Acute Gynaecology, Early Pregnancy and Advanced Endosurgery Unit, Sydney Medical School Nepean, Nepean Hospital, University of Sydney, Sydney, New South Wales, Australia.
Reproductive Medicine, Ginecologia, Goiânia, Brazil.
Aust N Z J Obstet Gynaecol. 2021 Apr;61(2):169-176. doi: 10.1111/ajo.13311. Epub 2021 Feb 1.
Endometriosis of the bowel can be associated with significant morbidity. Surgery to remove it carries risks. Options include conservative shaving or discoid resection and more radical segmental bowel resection.
To determine if more conservative shaving or discoid bowel resection is associated with fewer risks than more radical segmental resection.
This study is a systematic review. We considered eligible any cohort, observational or randomised controlled trial (RCT) study of at least ten women per arm comparing conservative vs radical bowel surgery for endometriosis. We divided complications into two groups, major and minor. One additional article was added due to its significance in answering our study question as well as the high quality of the study design as an RCT.
There were 3041 studies screened. Eleven studies were included (n = 1648). For major complications, the risk ratio for shaving and disc excision vs segmental resection is 0.31 (95% CI 0.21-0.46), while the risk difference is -0.25 (95% CI -0.41 to 0.10). For minor complications, the risk ratio is 0.63 (95% CI 0.36-1.09), while the risk difference is -0.03 (95% CI -0.12 to 0.05).
Conservative shaving or discoid excision surgery is associated with reduced complications. Previous studies demonstrated a trend toward this finding, but suffered from relatively low participant numbers, increasing the risk of type one statistical error. Our results allow surgeons to make informed choices about potential complications when deciding how to approach bowel endometriosis. The results also allow patients to have more information about the risks. However, outcomes in the studies analysed are heterogenous and are from low-quality evidence.
肠子宫内膜异位症可能会导致严重的发病率。手术切除它会带来风险。选择包括保守的刮除术或盘状切除术，以及更激进的节段性肠切除术。
确定更保守的刮除术或盘状肠切除术与更激进的节段性切除术相比是否风险更小。
这是一项系统评价。我们考虑了任何队列、观察性或随机对照试验（RCT）研究，这些研究至少有每臂 10 名妇女，比较了保守与激进的肠手术治疗子宫内膜异位症。我们将并发症分为两组，主要和次要并发症。由于其对回答我们的研究问题的重要性以及作为 RCT 的研究设计的高质量，因此增加了一篇额外的文章。
共筛选出 3041 篇研究。纳入了 11 项研究（n=1648）。对于主要并发症，刮除术和盘状切除术与节段性切除术相比，风险比为 0.31（95%CI 0.21-0.46），风险差为-0.25（95%CI-0.41 至 0.10）。对于次要并发症，风险比为 0.63（95%CI 0.36-1.09），风险差为-0.03（95%CI-0.12 至 0.05）。
保守的刮除术或盘状切除术与减少并发症相关。先前的研究表明了这种趋势，但由于参与者数量相对较少，增加了第一类统计错误的风险。我们的结果使外科医生在决定如何处理肠子宫内膜异位症时能够对潜在并发症做出明智的选择。结果也使患者能够获得更多关于风险的信息。然而，分析研究的结果是异质的，且来自低质量的证据。
