Gynecologic Division, BP-A Beneficência Portuguesa de São Paulo (Drs. Abrao, Andres, and Neto); Department of Obstetrics and Gynecology, Division of Gynecology, Faculty of Medicine, University of São Paulo (Drs. Abrao and Andres), São Paulo, São Paulo, Brazil; Department of Clinical Sciences, Rosalind Franklin University of Medicine and Science, North Chicago (Dr. Miller); Department of Minimally Invasive Gynecologic Surgery, Advocate Lutheran General Hospital, Park Ridge (Dr. Miller), Illinois; Department of Obstetrics and Gynecology and Women's Health, Montefiore Medical Center, Bronx, New York (Dr. Gingold); Department of Gynecology, Institute Clinic of Gynecology, Obstetrics, and Neonatology, Hospital Clínic de Barcelona (Drs. Rius and Carmona); Department of Gynecology, August Pi i Sunyer Biomedical Research Institute (Dr. Carmona), Barcelona, Spain.
Gynecologic Division, BP-A Beneficência Portuguesa de São Paulo (Drs. Abrao, Andres, and Neto); Department of Obstetrics and Gynecology, Division of Gynecology, Faculty of Medicine, University of São Paulo (Drs. Abrao and Andres), São Paulo, São Paulo, Brazil; Department of Clinical Sciences, Rosalind Franklin University of Medicine and Science, North Chicago (Dr. Miller); Department of Minimally Invasive Gynecologic Surgery, Advocate Lutheran General Hospital, Park Ridge (Dr. Miller), Illinois; Department of Obstetrics and Gynecology and Women's Health, Montefiore Medical Center, Bronx, New York (Dr. Gingold); Department of Gynecology, Institute Clinic of Gynecology, Obstetrics, and Neonatology, Hospital Clínic de Barcelona (Drs. Rius and Carmona); Department of Gynecology, August Pi i Sunyer Biomedical Research Institute (Dr. Carmona), Barcelona, Spain.
J Minim Invasive Gynecol. 2021 Nov;28(11):1941-1950.e1. doi: 10.1016/j.jmig.2021.09.709. Epub 2021 Sep 25.
To develop a new endometriosis classification system for scoring intraoperative surgical complexity and to examine its correlation with patient-reported pain and infertility.
Multicenter study of patients treated at 3 recognized endometriosis centers.
Three specialized endometriosis surgical centers in São Paulo, Brazil and Barcelona, Spain.
Patients aged 15 to 45 years with histologically proven endometriosis and no history of pelvic malignancy underwent laparoscopic treatment of endometriosis.
Demographic data and clinical history, including dysmenorrhea, noncyclic pelvic pain, dyspareunia, dysuria and dyschezia, were prospectively recorded. All patients were staged surgically according to the new 2021 American Association of Gynecologic Laparoscopists (AAGL) and revised American Society of Reproductive Medicine (ASRM) classification systems. The staging for each system was compared against a 4-level surgical complexity scale defined by the most complex procedure performed.
A total of 1224 patients undergoing surgery met inclusion criteria. The AAGL score discriminated between 4 stages of surgical complexity with high reproducibility (κ = 0.621), whereas the ASRM score discriminated between the complexity stages with poor reproducibility (κ = 0.317). The AAGL staging system correlated with dysmenorrhea, dyspareunia, dyschezia, total pain score, and infertility comparably with the ASRM staging system.
The AAGL 2021 Endometriosis Classification allows for identifying objective intraoperative findings that reliably discriminate surgical complexity levels better than the ASRM staging system. The AAGL severity stage correlates comparably with pain and infertility symptoms with the ASRM stage.
开发一种新的子宫内膜异位症分类系统，用于评分术中手术的复杂性，并研究其与患者报告的疼痛和不孕之间的相关性。
在 3 个公认的子宫内膜异位症中心治疗的患者的多中心研究。
巴西圣保罗和西班牙巴塞罗那的 3 个专门的子宫内膜异位症手术中心。
年龄在 15 至 45 岁之间、组织学证实患有子宫内膜异位症且无盆腔恶性肿瘤病史的患者接受腹腔镜子宫内膜异位症治疗。
前瞻性记录人口统计学数据和临床病史，包括痛经、非周期性盆腔疼痛、性交痛、排尿困难和排便困难。所有患者均根据新的 2021 年美国妇科腹腔镜医师协会（AAGL）和修订后的美国生殖医学学会（ASRM）分类系统进行手术分期。每个系统的分期与通过执行的最复杂程序定义的 4 级手术复杂性量表进行比较。
共有 1224 名接受手术的患者符合纳入标准。AAGL 评分能够区分 4 个手术复杂性阶段，且具有较高的可重复性（κ=0.621），而 ASRM 评分区分复杂性阶段的可重复性较差（κ=0.317）。AAGL 分期系统与痛经、性交痛、排便困难、总疼痛评分和不孕的相关性与 ASRM 分期系统相当。
AAGL 2021 年子宫内膜异位症分类能够识别客观的术中发现，能够更好地可靠区分手术复杂性水平，优于 ASRM 分期系统。AAGL 严重程度阶段与 ASRM 阶段的疼痛和不孕症状具有可比性。
