使用CO激光腹腔镜切除膀胱子宫内膜异位症后的结果：单中心207例病例回顾
Outcomes after Laparoscopic Excision of Bladder Endometriosis Using a CO Laser: A Review of 207 Cases in a Single Center.
作者信息
Soares Michelle, Luyckx Mathieu, Maillard Charlotte, Laurent Pauline, Gerday Amandine, Jadoul Pascale, Squifflet Jean
机构信息
Department of Gynecology, Saint-Luc University Hospital, Brussels (Drs. Soares, Luyckx, Maillard, Laurent, Gerday, Jadoul, and Squifflet); Brussels IVF, University Hospital Brussels (Dr. Soares).
Department of Gynecology, Saint-Luc University Hospital, Brussels (Drs. Soares, Luyckx, Maillard, Laurent, Gerday, Jadoul, and Squifflet); Institute of experimental and clinical research (IREC), Catholic University of Louvain, Belgium (Drs. Luyckx, Gerday, Jadoul, and Squifflet); TILS group - de Duve Institute, Catholic University of Louvain, Belgium (Dr. Luyckx).
出版信息
J Minim Invasive Gynecol. 2023 Jan;30(1):52-60. doi: 10.1016/j.jmig.2022.10.005. Epub 2022 Oct 21.
STUDY OBJECTIVE
Assess efficacy, safety, fertility outcomes and recurrence after laparoscopic resection of bladder endometriosis (BE) using a CO laser.
DESIGN
Retrospective cohort study.
SETTINGS
University gynecologic surgery unit, referral center for endometriosis.
PATIENTS
A total of 207 women having undergone laparoscopic BE excision between January 1998 and January 2019.
INTERVENTIONS
None.
MAIN OUTCOME MEASURES
Intra- and postoperative complication rates. Disease recurrence and fertility outcomes in patients with a minimum 1-year follow-up (n = 176) for "isolated" and "non-isolated" BE groups.
RESULTS
Forty-three patients presented with isolated BE. Bladder "shaving" without mucosae opening was performed in 50.7% cases. No intraoperative complications were noted. One postoperative grade 3 complication was related to BE excision: a bladder breach requiring closure by repeat laparoscopy. Mean (± SD) follow-up was 7.05 (± 4.65) years. In patients wishing to conceive (n = 132), the total pregnancy rate (PR) was 75% (48.5% spontaneous), 76.19% in the isolated BE group (56.3% spontaneous). Among the 94 patients with previous infertility, 74.5% conceived, 50% spontaneously. No statistical difference was found in PR and need for in vitro fertilization between isolated and nonisolated BE groups. BE recurrence rate was 3.4%. No difference was observed between groups with full-thickness bladder resection (4/88) and shaving (2/88) (p = .406). Age at surgery (hazard ratio 0.91 [0.84-0.98], p = .016) and postoperative pregnancy (hazard ratio 0.07 [0.01-0.91], p = .042) showed influence on disease recurrence.
CONCLUSIONS
The study demonstrates that laparoscopic BE removal is feasible with very low complications rates and was associated with high PR (both spontaneous and in vitro fertilization), even in patients with previous infertility. BE recurrence is lower than for other endometriosis locations. Bladder endometriosis; Laparoscopy; Deep infiltrating endometriosis; Fertility; Partial bladder resection.
研究目的
评估使用CO激光腹腔镜切除膀胱子宫内膜异位症（BE）后的疗效、安全性、生育结局及复发情况。
设计
回顾性队列研究。
地点
大学妇科手术科室，子宫内膜异位症转诊中心。
患者
1998年1月至2019年1月期间共207例接受腹腔镜BE切除术的女性。
干预措施
无。
主要观察指标
术中和术后并发症发生率。对“孤立性”和“非孤立性”BE组中至少随访1年（n = 176）的患者的疾病复发情况和生育结局。
结果
43例患者为孤立性BE。50.7%的病例采用不切开黏膜的膀胱“削除术”。未观察到术中并发症。1例术后3级并发症与BE切除有关：膀胱破裂，需再次腹腔镜手术缝合。平均（±标准差）随访时间为7.05（±4.65）年。希望怀孕的患者（n = 132）中，总妊娠率（PR）为75%（48.5%为自然妊娠），孤立性BE组为76.19%（56.3%为自然妊娠）。94例既往不孕的患者中，74.5%怀孕，50%为自然妊娠。孤立性和非孤立性BE组在PR及体外受精需求方面未发现统计学差异。BE复发率为3.4%。全层膀胱切除术组（4/88）和削除术组（2/88）之间未观察到差异（p = 0.406）。手术年龄（风险比0.91[0.84 - 0.98]，p = 0.016）和术后妊娠（风险比0.07[0.01 - 0.91]，p = 0.042）对疾病复发有影响。
结论
该研究表明，腹腔镜切除BE可行，并发症发生率极低，且与高PR（自然妊娠和体外受精）相关，即使是既往不孕的患者。BE复发率低于其他子宫内膜异位症部位。膀胱子宫内膜异位症；腹腔镜检查；深部浸润性子宫内膜异位症；生育力；部分膀胱切除术。
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