Frnco-European Multidisciplinary Endometriosis Institute (IFEMEndo), Clinique Tivoli-Ducos, Bordeaux, France; Department of Gynecology and Obstetrics, Aarhus University Hospital, Aarhus, Denmark.
Frnco-European Multidisciplinary Endometriosis Institute (IFEMEndo), Clinique Tivoli-Ducos, Bordeaux, France.
Fertil Steril. 2023 Oct;120(4):870-879. doi: 10.1016/j.fertnstert.2023.05.156. Epub 2023 May 22.
To assess the long-term risk of repeated surgery in women undergoing complete excision of endometriosis by an experienced surgeon and to identify circumstances leading up to repeat surgery.
Retrospective study based on data recorded in a large prospective database.
University Hospital.
PATIENT(S): A total of 1,092 patients managed for endometriosis, from June 2009 to June 2018, by one surgeon.
INTERVENTION(S): Complete excision of endometriosis lesions.
MAIN OUTCOME MEASURE(S): The recording of a repeated surgery linked to endometriosis performed during follow-up.
RESULT(S): Endometriosis was exclusively superficial in 122 patients (11.2%) and 54 women (5%) had endometriomas without associated deep endometriosis nodules. Deep endometriosis was managed in 916 women (83.9%), leading to infiltration or not of the bowel in 688 (63%) and 228 (20.9%) patients, respectively. A majority of patients were managed for severe endometriosis infiltrating the rectum (58.4%). Mean and median follow-up was 60 months. A total of 155 patients underwent a repeated surgery relating to endometriosis; 108 procedures were required because of recurrences (9.9%), 39 surgeries were related to the management of infertility by assisted reproductive techniques (3.6%), and in 8 surgeries, a direct relationship between surgery and endometriosis was probable but not certain (0.8%). The majority of procedures involved hysterectomy for adenomyosis (n=45, 4.1%). The probability of requiring repeated surgery at 1, 3, 5, 7, and 10 years was 3%, 11%, 18%, 23%, and 28%, respectively. Cox's multivariate model identified postoperative pregnancy and hysterectomy as being statistically significant independent predictors for a reduction in the probability of having a repeated surgery, after adjustment on continuous postoperative amenorrhea, the main localization of the disease, and management for endometriosis infiltrating the rectum during the first surgery.
CONCLUSION(S): Up to 28% of patients may require a repeated surgical procedure during the 10 years after complete excision of endometriosis. Conservation of the uterus is followed by an increased risk of repeated surgery. The study is based on outcomes resulting from a single surgeon, which limits the generalizability of results.
评估由经验丰富的外科医生对子宫内膜异位症进行完全切除手术后，女性重复手术的长期风险，并确定导致重复手术的情况。
基于大型前瞻性数据库中记录的数据进行的回顾性研究。
大学医院。
2009 年 6 月至 2018 年 6 月，一名外科医生共治疗了 1092 例子宫内膜异位症患者。
子宫内膜异位症病变的完全切除。
记录在随访期间进行的与子宫内膜异位症相关的重复手术。
122 例患者（11.2%）的子宫内膜异位症仅为表浅性，54 例患者（5%）有卵巢子宫内膜异位囊肿而无深部子宫内膜异位症结节。916 例患者接受了深部子宫内膜异位症治疗，其中 688 例（63%）和 228 例（20.9%）患者分别存在肠浸润或无肠浸润。大多数患者接受了严重浸润直肠的子宫内膜异位症的治疗（58.4%）。平均和中位随访时间为 60 个月。共有 155 例患者因子宫内膜异位症接受了重复手术；108 例手术是由于复发（9.9%）需要进行的，39 例手术是由于辅助生殖技术（3.6%）治疗不孕而需要进行的，在 8 例手术中，手术与子宫内膜异位症之间的直接关系可能但不确定（0.8%）。大多数手术涉及因子宫腺肌病而进行的子宫切除术（n=45，4.1%）。术后 1、3、5、7 和 10 年需要重复手术的概率分别为 3%、11%、18%、23%和 28%。Cox 多变量模型确定，术后妊娠和子宫切除术是调整术后持续闭经、疾病主要定位和第一次手术治疗直肠浸润性子宫内膜异位症后，降低重复手术概率的统计学上显著的独立预测因素。
在子宫内膜异位症完全切除后的 10 年内，多达 28%的患者可能需要进行重复手术。保留子宫后，重复手术的风险增加。该研究基于单一外科医生的治疗结果，这限制了研究结果的普遍性。
