Vallée Alexandre, Ceccaldi Pierre-François, Carbonnel Marie, Horsman Silvia, Murtada Rouba, Moawad Gaby, Feki Anis, Ayoubi Jean-Marc
Department of Epidemiology and Public Health, Foch hospital, 92150, Suresnes, France.
Unité de Recherche en Biomatériaux Innovants Et Interfaces (URB2i), Université Paris Cité, Paris, France.
Sci Rep. 2025 Mar 18;15(1):9369. doi: 10.1038/s41598-025-93705-y.
The debate around colorectal surgery for endometriosis has been ongoing, but to date no meta-analysis has investigated the impact of the different surgical approaches on the pregnancy rate. The aim of this meta-analysis study was to determine in women with deep infiltrating rectal endometriosis, how does colorectal resection surgery compare to other surgical techniques (e.g., rectal shaving, disc excision) in terms of pregnancy rates. We searched PubMed, Web of Science, Cochrane library and Clinical Trials for relevant studies published from inception to December 2024. We performed a systematic review and meta-analysis of all English language full-text articles addressing colorectal resection compared with other management of deep infiltrating rectal endometriosis and presenting pregnancy outcomes. We included a study when it (i) provided data on surgical management (shaving, disc excision, and/or colorectal resection) and (ii) detailed the pregnancy outcomes in each subgroup. Four authors independently performed the initial search to evaluate the eligibility criteria. Four authors extracted the data and a fifth author checked this extraction. Of the 113 full-text articles assessed for eligibility, we included 13 in the meta-analysis. These studies represented a total of 3,248 patients. Pregnancy information was available for 2,131 patients: 1073 colorectal resection, 502 shaving, 172 disc excisions, and 384 other practices (expectant management). Colorectal resection was associated with a lower pregnancy rate compared with the other techniques (N = 2,131, odds ratio [OR] = 0.64 [95% confidence interval 0.52-0.79], p < 0.001, I2 = 35%). There were similar results when comparing colorectal resection with rectal shaving (N = 952, OR = 0.51 [95% confidence interval 0.36-0.73], p < 0.001, I2 = 0%), but not when comparing colorectal resection with disc excision (N = 432, OR = 0.65 [95% confidence interval 0.37-1.13], p = 0.13). Conclusions Rectal resection for endometriosis is associated with a lower pregnancy rate compared with other type of surgery, such as shaving. Trial registration: PROSPERO registration number CRD42024512328.
围绕子宫内膜异位症结直肠手术的争论一直在持续，但迄今为止，尚无荟萃分析研究不同手术方式对妊娠率的影响。本荟萃分析研究的目的是确定在患有深部浸润性直肠子宫内膜异位症的女性中，结直肠切除术与其他手术技术（如直肠剃除术、盘状切除术）相比，妊娠率如何。我们在PubMed、科学网、考克兰图书馆和临床试验数据库中检索了从创刊到2024年12月发表的相关研究。我们对所有探讨结直肠切除术与深部浸润性直肠子宫内膜异位症其他治疗方法比较并呈现妊娠结局的英文全文文章进行了系统评价和荟萃分析。当一项研究（i）提供了手术治疗（剃除术、盘状切除术和/或结直肠切除术）的数据，且（ii）详细说明了每个亚组的妊娠结局时，我们将其纳入研究。四位作者独立进行了初步检索以评估纳入标准。四位作者提取数据，第五位作者检查了数据提取情况。在评估纳入资格的113篇全文文章中，我们将13篇纳入荟萃分析。这些研究共涉及3248例患者。2131例患者有妊娠信息：1073例行结直肠切除术，502例行剃除术，172例行盘状切除术，384例采用其他治疗方法（期待治疗）。与其他技术相比，结直肠切除术的妊娠率较低（N = 2131，比值比[OR] = 0.64 [95%置信区间0.52 - 0.79]，p < 0.001，I² = 35%）。结直肠切除术与直肠剃除术比较时也有类似结果（N = 952，OR = 0.51 [95%置信区间0.36 - 0.73]，p < 0.001，I² = 0%），但结直肠切除术与盘状切除术比较时无此结果（N = 432，OR = 0.65 [95%置信区间0.37 - 1.13]，p = 0.13）。结论：与其他类型的手术（如剃除术）相比，子宫内膜异位症直肠切除术的妊娠率较低。试验注册：PROSPERO注册号CRD42024512328。
