目的:本文旨在总结结直肠子宫内膜异位症外科治疗的最新文献。
结果:在过去的十年中,关于子宫内膜异位症的研究数量激增,专注于术前评估,围手术期管理,手术方法,和手术结果。这些研究中的许多都起源于具有不同手术方法和理念的大容量转诊中心。子宫内膜异位症的结直肠手术似乎对患者症状有积极影响,生活质量,和生育能力。然而,必须权衡这些益处与术后并发症的重大风险以及长期肠或膀胱功能障碍的可能性,特别是对于涉及下直肠的更彻底的手术。重要的是,大多数关于手术技术和结局的研究都受到观察性设计的限制.
结论:肠型子宫内膜异位症的外科治疗是复杂的,应该由多学科团队进行。方法的术前评估,包括适当的成像,对于手术计划和患者咨询至关重要。进行更保守或激进切除的决定是微妙的,仍然是一个有争议的领域。在提出明确建议之前,需要多中心随机对照试验形式的高质量研究。
OBJECTIVE: This review aims to summarize recent literature on the surgical treatment of colorectal endometriosis.
RESULTS: The last decade has seen a surge in the number of studies on bowel endometriosis, with a focus on preoperative evaluation, perioperative management, surgical approach, and surgical outcomes. Many of these studies have originated from large-volume referral centers with varying surgical approaches and philosophies. Colorectal surgery for endometriosis seems to have a positive impact on patient symptoms, quality of life, and fertility. However, these benefits must be weighed against a significant risk of postoperative complications and the potential for long-term bowel or bladder dysfunction, especially for more radical procedures involving the lower rectum. Importantly, most studies regarding surgical technique and outcomes have been limited by their observational design.
CONCLUSIONS: The surgical management of bowel endometriosis is complex and should be approached by a multidisciplinary team. Methodical preoperative evaluation, including appropriate imaging, is vital for surgical planning and patient counseling. The decision to perform a more conservative or radical excision is nuanced and remains an area of controversy. High quality studies in the form of multicenter randomized controlled trials are needed before clear recommendations can be made.