Gynecology Department, Hôpital de Hautepierre, Service de Gynécologie, 1 Avenue Molière, Strasbourg 67200, France.
Gynecology Department, Hôpital de Hautepierre, Service de Gynécologie, 1 Avenue Molière, Strasbourg 67200, France.
J Gynecol Obstet Hum Reprod. 2022 Apr;51(4):102348. doi: 10.1016/j.jogoh.2022.102348. Epub 2022 Feb 26.
Deep infiltrative endometriosis can lead to infertility with a spontaneous pregnancy rate between 8.7 and 13%. Surgical treatment of bowel endometriosis may improve spontaneous and ART fertility. The aim of this study was to evaluate post-operative fertility according to the surgical technic used (shaving vs. bowel resection).
A retrospective, monocentric study was carried-out in the University Hospital of Strasbourg, France, from September 2009 to October 2016. All patients with a desire to become pregnant and treated for colorectal deep infiltrating endometriosis were included. Two groups were analyzed and compared: shaving treatment vs. digestive resection (discoid or segmental). The primary outcome was pregnancy rate after surgery. Secondary outcomes were: mode of pregnancy occurrence (spontaneous versus ART), time of onset, term at birth, occurrence of complications during pregnancy.
94 patients were included (39 had a bowel resection and 55 a shaving). Both groups had similar pre-operative characteristics. The pregnancy rate was 52,1% for the total population with no significant differences between the two groups (p = 0.68). However, we found a significantly higher spontaneous pregnancies rate among the resection group with 73.7% (p = 0,0086). Pregnancy complications occurred in 50% of pregnancies, regardless of the surgical technic used.
This study suggests that, for patients with colorectal DIE, surgical treatment improves overall fertility. Furthermore, resection surgery seems to significantly improve the occurrence of spontaneous pregnancies. However, this surgery is not without risks and multidisciplinary discussions and thorough information to the patient are a prerequisite.
深部浸润性子宫内膜异位症可导致不孕，其自然妊娠率为 8.7%至 13%。肠子宫内膜异位症的手术治疗可能会提高自然和 ART 生育能力。本研究的目的是根据使用的手术技术（刮除术与肠切除术）评估术后生育能力。
这是一项在法国斯特拉斯堡大学医院进行的回顾性单中心研究，时间为 2009 年 9 月至 2016 年 10 月。所有有怀孕意愿并接受结直肠深部浸润性子宫内膜异位症治疗的患者均纳入研究。分析并比较了两组：刮除术治疗与消化道切除术（盘状或节段性）。主要结局是手术后的妊娠率。次要结局为：妊娠发生方式（自然与 ART）、发病时间、分娩时的孕龄、妊娠期间并发症的发生。
94 例患者入选（39 例行肠切除术，55 例行刮除术）。两组患者的术前特征相似。总人群的妊娠率为 52.1%，两组间无显著差异（p=0.68）。然而，我们发现切除术组的自发性妊娠率显著更高，为 73.7%（p=0.0086）。无论使用何种手术技术，妊娠并发症在 50%的妊娠中发生。
本研究表明，对于结直肠深部浸润性子宫内膜异位症患者，手术治疗可提高整体生育能力。此外，切除术似乎可显著提高自发性妊娠的发生。然而，这种手术并非没有风险，多学科讨论和对患者的充分信息告知是前提条件。
