Miklós Dominika, Dobó Noémi, Csibi Noémi, Brubel Réka, Szabó Gábor, Ács Nándor, Bokor Attila
1 Semmelweis Egyetem, Általános Orvostudományi Kar, Szülészeti és Nőgyógyászati Klinika Budapest, Baross u. 27., 1088 Magyarország.
Orv Hetil. 2023 Mar 5;164(9):348-354. doi: 10.1556/650.2023.32714.
Deep infiltrating endometriosis penetrates the peritoneal surface beneath 5 mm. The bowel is affected in 3-37% of the cases.
The aim of the authors was to analyze the results of the surgical procedures performed for bowel endometriosis.
Between 2009 and 2020, 675 patients underwent bowel endometriosis surgery at the Department of Obstetrics and Gyanecology of Semmelweis University. Four surgical approaches were performed: shaving, discoid, segmental and NOSE resection.
182 shaving, 93 discoid, 130 NOSE and 270 segmental bowel resections were performed. Ultra-deep anastomosis was performed in 40 cases. The median operative time was 85 minutes, the shortest intervention lasted 25 minutes, the longest 585 minutes. The average operating time was 260 (± 161.3) minutes for the first, and 114 (± 47.0) minutes for the last ten operations. The average blood loss was 10 (± 20.3) mL. The average hospital stay was 6 (± 2.3) days. Serious surgical complication (Clavien-Dindo III or more severe) developed in 18 cases. In a total of 17 cases sigmoideo- or ileostomy were used. Conversion to laparotomy was necessary in 6 cases.
The same team performed all the interventions, which can show the effectiveness of the surgical techniques instead of the technique of individual surgeons. The complication rate is low in the case of an experienced surgical team, and the operating time decreases significantly in proportion to the number of operations performed.
Bowel endometriosis can be treated safely and effectively with both conservative (shaving or discoid) and radical (segmental or NOSE resection) approach. Orv Hetil. 2023; 164(9): 348-354.
深部浸润性子宫内膜异位症穿透腹膜表面达5毫米以下。肠道受累病例占3% - 37%。
作者旨在分析肠道子宫内膜异位症手术治疗的结果。
2009年至2020年期间，塞梅维斯大学妇产科有675例患者接受了肠道子宫内膜异位症手术。采用了四种手术方法：刮除术、盘状切除术、节段性切除术和经自然腔道内镜手术（NOSE）切除术。
进行了182例刮除术、93例盘状切除术、130例经自然腔道内镜手术切除术和270例节段性肠切除术。40例进行了超深部吻合术。中位手术时间为85分钟，最短手术持续25分钟，最长585分钟。首次手术的平均手术时间为260（±161.3）分钟，最后十次手术的平均手术时间为114（±47.0）分钟。平均失血量为10（±20.3）毫升。平均住院时间为6（±2.3）天。18例出现严重手术并发症（Clavien - Dindo III级或更严重）。总共17例使用了乙状结肠造口术或回肠造口术。6例需要转为开腹手术。
所有干预措施均由同一团队实施，这能体现手术技术的有效性而非个别外科医生的技术水平。对于经验丰富的手术团队，并发症发生率较低，且手术时间会随着手术例数的增加而显著减少。
肠道子宫内膜异位症采用保守（刮除术或盘状切除术）和根治（节段性切除术或经自然腔道内镜手术切除术）方法均可安全有效地治疗。《匈牙利医学周报》。2023年；164（9）：348 - 354。
