Markowitz Melissa A, Doernberg Molly, Li Howard J, Cho Yonghee K
Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut, USA.
Gynecol Minim Invasive Ther. 2024 Oct 21;13(4):221-227. doi: 10.4103/gmit.gmit_137_23. eCollection 2024 Oct-Dec.
The objective of this study was to quantify the time to diagnosis of endometriosis by laparoscopy for patients of varying body mass index (BMI), as well as the safety of laparoscopy for endometriosis by BMI.
We performed a retrospective cohort study of reproductive-age women receiving a primary laparoscopic diagnosis of endometriosis at an academic tertiary hospital from January 2017 to December 2020. Patients excluded were those undergoing repeat laparoscopy, with previously histologically diagnosed endometriosis, asymptomatic endometriosis, an unknown first gynecologic encounter, or an unknown initial BMI. Our primary outcome was time to surgical diagnosis of endometriosis by BMI class. Our secondary outcome was the evaluation of peri/postoperative risk of laparoscopy for endometriosis.
A total of 152 patients received a primary surgical diagnosis of endometriosis, including 44% normal or underweight patients, 29% overweight patients, and 27% obese patients. Obese patients experienced a delay from gynecologic presentation to diagnostic laparoscopy (18.4 months, interquartile range [IQR] 3.1-42.8) compared to overweight patients (9.0 months, IQR 2.5-23.2) and normal and underweight patients (3.8 months, IQR 1.1-17.0) ( = 0.02). Although a higher percentage of overweight and obese patients was Hispanic and non-Hispanic Black, multiple linear regression maintained a significant relationship between time to surgery and BMI ( = 0.03). Perioperative and postoperative complications did not differ by BMI class. There were no differences in repeat laparoscopy for endometriosis within 3 years by BMI ( = 0.99).
BMI is independently associated with time to surgical diagnosis of endometriosis in our retrospective study. Diagnostic laparoscopy appears safe in obese patients, without significant perioperative morbidity.
本研究的目的是量化不同体重指数（BMI）的子宫内膜异位症患者通过腹腔镜检查确诊的时间，以及按BMI评估腹腔镜检查诊断子宫内膜异位症的安全性。
我们对2017年1月至2020年12月在一家学术性三级医院接受初次腹腔镜诊断为子宫内膜异位症的育龄妇女进行了一项回顾性队列研究。排除的患者包括接受重复腹腔镜检查的患者、先前经组织学诊断为子宫内膜异位症的患者、无症状子宫内膜异位症患者、首次妇科就诊情况不明的患者或初始BMI不明的患者。我们的主要结局是按BMI类别进行子宫内膜异位症手术诊断的时间。我们的次要结局是评估腹腔镜检查诊断子宫内膜异位症的围手术期/术后风险。
共有152例患者接受了子宫内膜异位症的初次手术诊断，其中44%为体重正常或体重过轻的患者，29%为超重患者，27%为肥胖患者。与超重患者（9.0个月，四分位间距[IQR]2.5 - 23.2）和体重正常及体重过轻的患者（3.8个月，IQR 1.1 - 17.0）相比，肥胖患者从妇科就诊到诊断性腹腔镜检查的时间有所延迟（18.4个月，IQR 3.1 - 42.8）（P = 0.02）。尽管超重和肥胖患者中西班牙裔和非西班牙裔黑人的比例较高，但多元线性回归显示手术时间与BMI之间仍存在显著关系（P = 0.03）。围手术期和术后并发症在不同BMI类别之间无差异。按BMI分类，3年内子宫内膜异位症重复腹腔镜检查的情况无差异（P = 0.99）。
在我们的回顾性研究中，BMI与子宫内膜异位症手术诊断时间独立相关。诊断性腹腔镜检查在肥胖患者中似乎是安全的，围手术期发病率无显著增加。
