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首页> 外文期刊>Surgical Endoscopy >Combined vaginal-laparoscopic-abdominal approach for the surgical treatment of rectovaginal endometriosis with bowel resection: a comparison of this new technique with various established approaches by laparoscopy and laparotomy.
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Combined vaginal-laparoscopic-abdominal approach for the surgical treatment of rectovaginal endometriosis with bowel resection: a comparison of this new technique with various established approaches by laparoscopy and laparotomy.

机译：阴道-腹腔镜-腹部联合手术治疗直肠阴道子宫内膜异位症并进行肠切除术：该新技术与腹腔镜和剖腹术的各种既定方法的比较。

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BACKGROUND: A new combined vaginal-laparoscopic-abdominal approach for rectovaginal endometriosis allows intraoperative digital bowel palpation to assess bowel infiltration and prevents unnecessary bowel resections. This technique was compared to various established approaches where bowel resection was indicated by clinical symptoms and imaging results only. METHODS: Patients operated for rectovaginal endometriosis with endometriotic bowel involvement between March 2002 and April 2006 at the gynecological department Charite, Berlin, Germany were included. Bowel involvement was suspected by clinical symptoms, clinical examination, and/or results of imaging techniques. The study group (SG) was operated by the combined vaginal-laparoscopic-abdominal approach (n = 30) and the control group (CG) (n = 18) by laparoscopy (n = 4), laparotomy (n = 3), laparoscopy followed by laparotomy for bowel resection (n = 8) or laparoscopy followed by vaginal bowel resection (n = 3). In all cases histopathology was performed. RESULTS: The study group and the control group were comparable regarding age, body mass index, symptoms, American Society for Reproductive Medicine (ASRM) classification, colorectal operative procedures, operating times, length of the resected bowel specimen, and concomitant surgical procedures. However, only in the CG were protective stomas required (p = 0.047). There were significantly less complications in the SG (p = 0.027). No patient experienced leakage of anastomosis. Bowel involvement by endometriosis was confirmed by histopathology in the SG in all cases whereas in the CG only in 16/18 (88.9%) cases. Hospitalization time was significantly shorter in the SG. Rehospitalizations were necessary only in the CG to repair one rectovaginal fistula and to reverse three stomas. CONCLUSIONS: With the presented technique of a combined vaginal-laparoscopic-abdominal surgical procedure for rectovaginal endometriosis, we showed that the complication rate, rehospitalization rate, and hospitalization time were significantly lower than in the patients of the CG. Furthermore, the combined vaginal-laparoscopic-abdominal technique allowed better evaluation of the invasiveness of the endometriotic lesion and avoided unnecessary bowel surgery.
机译：背景：用于阴道阴道子宫内膜异位症的新的阴道-腹腔镜-腹部联合手术方法可在术中数字触诊以评估肠浸润并防止不必要的肠切除。将该技术与各种已建立的方法进行了比较，在这些方法中，仅通过临床症状和影像学结果即可指示肠切除。方法：纳入2002年3月至2006年4月在德国柏林的Charite妇产科接受直肠内膜异位症手术并伴有子宫内膜异位症的患者。临床症状，临床检查和/或成像技术结果怀疑肠受累。研究组（SG）通过腹腔镜（n = 4），腹腔镜切开术（n = 3），腹腔镜（n = 30）和腹腔镜（n = 4）的对照组（CG）（n = 18）进行手术然后进行剖腹手术以进行肠切除（n = 8）或进行腹腔镜检查，然后进行阴道肠切除（n = 3）。在所有情况下均进行了组织病理学检查。结果：研究组和对照组在年龄，体重指数，症状，美国生殖医学学会（ASRM）分类，结直肠手术程序，手术时间，切除肠标本的长度以及伴随的手术程序方面具有可比性。但是，仅在CG中才需要保护性气孔（p = 0.047）。 SG的并发症明显较少（p = 0.027）。没有患者发生吻合口漏。在所有病例中，SG均通过组织病理学证实肠内膜异位受累，而在CG中只有16/18（88.9％）病例证实肠受累。 SG的住院时间明显缩短。仅在CG中需要进行再入院术以修复1个直肠阴道瘘并逆转3个气孔。结论：利用所提出的阴道-腹腔镜-腹部联合手术方法治疗直肠阴道子宫内膜异位症，我们发现其并发症发生率，再次住院率和住院时间均明显低于CG患者。此外，阴道-腹腔镜-腹部联合技术可以更好地评估子宫内膜异位病变的侵袭性，并避免不必要的肠手术。

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