Department of Obstetrics & Gynecology, Mayo Clinic, Rochester, MN (Dr. Warring).
Department of Obstetrics & Gynecology, Mayo Clinic, Rochester, MN (Dr. Warring); Division of Minimally Invasive Gynecologic Surgery, Mayo Clinic, Rochester, MN (Drs. Cope, Burnett, Khan).
J Minim Invasive Gynecol. 2022 Sep;29(9):1037. doi: 10.1016/j.jmig.2022.06.017. Epub 2022 Jun 22.
To highlight different surgical approaches for managing deep infiltrating endometriosis involving the rectosigmoid colon.
Demonstration of specific surgical techniques with educational narrated video footage.
Bowel endometriosis is reported in 3.8% to 37% of patients with endometriosis [1]. Most commonly, the rectosigmoid colon is involved. Pelvic ultrasound and magnetic resonance imaging may be useful in diagnosis and for surgical planning [2]. Treatment options include observation, medications, or surgery. There are various surgical techniques that can be used for excision of deep infiltrating endometriosis involving the rectosigmoid colon. Serosal shaving, discoid resection, and complete resection are the possible types of surgical interventions that are demonstrated in this surgical education video at an academic medical center. Serosal shaving is used for lesions with minimal involvement of the muscularis. It can be done sharply or with electrosurgery and it is imperative to assess bowel integrity after shaving. Discoid resection is used for lesions with muscularis involvement, <3 cm in size, and encompassing less than one-third to a half of the bowel circumference. Full-thickness discoid bowel resection can be done in various ways including manual resection with primary suture closure, regular stapler transabdominally, or EEA stapler (Medtronic EEA Circular Stapler, Minneapolis, MN) transrectally. Segmental resection is used for lesions >3 cm in size, involving >50% of the bowel circumference, or for multifocal lesions. Various suture and stapler methods exist for this technique.
Based on the imaging and intraoperative findings, a surgical technique was chosen and demonstrated. The types of surgical techniques demonstrated include laparoscopic serosal shaving, discoid resection with manual resection and primary suture closure, discoid resection with EEA stapler, and segmental resection.
Knowledge of different surgical approaches to excise endometriosis is essential to appropriately address a patient's unique pathology. The choice of which surgical technique to use should include consideration of the location of the lesion, depth and circumference of involvement, and the number of nodules present.
强调涉及直肠乙状结肠的深部浸润性子宫内膜异位症的不同手术方法。
带有教育解说视频片段的特定手术技术演示。
肠子宫内膜异位症在子宫内膜异位症患者中的报告率为 3.8%至 37%[1]。最常见的受累部位是直肠乙状结肠。盆腔超声和磁共振成像可能有助于诊断和手术计划[2]。治疗选择包括观察、药物治疗或手术。对于涉及直肠乙状结肠的深部浸润性子宫内膜异位症，可以使用各种手术技术进行切除。本学术医疗中心的手术教育视频演示了几种可能的手术干预类型，包括浆膜刮除术、圆盘状切除术和全层切除术。浆膜刮除术用于病变累及肌层最小的情况。可以用锐器或电外科进行，刮除后必须评估肠完整性。圆盘状切除术用于病变累及肌层，<3cm 大小，并且累及肠周径的不到三分之一到一半。全层圆盘状肠切除术可以通过多种方式进行，包括手动切除和一期缝合、常规吻合器经腹或 EEA 吻合器（美敦力 EEA 圆形吻合器，明尼苏达州明尼阿波利斯）经直肠。节段切除术用于病变>3cm 大小、累及>50%肠周径或多发病变。该技术存在各种缝合和吻合器方法。
根据影像学和术中发现，选择并演示了一种手术技术。演示的手术技术类型包括腹腔镜下浆膜刮除术、手动切除和一期缝合的圆盘状切除术、EEA 吻合器的圆盘状切除术和节段切除术。
了解切除子宫内膜异位症的不同手术方法对于正确处理患者的独特病理至关重要。选择使用哪种手术技术应包括考虑病变的位置、受累的深度和周径以及存在的结节数量。
