d'Avout-Fourdinier Perrine, Lempicka Marta, Gilibert André, Savoye-Collet Céline, Marpeau Loïc, Hennetier Clotilde, Tuech Jean-Jacques, Roman Horace
Department of Radiology, Rouen University Hospital, 76031 Rouen, France.
Health Informatics Department, Rouen University Hospital, 76031 Rouen, France.
J Gynecol Obstet Hum Reprod. 2020 Sep;49(7):101792. doi: 10.1016/j.jogoh.2020.101792. Epub 2020 May 19.
The aim of our study is to describe MRI appearance of a posterior rectal pouch (PRP) for patients managed for low rectal endometriosis by large full-thickness disc excision and to assess its relationship with postoperative functional digestive symptoms.
Single center retrospective study including patients managed by low/mid rectal disc excision using a semi-circular stapler (the Rouen technique) from June 2009 to October 2016. Intraoperative findings and data provided by standardized gastrointestinal self-questionnaires (GIQLI, KESS, Wexner and Bristol), before and 1 year after the surgery, were prospectively recorded. Postoperative pelvic MRI were reviewed and PRP was assessed in three planes and its volume was estimated on a 3D T2 weighted sequence.
Eighteen patients were included in the study. All patients had postoperative PRP while none of them presented with rectal stenosis. The mean (± SD) volume of the PRP was estimated at 66 ± 32 mL. The mean antero-posterior diameter was 56 mm ± 22 mm, mean height at 44 mm ± 15 mm and mean width at 46 mm ± 11 mm. No positive correlation between the volume of the PRP and the GIQLI questionnaire was found at one year after surgery (r = -0.24, 95%CI -0.51-0.69, p = 0.44).
Large disc excision of low and mid rectum leads to a posterior rectal pouch, with no significant impact on postoperative functional digestive outcomes, but it is not followed by bowel stenosis.
我们研究的目的是描述通过全层大圆盘切除术治疗低位直肠子宫内膜异位症患者的直肠后袋（PRP）的MRI表现，并评估其与术后功能性消化症状的关系。
单中心回顾性研究，纳入2009年6月至2016年10月期间采用半圆形吻合器（鲁昂技术）进行低位/中位直肠圆盘切除术的患者。前瞻性记录手术前后通过标准化胃肠道自我调查问卷（GIQLI、KESS、韦克斯纳和布里斯托尔）提供的术中发现和数据。对术后盆腔MRI进行回顾，在三个平面评估PRP，并在三维T2加权序列上估计其体积。
18例患者纳入研究。所有患者术后均有PRP，无一例出现直肠狭窄。PRP的平均（±标准差）体积估计为66±32mL。前后平均直径为56mm±22mm，平均高度为44mm±15mm，平均宽度为46mm±11mm。术后一年，未发现PRP体积与GIQLI问卷之间存在正相关（r=-0.24，95%CI -0.51-0.69，p=0.44）。
低位和中位直肠的大圆盘切除术会导致直肠后袋形成，对术后功能性消化结果无显著影响，但不会导致肠狭窄。
