Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Faculté de Médecine Sorbonne Université, Institut Universitaire de Cancérologie (IUC), France; Centre CALG (Cancer Associé à La Grossesse), France.
Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Faculté de Médecine Sorbonne Université, Institut Universitaire de Cancérologie (IUC), France; Centre CALG (Cancer Associé à La Grossesse), France.
J Gynecol Obstet Hum Reprod. 2020 Feb;49(2):101649. doi: 10.1016/j.jogoh.2019.101649. Epub 2019 Nov 21.
To evaluate the risk of rectovaginal fistula after en bloc hysterectomy and colorectal resection (H-CR) for endometriosis using prevesical peritoneum interposition.
A retrospective study conducted at Tenon University Hospital, expert center in endometriosis, from June 2016 to June 2018. Patients undergoing H-CR with prevesical peritoneum interposition without protective defunctioning stoma were included.
Of the 160 patients who underwent surgery with colorectal resection for endometriosis during the study period, 27 had H-CR (15 with segmental and 12 with discoïd colorectal resection) and were included. The median age (range) was 45 years (41-47.5). Eight patients (13 %) were nulliparous. All procedures were performed by laparoscopy. Parametrial resection was performed in 14 cases (52 %). Associated bowel procedures were ileocecal resection (n = 5) and appendectomy (n = 2). Median follow-up (range) was 14.6 months (10.5-20.2). Nine (33.3 %) patients experienced intra- or postoperative complications including one grade I, four grade II, two grade IIIA and two grade IIIB complications (Clavien-Dindo classification). Seven patients (26 %) experienced postoperative voiding dysfunction. One suspicion of rectovaginal fistula associated with pelvic abscess was diagnosed 4 weeks after surgery but not confirmed during a second operation.
Despite the small sample size, the present pilot study supports the practice of prevesical peritoneum interposition to limit the risk of rectovaginal fistula in patients who undergo H-CR for deep endometriosis.
使用膀胱前腹膜间置术评估子宫内膜异位症整块子宫切除术和结直肠切除术（H-CR）后直肠阴道瘘的风险。
这是一项回顾性研究，于 2016 年 6 月至 2018 年 6 月在 Tenon 大学医院（子宫内膜异位症专家中心）进行。纳入接受 H-CR 并使用膀胱前腹膜间置术且未行保护性结肠造口术的患者。
在研究期间，160 名接受结直肠切除术治疗子宫内膜异位症的患者中，有 27 名患者接受了 H-CR（15 名患者行节段性切除术，12 名患者行盘状结直肠切除术），并被纳入研究。患者的中位年龄（范围）为 45 岁（41-47.5 岁）。8 名患者（13%）为未产妇。所有手术均通过腹腔镜进行。14 例患者行宫旁切除术（52%）。合并肠管手术包括回盲部切除术（n=5）和阑尾切除术（n=2）。中位随访时间（范围）为 14.6 个月（10.5-20.2 个月）。9 名（33.3%）患者发生了围手术期并发症，包括 1 例 I 级、4 例 II 级、2 例 IIIA 级和 2 例 IIIB 级并发症（Clavien-Dindo 分级）。7 名（26%）患者术后出现排尿功能障碍。术后 4 周诊断出 1 例疑似直肠阴道瘘伴盆腔脓肿，但在第二次手术中未得到证实。
尽管样本量较小，但本初步研究支持在因深部子宫内膜异位症行 H-CR 的患者中使用膀胱前腹膜间置术来限制直肠阴道瘘的风险。
