Department of Obstetrics and Gynecology, Hôpital Universitaire de la Croix-Rousse, Hospices Civils de Lyon, Université Lyon 1, Lyon (Drs. Philip, Froc, and Dubernard).
Department of Obstetrics and Gynecology, Hôpital Universitaire de la Croix-Rousse, Hospices Civils de Lyon, Université Lyon 1, Lyon (Drs. Philip, Froc, and Dubernard).
J Minim Invasive Gynecol. 2021 Nov;28(11):1889-1897.e1. doi: 10.1016/j.jmig.2021.04.020. Epub 2021 May 6.
To describe the surgical management and risks of postoperative complications of patients with urinary tract endometriosis in France in 2017.
Multicenter retrospective cohort pilot study.
Departments of gynecology at 31 expert endometriosis centers.
All women managed surgically for urinary tract endometriosis from January 1, 2017, to December 31, 2017. We distinguished patients with isolated bladder endometriosis or isolated ureteral endometriosis (IUE) from those with endometriosis in both locations (mixed locations [ML]).
Surgeons belonging to the French Colorectal Infiltrating Endometriosis Study (FRIENDS) group enrolled patients who filled a 24-item questionnaire on the day of the inclusion and 3 months later. Data were collected on operative routes, surgical management, and postoperative complications according to the Clavien-Dindo classification in a single anonymized database.
A total of 232 patients from 31 centers were included. Isolated bladder endometriosis was found in 82 patients (35.3%), IUE in 126 patients (54.4%), and ML in 24 patients (10.3%). Surgery was performed by laparoscopy, laparotomy, or robot-assisted laparoscopy in 74.1%, 11.2%, and 14.7% of the cases, respectively. Among the 150 ureteral lesions (IUE and ML), 114 were managed with ureterolysis (76%), 28 with ureteral resection (18.7%), 4 with nephrectomy (2.7%), and 23 with cystectomy (15.3%). Concerning bladder endometriosis, a partial cystectomy was performed in 94.3% of the cases. We reported 61 postoperative complications (26.3%): 44 low-grade complications according to the Clavien-Dindo classification (18%), 16 grade III complications (7%), and 1 grade IV complication (peritonitis).
The surgical management of ureteral and bladder endometriosis is usually feasible and safe through laparoscopic surgery. Ureteral resection, when necessary, is more strongly associated with laparotomy and with more complications than other procedures. Prospective controlled studies are still mandatory to assess the best surgical management for patients.
描述 2017 年法国泌尿道子宫内膜异位症患者的手术治疗方法和术后并发症风险。
多中心回顾性队列研究。
31 个子宫内膜异位症专家中心的妇科。
所有于 2017 年 1 月 1 日至 12 月 31 日接受泌尿道子宫内膜异位症手术治疗的女性。我们将仅患有膀胱子宫内膜异位症或单侧输尿管子宫内膜异位症（孤立性膀胱子宫内膜异位症或单侧输尿管子宫内膜异位症，IUE）的患者与同时存在两处病变的患者（混合病变 [ML]）区分开来。
属于法国结直肠浸润性子宫内膜异位症研究（FRIENDS）组的外科医生在纳入当天和 3 个月后为每位患者填写了一份 24 项的问卷。根据 Clavien-Dindo 分类，在一个匿名数据库中收集手术途径、手术管理和术后并发症的数据。
共纳入 31 个中心的 232 名患者。82 名患者（35.3%）为孤立性膀胱子宫内膜异位症，126 名患者（54.4%）为 IUE，24 名患者（10.3%）为 ML。74.1%、11.2%和 14.7%的手术分别通过腹腔镜、剖腹手术或机器人辅助腹腔镜进行。在 150 例输尿管病变（IUE 和 ML）中，114 例行输尿管松解术（76%），28 例行输尿管切除术（18.7%），4 例行肾切除术（2.7%），23 例行膀胱切除术（15.3%）。对于膀胱子宫内膜异位症，94.3%的病例行部分膀胱切除术。我们报告了 61 例术后并发症（26.3%）：根据 Clavien-Dindo 分类，44 例为低级别并发症（18%），16 例为 3 级并发症（7%），1 例为 4 级并发症（腹膜炎）。
通过腹腔镜手术通常可以安全地治疗输尿管和膀胱子宫内膜异位症。如果需要，输尿管切除术与剖腹手术的关联更紧密，且与其他手术相比，并发症更多。仍需要前瞻性对照研究来评估患者的最佳手术治疗方法。
