Unit of Oncological Gynecology, Women's Children's and Public Health Department, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy.
Gynecology and Breast Care Center, Mater Olbia Hospital, Olbia, Italy.
Arch Gynecol Obstet. 2024 Jun;309(6):2697-2707. doi: 10.1007/s00404-024-07412-6. Epub 2024 Mar 21.
The surgical approach to bowel endometriosis is still unclear. The aim of the study is to compare TICA to conventional specimen extractions and extra-abdominal insertion of the anvil in terms of both complications and functional outcomes.
This is a single-center, observational, retrospective study conducted enrolling symptomatic women underwent laparoscopic excision of deep endometriosis with segmental bowel resection between September 2019 and June 2022. Women who underwent TICA were compared to classical technique (CT) in terms of intra- and postoperative complications, moreover, 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. Pain symptoms were assessed using Visual Analogue Scale (VAS) scores.
The sample included 64 women. TICA was performed on 31.2% (n = 20) of the women, whereas CT was used on 68.8% (n = 44). None of the patients experienced rectovaginal, vesicovaginal, ureteral or vesical fistula, or ureteral stenosis and uroperitoneum, and in no cases was it necessary to reoperate. Regarding the two surgical approaches, no significant difference was observed in terms of complications. As concerns pain symptoms at 6-month follow-up evaluations on stratified data, except for dysuria, all VAS scales reported showed significant reductions between median values, for both surgery interventions. As well, significant improvements were further observed in KESS scores and overall GIQLI. Only the GIQLI evaluation was significantly smaller in the TICA group compared to CT after the 6-month follow-up.
We did not find any significant differences in terms of intra- or post-operative complications compared TICA and CT, but only a slight improvement in the Gastro-Intestinal Quality of Life Index in patients who underwent the CT compared to the TICA technique.
肠子宫内膜异位症的手术方法仍不明确。本研究旨在比较 TICA 与传统标本提取和体外吻合器插入在并发症和功能结果方面的差异。
这是一项单中心、观察性、回顾性研究，纳入了 2019 年 9 月至 2022 年 6 月期间接受腹腔镜下深部子宫内膜异位症切除术伴肠段切除术的有症状女性。比较 TICA 与经典技术（CT）在术中及术后并发症方面的差异，此外，使用经过验证的问卷[Knowles-Eccersley-Scott-Symptom（KESS）问卷和胃肠道生活质量指数（GIQLI）]评估与盆腔器官相关的功能结果。采用视觉模拟评分（VAS）评估疼痛症状。
样本包括 64 名女性。31.2%（n=20）的女性行 TICA，68.8%（n=44）的女性行 CT。所有患者均未发生直肠阴道、膀胱阴道、输尿管或膀胱瘘，或输尿管狭窄和尿腹，且均无需再次手术。关于两种手术方法，并发症方面无显著差异。在分层数据的 6 个月随访评估中，除排尿困难外，所有 VAS 评分报告的疼痛症状中位数均显著降低，两种手术干预均如此。同时，KESS 评分和总体 GIQLI 也进一步改善。仅在 6 个月随访后，TICA 组的 GIQLI 评估值明显小于 CT 组。
我们未发现 TICA 和 CT 在术中或术后并发症方面有任何显著差异，但与 TICA 技术相比，接受 CT 治疗的患者的胃肠道生活质量指数仅略有改善。
