Department of Diagnostic Imaging, Chamié Imagem da Mulher, Rua Casa do Ator, 1117, cj 72, São Paulo, São Paulo, 04546-004, Brazil.
Department of Diagnostic Imaging, Fleury Medicina e Saúde, São Paulo, São Paulo, Brazil.
Abdom Radiol (NY). 2020 Jun;45(6):1847-1865. doi: 10.1007/s00261-020-02434-5.
Deeply infiltrative endometriosis (DIE) is a common gynecologic disease affecting women of reproductive age and often causing chronic pelvic pain and infertility. Clinical treatment options and preventive actions are ineffective due to the lack of knowledge about the etiology of DIE. Surgical treatment is currently the only alternative to eradicate the disease. Diagnostic imaging plays a crucial role for surgical planning and postoperative evaluation. Transvaginal sonography (TVS) with a dedicated protocol and magnetic resonance imaging (MRI) can be used to evaluate recurrent disease. Extensive pelvic surgery may cause anatomical changes and a variable spectrum of postoperative findings. Residual disease and complications can be also evaluated and are of great importance to estimate pain relief and fertility prognosis. The most common imaging findings following radical surgery for DIE are fibrotic scars in the retrocervical space and bowel anastomosis, absence of the posterior vaginal fornix and loculated fluid in the pararectal spaces. Ovaries are the most frequent site of early recurrence. Complications include infection, hemorrhage, urinary/evacuatory voiding dysfunctions as well as bowel and ureteral stenosis. The purpose of this article is to review the surgical techniques currently used to treat endometriosis in the retrocervical space, vagina, bladder, bowel, ureters, and ovaries and to describe the most common imaging findings including normal aspects, residual disease, complications, and recurrence.
深部浸润型子宫内膜异位症（DIE）是一种常见的妇科疾病，影响育龄妇女，常导致慢性盆腔痛和不孕。由于对 DIE 的病因缺乏了解，临床治疗选择和预防措施均无效。目前手术治疗是根治疾病的唯一选择。诊断性影像学检查在手术规划和术后评估中起着至关重要的作用。专用方案的经阴道超声（TVS）和磁共振成像（MRI）可用于评估复发性疾病。广泛的盆腔手术可能导致解剖结构的改变和一系列多变的术后表现。残余疾病和并发症也可进行评估，对于估计疼痛缓解和生育预后具有重要意义。DIE 根治性手术后最常见的影像学表现为宫颈后间隙和肠吻合处的纤维瘢痕、阴道后穹窿缺失和直肠旁间隙分隔性积液。卵巢是早期复发的最常见部位。并发症包括感染、出血、尿/排粪功能障碍以及肠和输尿管狭窄。本文旨在回顾目前用于治疗宫颈后间隙、阴道、膀胱、肠、输尿管和卵巢子宫内膜异位症的手术技术，并描述最常见的影像学表现，包括正常表现、残余疾病、并发症和复发。
