Department of gynecology, Croix Rousse University Hospital, Hospices civils de Lyon (HCL), 103 Grande Rue de la Croix-Rousse, 69004 Lyon, France.
Department of gynecology, Lyon-Sud university hospital, HCL, 165 Chemin du Grand Revoyet, 69310 Pierre-Bénite, France.
J Gynecol Obstet Hum Reprod. 2021 Oct;50(8):102147. doi: 10.1016/j.jogoh.2021.102147. Epub 2021 Apr 20.
Surgical management of Diaphragmatic and thoracic endometriosis (DTE) is still controversial, a thoracic or an abdominal approach can be proposed.
We conducted a multicentric retrospective study in 8 thoracic, gynecology or digestive surgery units in 5 French university hospitals. The main objective was to review the current management of DTE.
50 patients operated for DTE from 2010 to 2017 were included: 26 with a thoracic approach and 24 with an abdominal approach. Preoperative pelvic endometriosis (PE) concerned 25 patients. In 38 patients, DTE diagnosis was made on clinical symptoms (pneumothorax (n = 19), chronic or catamenial chest pain (n = 18) or hemopneumothorax (n = 1)). Median time from onset of symptoms to diagnosis was 47 months (0-212). PE surgery concurrently occurred in 22 patients. We report diaphragmatic nodules, pleuropulmonary nodules and diaphragmatic perforations in 42, 5 and 22 women respectively. Lesions were right-sided in 45 patients. Nodules were destructed in 12 cases and resected in 38 cases. When a diaphragmatic reconstruction was needed (n = 31), a simple suture was performed in 26 patients, while 5 patients needed a mesh repair. Pleural symphysis was performed for all patients who received a thoracic approach. DTE resection was considered complete in 46 patients. Three patients had severe 30-days complications of DTE surgery. Median follow-up was 20 months (range 1-69). Recurrence occurred in 10 patients.
The results emphasize the importance of systematically looking for chest pain in patients suffering from PE and underline the lack of a standardized procedure and treatment in DTE.
膈疝和胸腔子宫内膜异位症（DTE）的手术治疗仍存在争议，可以采用胸腔或腹部方法。
我们在法国 5 所大学附属医院的 8 个胸科、妇科或消化外科单位进行了一项多中心回顾性研究。主要目的是回顾 DTE 的当前治疗方法。
2010 年至 2017 年期间，50 例 DTE 患者接受了手术治疗：26 例采用胸腔入路，24 例采用腹部入路。25 例患者术前有盆腔子宫内膜异位症（PE）。38 例患者的 DTE 诊断基于临床症状（气胸（n=19）、慢性或月经性胸痛（n=18）或血胸和气胸（n=1））。从症状出现到诊断的中位时间为 47 个月（0-212）。22 例患者同时行 PE 手术。我们分别报告了 42 例女性的膈结节、肺胸膜结节和膈穿孔，5 例和 22 例女性的膈穿孔。病变位于右侧 45 例。12 例有结节破坏，38 例有结节切除。需要膈肌重建时（n=31），26 例患者行单纯缝合，5 例患者需行网片修复。所有接受胸腔入路的患者均行胸膜融合术。46 例患者认为 DTE 切除完全。3 例患者术后 30 天出现严重并发症。中位随访时间为 20 个月（范围 1-69）。10 例患者复发。
结果强调了在患有 PE 的患者中系统寻找胸痛的重要性，并强调了 DTE 缺乏标准化的手术程序和治疗方法。
