Surgical Treatment of Intestinal Endometriosis: Outcomes of Three Different Techniques

Abstract Objective To outline the demographic and clinical characteristics of patients with deep intestinal endometriosis submitted to surgical treatment at a tertiary referral center with a multidisciplinary team, and correlate those characteristics with the surgical procedures performed and operative complications. Methods A prospective cohort from February 2012 to November 2016 of 32 women with deep intestinal endometriosis operations. The variables analyzed were: age; obesity; preoperative symptoms (dysmenorrhea, dyspareunia, acyclic pain, dyschezia, infertility, urinary symptoms, constipation and intestinal bleeding); previous surgery for endometriosis; Enzian classification; size of the intestinal lesion; and surgical complications. Results Themean age was 37.75 (±5.72) years. A total of 7 patients (22%) had a prior history of endometriosis. The mean of the largest diameter of the intestinal lesions identified intraoperatively was of 28.12 mm (±14.29 mm). In the Enzian classification, there was a predominance of lesions of the rectum and sigmoid, comprising 30 cases (94%). There were no statistically significant associations between the predictor variables and the outcome complications, even after the multiple logistic regression analysis. Regarding the size of the lesion, there was also no significant correlation with the outcome complications (p = 0.18; 95% confidence interval [95%CI]:0.94-1.44); however, there was a positive association between grade 3 of the Enzia classification and the more extensive surgical techniques: segmental intestinal resection and rectosigmoidectomy, with a prevalence risk of 4.4 (p < 0.001; 95%CI:1.60-12.09). Conclusion The studied sample consisted of highly symptomatic women. A high prevalence of deep infiltrative endometriosis lesions was found located in the rectum and sigmoid region, and their size correlated directly with the extent of the surgical resection performed.

摘要 目的：概述某三级转诊中心多学科团队（multidisciplinary team）收治并接受手术治疗的深部肠型子宫内膜异位症（deep intestinal endometriosis）患者的人口学与临床特征，并分析上述特征与所实施手术方式及手术并发症的相关性。
方法：本研究为2012年2月至2016年11月开展的前瞻性队列研究，共纳入32例行手术治疗的深部肠型子宫内膜异位症女性患者。本次分析的变量包括：年龄、肥胖状况、术前症状（痛经、性交痛、非周期性疼痛、排便痛、不孕、泌尿系统症状、便秘及肠道出血）、子宫内膜异位症既往手术史、Enzian分型（Enzian classification）、肠道病灶大小及手术并发症。
结果：患者平均年龄为37.75±5.72岁。共计7例患者（22%）有子宫内膜异位症手术既往史。术中探查确认的肠道病灶最大直径平均值为28.12±14.29 mm。Enzian分型中以直肠及乙状结肠病灶为主，共计30例（94%）。无论是否开展多因素logistic回归分析，各预测变量与手术并发症结局均未发现具有统计学意义的关联。针对病灶大小的分析显示，其与手术并发症结局亦无显著相关性（p=0.18；95%置信区间[95%CI]：0.94~1.44）；但Enzian分型3级与更广泛的手术术式（肠段切除术及直肠乙状结肠切除术）呈正相关，相对风险为4.4（p<0.001；95%CI：1.60~12.09）。
结论：本研究纳入的样本均为症状显著的女性患者。研究发现，深部浸润型子宫内膜异位症病灶多分布于直肠及乙状结肠区域，且病灶大小与所实施的手术切除范围呈正相关。