Department of Obstetrics and Gynecology, Barzilai University Medical Center, Ashkelon, and Faculty of Health Sciences, Ben-Gurion University of Negev, Beer-Sheva (Dr. Namazov), Israel.
Women's Centre, Oxford University Hospital, Oxford (Dr. Kathurusinghe), United Kingdom.
J Minim Invasive Gynecol. 2020 Nov-Dec;27(7):1482-1489. doi: 10.1016/j.jmig.2020.04.019. Epub 2020 Apr 30.
To report the technique of double disk excision of deep endometriosis nodules infiltrating the mid or low rectum and surgical outcomes.
A retrospective case series using data prospectively recorded in the North-West Inter Regional Female Cohort for Patients with Endometriosis database.
University tertiary referral center.
Twenty women managed for large deep endometriosis nodules infiltrating the mid or low rectum.
Double disk excision using transanal end-to-end anastomosis circular stapler.
Twenty women managed by double disk excision from May 2016 to September 2019 were included in the study. The mean time of intervention was 149 ± 74 minutes. The cumulated mean diameter of the excised rectal disks was 53.4 ± 19.1 mm, whereas in 85% of the women, it was ≥50 mm. The mean distance between the lowest margin of the disk and the anal verge was 66 mm. Vaginal infiltration was removed in 15 patients (75%), and in 6 patients (30%) it exceeded 30 mm in diameter. Owing to the presence of sigmoid colon nodules, 2 patients (10%) underwent concomitant segmental sigmoid resection of 4 cm and 6 cm in length, respectively. Transitory stoma was performed in 8 patients (40%) owing to concomitant vaginal excision >3 cm in size. After a follow-up varying from 3 months to 42 months, no digestive fistula was recorded. The rate of Clavien-Dindo 3 complications was 15%.
Double disk excision is suitable for excising large deep endometriosis nodules infiltrating the mid or low rectum and is associated with a low severe complication rate with good functional outcomes in women. Further studies are required to assess the improvement of functional outcomes in deep endometriosis nodules infiltrating the mid or low rectum in comparison with colorectal resection.
报告双盘切除浸润中低位直肠的深部子宫内膜异位症结节的技术和手术结果。
一项使用西北地区女性子宫内膜异位症患者队列数据库前瞻性记录的数据的回顾性病例系列研究。
大学三级转诊中心。
20 名患有浸润中低位直肠的大型深部子宫内膜异位症结节的妇女。
使用经肛门端端吻合圆形吻合器进行双盘切除。
2016 年 5 月至 2019 年 9 月，共有 20 名接受双盘切除治疗的女性纳入研究。干预的平均时间为 149 ± 74 分钟。切除的直肠盘的累积平均直径为 53.4 ± 19.1 毫米，而在 85%的女性中，直径≥50 毫米。盘的最低边缘与肛门缘之间的平均距离为 66 毫米。15 名患者（75%）阴道浸润被切除，6 名患者（30%）阴道浸润直径超过 30 毫米。由于存在乙状结肠结节，2 名患者（10%）分别接受了 4 厘米和 6 厘米长的乙状结肠节段切除。由于阴道切除大于 3 厘米，8 名患者（40%）进行了暂时性造口术。随访时间 3 个月至 42 个月，未记录到消化性瘘管。Clavien-Dindo 3 级并发症的发生率为 15%。
双盘切除适用于切除浸润中低位直肠的大型深部子宫内膜异位症结节，且与低严重并发症发生率相关，对女性的功能结局有较好的改善。需要进一步的研究来评估浸润中低位直肠深部子宫内膜异位症结节与结直肠切除术相比对功能结局的改善。
