受了疑似子宫内膜异位症的腹腔镜治疗，包括浅表子宫内膜异位症切除术（55.4%）、深部浸润性子宫内膜异位症切除术（24.9%）、子宫内膜异位症灼烙术（38.3%）、子宫切除术（23.2%）、卵巢囊肿切除术（35.5%）、输卵管切除术（18.6%）、卵巢切除术（15.1%）和肠切除术（1.0%）。女性在手术后 60 天内接受随访，在此期间，18 名女性（4.5%）出现主要围手术期并发症。有并发症的女性与无并发症的女性在患者特征和术前影像学检查方面相似。患有高级子宫内膜异位症的女性，包括 III 期或 IV 期子宫内膜异位症、深部浸润性子宫内膜异位症或直肠阴道疾病，更有可能发生并发症，但这并未达到统计学意义（有并发症的女性中 77.8%患有高级子宫内膜异位症，无并发症的女性中 56.7%患有高级子宫内膜异位症，P=0.077）。有并发症的女性更有可能接受粘连松解术或输尿管松解术（有并发症的女性中 88.9%接受粘连松解术，无并发症的女性中 52.5%接受粘连松解术，P=0.002；有并发症的女性中 61.1%接受输尿管松解术，无并发症的女性中 28.8%接受输尿管松解术，P=0.003）。有并发症的女性的手术总次数更多（4.3±1.2 次与 3.2±1.5 次，P=0.003）。有并发症的女性与无并发症的女性在其他手术特征方面相似。
腹腔镜治疗疑似子宫内膜异位症后的并发症无法通过术前患者特征或高级子宫内膜异位症的手术发现来预测。粘连松解术、输尿管松解术和手术总次数的增加可能是围手术期并发症的预测因素，这表明与未接受这些手术的女性相比，手术复杂性（以手术次数衡量）可能会增加并发症的风险，而不是疾病的严重程度。
