在法国子宫内膜异位症专家中心,手术经验和医院手术量与严重并发症的风险有关。然而,对中欧国家的其他认证单位知之甚少。
这项回顾性观察性研究包括2018年1月至2020年1月在19个参与的子宫内膜异位症专家中心接受结直肠子宫内膜异位症手术的937名女性。所有女性都通过直肠剃须完全切除结直肠子宫内膜异位症,盘状或节段切除。术后严重并发症定义为Clavien-Dindo分类系统的III-IV级,包括吻合口漏,瘘管,盆腔脓肿和血肿。执行少于40个中心的手术结果(第1组),比较了2年内40-59例(第2组)和≥60例(第3组)。
III级和IV级并发症的总并发症发生率为5.1%(48/937),吻合口漏的发生率,瘘管形成,部分切除术中的脓肿和出血,盘状切除术和直肠剃须,分别,如下:吻合口漏3.6%(14/387),1.4%(3/222),0.6%(2/328);瘘管形成1.6%(6/387),0.5%(1/222),0.9%;(3/328);脓肿0.5%(2/387),0%(0/222)和0.6%(2/328);出血2.1%(8/387),0.9%(2/222)和1.5%(5/328)。节段性切除术(30/387,7.8%)的总并发症发生率高于盘状切除术(6/222,2.7%,P=0.015)或剃须程序(12/328,3.7%,P=0.089)。在低容量中心(组1)中,所进行的手术数量与总体并发症发生率之间没有显着相关性(rSpearman=-0.115;P=0.639),并发症的变异性很高。然而,组间比较显示,第3组的总体严重并发症发生率显著低于第2组(2.9%vs6.9%;P=0.017),其他组间无显著差异.
活动量低的中心确实存在并发症发生率的高变异性。随着活动量的增加,主要并发症可能会减少,但这种影响不能普遍适用于所有机构和环境。
Surgical experience and hospital procedure volumes have been associated with the risk of severe complications in expert centers for endometriosis in France. However, little is known about other certified units in Central European countries.
This retrospective observational study included 937 women who underwent surgery for colorectal endometriosis between January 2018 and January 2020 in 19 participating expert centers for endometriosis. All women underwent complete excision of colorectal endometriosis by rectal shaving, discoid or segmental resection. Postoperative severe complications were defined as grades III-IV of the Clavien-Dindo classification system including anastomotic leakage, fistula, pelvic abscess and hematoma. Surgical outcomes of centers performing less than 40 (group 1), 40-59 (group 2) and ≥60 procedures (group 3) over a period of 2 years were compared.
The overall complication rate of grade III and IV complications was 5.1% (48/937), with rates of anastomotic leakage, fistula formation, abscess and hemorrhage in segmental resection, discoid resection and rectal shaving, respectively, as follows: anastomotic leakage 3.6% (14/387), 1.4% (3/222), 0.6% (2/328); fistula formation 1.6% (6/387), 0.5% (1/222), 0.9%; (3/328); abscess 0.5% (2/387), 0% (0/222) and 0.6% (2/328); hemorrhage 2.1% (8/387), 0.9% (2/222) and 1.5% (5/328). Higher overall complication rates were observed for segmental resection (30/387, 7.8%) than for discoid (6/222, 2.7%, P = 0.015) or shaving procedures (12/328, 3.7%, P = 0.089). No significant correlation was observed between the number of procedures performed and overall complication rates (rSpearman = -0.115; P = 0.639) with a high variability of complications in low-volume centers (group 1). However, an intergroup comparison revealed a significantly lower overall severe complication rate in group 3 than in group 2 (2.9% vs 6.9%; P = 0.017) without significant differences between other groups.
A high variability in complication rates does exist in centers with a low volume of activity. Major complications may decrease with an increase in the volume of activity but this effect cannot be generally applied to all institutions and settings.