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Anatomical distribution of pelvic deep infiltrating endometriosis and its relationship with pain symptoms

Chinese Medical Journal 2012年第2期125卷 209-213页

作者： Dai Yi Leng Jin-hua Lang Jing-he Li Xiao-yan Zhang Jun-ji Peking Union Med Coll Peking Union Med Coll Hosp Dept Obstet & Gynecol Beijing 100730 Peoples R China Chinese Acad Med Sci Beijing 100730 Peoples R China

Background endometriosis is a controversial and enigmatic *** infiltrating endometriosis （DIE） is responsible for painful symptoms and is the least understood type of *** work has been devoted to define the location of DIE lesions and its relationships with *** aim of the study was to investigate the relationship between the anatomical distribution of DIE lesions and pain *** Clinical data from 354 patients between May 2003 and December 2007 with laparoscopically diagnosed endometriosis were collected including 177 DIE patients and 177 non-DIE *** pain symptoms,including dysmenorrhea （DM）,chronic pelvic pain （CPP,defined as intermittent or permanent pelvic pain,not related to the menstruation and longer than 6 months）,deep dyspareunia （pelvic pain at intercourse） and dyschezia （pelvic pain with defecation）,were recorded for every patient before *** lesions were recorded by their anatomical distributions,the depth of infiltration and lesion *** the relationship between the anatomical distribution of DIE lesions and pain symptoms was ***＇s chi-square test or Fisher＇s exact test,one-way analysis of variance （ANOVA） and linear regression and binary Logistic regression were used for statistical *** The duration （（13.79±3.94） years） of pain suffering in DIE patients was much longer than that of non-DIE patients （P 〈0.01）.In DIE patients,60.7% of the uterosacral ligament （USL） nodules were bilateral （P 〈0.01）; 44.6% of the cul-de-sacs were completely *** invasion was observed in 19.9% of DIE patients （P=0.03）; pelvic adhesion was also more *** to 98.41% of the deep infiltrative lesions were located in the posterior pelvic *** lesions were also found in bladder （1.58%）,USL （67.08%）,cul-de-sac （12.02%）,recto-vaginal septum （12.66%）,rectum and rectosigmoid junction （2.85%） and ureter （3.80%）.The odds ratio of USL-DIE for CPP,deep dyspareunia,d

关键词： endometriosis deep infiltrating endometriosis pain anatomy

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Analysis of the Predictive Factors for the Recurrence of deep infiltrating endometriosis:A 2-Year Prospective Study

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Reproductive and Developmental Medicine 2019年第4期3卷 213-221页

作者： Yun-Xi Zheng Qi Cheng Kai-Kai Chang Jing-Yao Ruan Qi Tian Shou-Xin Gu Yun Chen Xiao-Fang Yi Department of Gynecology Obstetrics and Gynecology HospitalFudan UniversityShanghai 200011China Department of Obstetrics and Gynecology Shanghai Medical SchoolFudan UniversityShanghai 200011China Department of Gynecology Shanghai Key Laboratory of Female Reproductive Endocrine Related DiseasesShanghai 200011China

Objective:To investigate factors that may be associated with the recurrence of deep infiltrating endometriosis(DIE)and DIE-related ***:Starting in September 2014,women with a confirmed diagnosis of DIE based on surgical and histological findings were included in the prospective study with a 2-year follow-up in our hospital.A total of 84 consecutive patients were included,all of whom underwent laparoscopic *** data were obtained from the medical records of the ***-up data,including presence of pain as assessed using the visual analog scale(VAS)score and ultrasonography/magnetic resonance imaging findings,were obtained at 3,6,9,12,and 24 months ***,such as age,body mass index,severity and duration of symptoms,size and location of the lesion,and pre-and postoperative medical treatment,were evaluated using univariate and multivariate analyses to identify factors correlated to ***:A total of 11(13.1%)patients presented with recurrence,with a mean time to recurrence of 14.2 *** univariate analysis showed that the longer duration of menstruation(7.4 vs.6.0,P=0.010),the more advanced revised American Fertility Society(rAFS)stage(Stages I and II *** and IV,χ^(2)=9.964,P=0.001),the higher VAS score for dysmenorrhea(9.4 vs.5.2,P=0.001),and the more severe pain during defecation(7.8 vs.4.8,P=0.016)were positively correlated to DIE ***,the multivariate analysis also revealed that a more severe dysmenorrhea and advanced rAFS stage were the independent factors associated with the recurrence of DIE,with an odds ratio of 1.895(confidence interval[CI]:1.061-3.385,P=0.031)and 4.310(CI:1.091-17.028,P=0.037),***:More than 10%of patients presented with recurrence of DIE 2 years after *** of DIE was more common in patients who complained of more severe dysmenorrhea and had an advanced rAFS stage.

关键词： deep infiltrating endometriosis Laparoscopic Surgery Recurrence Revised American Fertility Society Stage Visual Analog Scale

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腹腔镜手术对于改善深部浸润型子宫内膜异位症患者妊娠结局的meta分析

腹腔镜手术对于改善深部浸润型子宫内膜异位症患者妊娠结局的meta...

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作者： Marian Ali addawe 中南大学

学位级别：硕士

背景:子宫内膜异位症是一种发病机制不明确但常见的妇科疾病,其发病机制可能与种植学说、盆腔微环境、上皮间质转化、体腔上皮化生等因素有关。子宫内膜异位分为四种类型,卵巢型、腹膜型、深部浸润型及其他远处转移型。其中深部浸润型(D... 详细信息

背景:子宫内膜异位症是一种发病机制不明确但常见的妇科疾病,其发病机制可能与种植学说、盆腔微环境、上皮间质转化、体腔上皮化生等因素有关。子宫内膜异位分为四种类型,卵巢型、腹膜型、深部浸润型及其他远处转移型。其中深部浸润型(deep infiltrating endometriosis,DIE)是指病灶浸润深度≥5mm的子宫内膜异位症,发生率约占子宫内膜异位症的12%,累及部位包括宫骶韧带、直肠子宫陷凹、阴道穹隆、阴道直肠隔、直肠或者结肠壁等,也可侵犯膀胱壁和输尿管。DIE的发生机制尚不明确,不仅与卵巢型及腹膜型子宫内膜异位症有一定相关性,也不同于这两种,可能形成于新生儿期,也可能与先天及后天环境的改变有关。DIE的临床表现根据病灶累及的部位不同而出现不同的症状,其中最主要的是疼痛(慢性盆腔痛、痛经、性交痛等)和不孕。子宫内膜异位症患者合并不孕的发生率约为25-40%,12%以上的患者合并DIE,且大量研究发现DIE合并不孕患者自发性妊娠率约为10%,因此对于如何提高DIE合并不孕患者的妊娠率是十分重要的。DIE的治疗包括手术和药物治疗,手术可以去除病灶,改善症状。药物包括促性腺激素释放激素类似物Gn RH-ɑ、避孕药、孕激素等,药物治疗可以抑制和延迟疾病的复发和进展,非甾体抗炎药可以缓解疼痛等。对于有症状的DIE患者经过多个学科的医师进行评估后来选择手术治疗或是药物治疗。然而对于那些DIE合并不孕的育龄期女性,既往研究认为手术可以提高妊娠率,但体外受精(In vitro fertility,IVF)也可以改善DIE合并不孕患者的妊娠结局。IVF可以直接将胚胎移植入子宫腔内,但是盆腔内微环境没有改变,解剖结构的异常没有得到纠正,也会影响受精、胚胎的着床和发育,从而增加异位妊娠以及流产的风险,一定程度上影响IVF的结局。手术可以切除异位病灶、恢复盆腔内正常的解剖结构,提高妊娠率,对IVF的结局也有积极的作用,但是DIE手术难度大,且不可避免会对卵巢功能造成一定影响,且术后随之而来的相关并发症,如肠瘘、腹腔感染、出血、粘连等,会影响患者生活质量,甚至造成很多患者失去了生育的意愿,这一系列问题,都对深部浸润型内异症合并不孕的临床决策上产生分歧,引起多年来的讨论。尽管多年来,DIE的手术方式和手术经验已取得了很大的进步,手术的并发症明显降低,但是手术是否能改善DIE患者妊娠结局尚不清楚。因此,手术对于DIE合并不孕的患者术后妊娠率是否有帮助,且手术是否可以改善IVF的结局,在IVF前是否有必要手术,是近年来一直争论的问题。有研究表明手术可以改善IVF的结局,但是也有研究认为手术甚至会对IVF的结局有负面的影响,另有研究认为手术并不会影响IVF的结局。因此,本研究采用Meta分析方法,探讨手术是否提高DIE合并不孕患者的妊娠率,为临床提供更多循证医学证据,指导临床医生的决策。目的:本研究主要分为两个部分:(1)确定腹腔镜手术改善DIE患者生育结果的有效性;(2)比较DIE合并不孕患者在IVF前接受或不接受手术的生殖结果。方法:本研究对腹腔镜手术改善DIE患者妊娠结局进行系统回顾和荟萃分析。在Web of Knowledge,Pub Med,Cochrane Library,Embase,Elsevier以及与研究目的相关的一些期刊网站上广泛检索关于不孕和深部浸润型子宫内膜异位症的文献。在文章检索过程中使用了医学主题词表。检索词endometriosis,deep endometriosis,deep infiltrating endometriosis,bowel endometriosis,colorectal endometriosis,rectovaginal endometriosis,were combined with surgery,laparoscopy,fertility,infertility和IVF。纳入因DIE行辅助生殖技术的文献,排除病例报告研究,仅纳入英文文献。采用一套基于PICO的标准并进行质量评估和偏倚风险评估。评估以下七个领域的风险水平(低、中、严重或关键的偏倚风险或无信息风险)。分别评估了每项研究的方法学质量:(1)由混杂实验因素引起的偏倚;(2)参与者选择的偏倚;(3)干预措施分类的偏倚;(4)由于偏离预期干预措施而产生的偏差;(5)由于数据缺失而产生的偏倚;(6)结果测量中的偏倚;(7)报告结果选择中的偏倚。资料上传至EPPI-Reviewer 4对全文进行编码。使用Stata version 16对纳入文献进行统计学异质性分析,异质性用I2统计量,当P≥0.1和I2≤50%时,表示各研究间无统计学异质性,采用固定效应模型;若P50%,表示各研究间存在统计学异质性,则对异质性来源进行分

关键词： deep infiltrating endometriosis IVF fertility surgery

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Robotic Assisted Surgery for endometriosis—“Is the Way Forward?”

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Open Journal of Obstetrics and Gynecology 2016年第2期6卷 93-102页

作者： Rooma Sinha Madhumathi Sanjay Rupa Bana Fozia Jeelani Samita Kumari Department of Gynecology & Minimally Access Surgery Apollo Health City Hyderabad India

endometriosis is a chronic and progressive gynecologic disorder that affects 10% - 50% of women of reproductive age worldwide. Chronic pain and infertility are the most debilitating problems associated with it requiring both medical and surgical treatment. Laparoscopy is considered the gold standard for diagnosis and treatment. However, a 10% rate of conversion to laparotomy has been reported when performed by skilled laparoscopic surgeons and much higher in low volume less skilled surgeons. To improve surgical outcomes, robotic assistance is the logical next step in performing minimally invasive gynecological surgeries, especially in complex endometriosis cases. Enhanced 3D visualization and 10× magnification along with Endowrist instruments with seven degrees of freedom facilitates precise and careful dissection. Firefly technology using ICG green dye can improve detection of small and invisible lesions. Robotics is useful in deep infiltrating disease manifesting as lesions deeper than the superficial tissues of rectovaginal septum, vaginal fornix, pelvic sidewalls, parametrium, bowel or ureter and bladder. Trials show no increase in surgical time, blood loss, or intra- or postoperative complications and similar clinical outcome when robotics is compared with laparoscopy. At present, it is more appropriate to compare it with laparotomy rather than laparoscopy. Robotics can be used to manage recurrence of endometriosis after hysterectomy. Surgeons experienced in conventional laparoscopy can utilize robotic platform for deep infiltrating endometriosis for performing complex surgical dissection and achieving the surgical goals in mind and reduce conversions to open surgery. Robotic assistance can bridge the gap in performance of laparoscopic surgery in advanced endometriosis.

关键词： endometriosis Advanced Robotic Surgery Laparoscopy deep infiltrating endometriosis Hysterectomy Recurrence

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