Zeppernick Felix, Zeppernick Magdalena, Wölfler Monika Martina, Janschek Elisabeth, Holtmann Laura, Bornemann Sebastian, Oehmke Frank, Salehin Darius, Scheible Chi Mi, Brandes Iris, Vingerhagen-Pethick Sigrid, Cornelius Claus-Peter, Boosz Alexander, Krämer Bernhard, Sillem Martin, Keckstein Jörg, Schweppe Karl-Werner, Meinhold-Heerlein Ivo
Zentrum für Frauenheilkunde und Geburtshilfe der Justus Liebig-Universität Gießen, Gießen, Germany.
Frauenklinik der medizinischen Universität Graz, Graz, Austria.
Geburtshilfe Frauenheilkd. 2024 Jul 9;84(7):646-655. doi: 10.1055/a-2324-3778. eCollection 2024 Jul.
After puberty, at least 10% of all women and girls suffer from endometriosis. Surgery is useful for both the diagnosis and therapy. To date, quality indicators for the surgical treatment of endometriosis are lacking. QS ENDO aims to record the quality of care provided in the DACH region and to introduce quality indicators for the diagnosis and treatment of endometriosis. In the first phase of the study, QS ENDO real, the reality of care was recorded using a questionnaire. The second phase, QS ENDO pilot, investigated the treatment of patients who underwent surgery in certified endometriosis centers in a defined time-period. The surgical data of 10 patients from each of the 44 endometriosis centers in the DACH region was recorded using an online tool. Collected data included the approach used, the endometriosis phenotype, a description of the surgical site, resection status, histological confirmation, the use of a classification, and any complications. All operations were carried out in October 2016 as the defined time-period. The surgical approaches used were compared with the recommendations in the current guidelines. The data of 435 patients with a median age of 34 years were evaluated. 315 (72.4%) were nulliparous. 120 patients had given birth to at least one child and 42.5% (51) of them had delivered their child by caesarean section. About 50% of all patients also had deep infiltrating endometriosis in addition to ovarian endometriosis, and the median NAS score was 7.5. With regards to the surgical treatment, endometriomas were completely resected in 81% (94) of patients. 87.3% of patients underwent resection of peritoneal endometriosis. Forty-one patients had a hysterectomy, with a total hysterectomy carried out in 26 (63.4%) and a supracervical hysterectomy in 15 (36.6%) patients. Of the 59 patients with bowel endometriosis, half had segmental resection and half had shaving of the anterior rectal wall. Complications requiring revision occurred in 0.9% of cases. The surgical procedures carried out in the certified endometriosis centers of the DACH region are largely in line with the recommendations for appropriate surgical approaches in the current standard guidelines.
青春期后，至少10%的成年女性和女孩患有子宫内膜异位症。手术对诊断和治疗均有帮助。迄今为止，子宫内膜异位症手术治疗的质量指标尚不完善。QS ENDO旨在记录德国、奥地利和瑞士（DACH）地区的医疗服务质量，并引入子宫内膜异位症诊断和治疗的质量指标。在研究的第一阶段，即QS ENDO实际情况阶段，通过问卷调查记录了医疗实际情况。第二阶段，即QS ENDO试点阶段，对在规定时间段内在认证的子宫内膜异位症中心接受手术的患者的治疗情况进行了调查。使用在线工具记录了DACH地区44个子宫内膜异位症中心中每个中心10例患者的手术数据。收集的数据包括所采用的手术方式、子宫内膜异位症的表型、手术部位描述、切除情况、组织学确认、分类的使用以及任何并发症。所有手术均在2016年10月这个规定时间段内进行。将所采用的手术方式与当前指南中的建议进行了比较。对435例中位年龄为34岁的患者的数据进行了评估。其中315例（72.4%）未生育。120例患者至少生育过一个孩子，其中42.5%（51例）为剖宫产分娩。除卵巢子宫内膜异位症外，约50%的患者还患有深部浸润性子宫内膜异位症，中位NAS评分为7.5。在手术治疗方面，81%（94例）的患者的卵巢子宫内膜异位囊肿被完全切除。87.3%的患者接受了腹膜子宫内膜异位症切除术。41例患者进行了子宫切除术，其中26例（63.4%）进行了全子宫切除术，15例（36.6%）进行了次全子宫切除术。在59例肠道子宫内膜异位症患者中，一半接受了节段性切除，一半接受了直肠前壁刮除术。需要再次手术的并发症发生率为0.9%。DACH地区认证的子宫内膜异位症中心所开展的手术程序在很大程度上符合当前标准指南中关于适当手术方式的建议。
