From the Center of Endometriosis, Belem, Para (Dr. Quintairos); Division of Gynecology Endoscopy and Endometriosis (Drs. Quintairos and Ribeiro), Department of Obstetrics and Gynecology, Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil.
Department of Obstetrics and Gynecology (Dr. Brito), School of Medical Sciences, University of Campinas.
J Minim Invasive Gynecol. 2022 Nov;29(11):1231-1240. doi: 10.1016/j.jmig.2022.09.551. Epub 2022 Sep 29.
To assess bowel function in women with deep infiltrating endometriosis according to surgical approach (radical vs conservative).
Five databases were searched from 1970 to September 2021 to retrieve studies comparing radical (colorectal segmental resection) and conservative (shaving or discoid excision) surgery for bowel function in women with deep infiltrating endometriosis.
No language restriction was applied. Two reviewers extracted and combined data from the included studies, applying a meta-analytic model with random effects in all calculations. Results are expressed in risk ratio (RR) with 95% confidence interval (CI). Assessment of risk of bias and quality of evidence was performed by the Newcastle-Ottawa and Grading of Recommendations, Assessment, Development and Evaluation, respectively.
TABULATION, INTEGRATION, AND RESULTS: We included 13 studies in our meta-analysis, and most of them were of nonrandomized design. Conservative surgery had fewer events of constipation and frequent bowel movements when compared with radical surgery (RR, 2.31; 95% CI, 1.21-4.43; I = 0%; 3 studies; RR, 2.80; 95% CI 1.17-6.75; I = 0%; 2 studies, respectively). Defecation pain, anal incontinence loss, minor and major lower anterior resection syndrome, and Clavien-Dindo complications grade I to IV showed no statistically significant difference between surgeries. Grading of Recommendations, Assessment, Development and Evaluation assessment was low to very low for all outcomes.
Conservative surgery (shaving or discoid excision) presented fewer events of constipation and frequent bowel movements than colorectal segmental resection. There was a very low quality of evidence to provide recommendations regarding bowel function.
根据手术方式（根治性与保守性）评估深部浸润性子宫内膜异位症女性的肠道功能。
从 1970 年至 2021 年 9 月，检索了 5 个数据库，以检索比较深部浸润性子宫内膜异位症女性采用根治性（结肠节段切除术）和保守性（刮除或盘状切除术）手术对肠道功能影响的研究。
未对语言进行限制。两名审查员从纳入的研究中提取和合并数据，在所有计算中应用具有随机效应的荟萃分析模型。结果以风险比（RR）和 95%置信区间（CI）表示。使用纽卡斯尔-渥太华量表和推荐评估、制定与评价分级系统评估偏倚风险和证据质量。
列表、整合和结果：我们的荟萃分析纳入了 13 项研究，其中大多数为非随机设计。与根治性手术相比，保守性手术发生便秘和频繁排便的事件较少（RR，2.31；95%CI，1.21-4.43；I=0%；3 项研究；RR，2.80；95%CI，1.17-6.75；I=0%；2 项研究）。排便疼痛、肛门失禁丧失、小和大前位直肠切除术综合征以及 Clavien-Dindo 并发症 I 至 IV 级在手术之间无统计学差异。所有结局的推荐评估、制定与评价分级系统评估均为低至极低。
与结肠节段切除术相比，保守性手术（刮除或盘状切除术）发生便秘和频繁排便的事件较少。提供关于肠道功能的建议的证据质量非常低。
