Ianieri Manuel Maria, De Cicco Nardone Alessandra, Benvenga Greta, Greco Pierfrancesco, Pafundi Pia Clara, Alesi Maria Vittoria, Campolo Federica, Lodoli Claudio, Abatini Carlo, Attalla El Halabieh Miriam, Pacelli Fabio, Scambia Giovanni, Santullo Francesco
Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Unit of Oncological Gynecology, Women's Children's and Public Health Department, Rome, Italy.
Catholic University of the Sacred Heart, Rome, Italy.
Int J Gynaecol Obstet. 2024 Jan;164(1):277-285. doi: 10.1002/ijgo.15019. Epub 2023 Aug 9.
Surgical management of bowel endometriosis is still controversial. Recently, many authors have pointed out the potential benefits of preserving the superior rectal artery, thus ensuring better perfusion of the anastomosis. The aim of this study was to evaluate the complication rate and functional outcomes of a bowel resection technique for deep endometriosis (DE) involving a nerve- and vascular-sparing approach.
A single-center retrospective study was conducted by enrolling patients who underwent segmental resection of the rectus sigmoid for DE in our department between September 2019 and April 2022. Intraoperative and postoperative complications were recorded for each woman, and functional outcomes relating to the pelvic organs were assessed using validated questionnaires (Knowles-Eccersley-Scott-Symptom [KESS] questionnaire and Gastro-Intestinal Quality of Life Index [GIQLI] for bowel function, Bristol Female Lower Urinary Tract Symptoms [BFLUTS] for urinary function, and Female Sexual Function Index [FSFI] for sexual function). These were evaluated preoperatively and postoperatively after 6 months from surgery.
Sixty-one patients were enrolled. No patients had Clavien-Dindo grade 3 or 4 complications, there were no rectovaginal fistulas or ureteral lesions, and in no cases was it necessary to reoperate. Temporary bladder voiding deficits were reported in 8.2% of patients, which were treated with self-catheterizations, always resolving within 45 days of surgery. Gastrointestinal function evaluated by KESS and GIQLI improved significantly after surgery, whereas sexual function appeared to worsen, although without reaching the level of statistically significant validity.
Our vascular- and nerve-sparing segmental bowel resection technique for DE had a low intraoperative and postoperative complication rate and produced an improvement in gastrointestinal function after surgery.
肠道子宫内膜异位症的手术治疗仍存在争议。最近，许多作者指出保留直肠上动脉的潜在益处，从而确保吻合口有更好的灌注。本研究的目的是评估一种用于深部子宫内膜异位症（DE）的肠道切除技术的并发症发生率和功能结局，该技术采用保留神经和血管的方法。
进行一项单中心回顾性研究，纳入2019年9月至2022年4月期间在我科因DE接受乙状结肠节段性切除的患者。记录每位女性的术中及术后并发症，并使用经过验证的问卷评估与盆腔器官相关的功能结局（用于肠道功能的诺尔斯 - 埃克斯利 - 斯科特症状[KESS]问卷和胃肠道生活质量指数[GIQLI]、用于泌尿功能的布里斯托尔女性下尿路症状[BFLUTS]以及用于性功能的女性性功能指数[FSFI]）。在术前及术后6个月进行评估。
共纳入61例患者。没有患者出现Clavien - Dindo 3级或4级并发症，没有直肠阴道瘘或输尿管损伤，也没有病例需要再次手术。8.2%的患者报告有暂时性膀胱排尿障碍，通过自我导尿治疗，均在术后45天内恢复。通过KESS和GIQLI评估的胃肠功能在术后显著改善，而性功能似乎有所恶化，尽管未达到具有统计学意义的有效水平。
我们用于DE的保留血管和神经的节段性肠切除技术术中及术后并发症发生率低，术后胃肠功能得到改善。
