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1.
Caterina Exacoustos Giovanna De Felice Alessandra Pizzo Giulia Morosetti Lucia Lazzeri Gabriele Centini Emilio Piccione Errico Zupi 《Journal of minimally invasive gynecology》2018,25(5):884-891
Study Objective
To assess the association between ovarian endometriomas detectable at transvaginal ultrasound (TVS) and other specific extraovarian lesions including adhesions, deep infiltrating endometriosis (DIE), and adenomyosis.Design
Retrospective observational study (Canadian Task Force classification II-2).Setting
Two university hospitals.Patients
Two hundred fifty-five symptomatic women with at least 1 ovarian endometrioma found on ultrasound after presentation with pain or irregular menstruation.Interventions
Patients underwent TVS followed by either medical or surgical treatment.Measurements and Main Results
Two hundred fifty-five women, aged 20 to 40 years, underwent TVS and were found to have at least 1 endometrioma with a diameter?>?20?mm. Associated sonographic signs of pelvic endometriosis (adhesions, DIE, and adenomyosis) were recorded, and a subgroup of patients (n?=?50) underwent laparoscopic surgery within 3 months of TVS. Mean endometrioma diameter was 40.0?±?18.1?mm, and bilateral endometriomas were observed in 65 patients (25.5%). TVS showed posterior rectal DIE in 55 patients (21.5%) and a thickening of at least 1 uterosacral ligament in 93 patients (36.4%). One hundred eighty-six patients (73%) had adhesions, and 134 patients (53%) showed signs of myometrial adenomyosis on TVS. Thirty-eight patients (15%) exhibited only a single isolated endometrioma with a mobile ovary and no other signs of pelvic endometriosis/adenomyosis at TVS.Conclusion
Ovarian endometriomas are indicators for pelvic endometriosis and are rarely isolated. Particularly, left endometriomas were found to be associated with rectal DIE and left uterosacral ligament localization and bilateral endometriomas correlated with adhesions and pouch of Douglas obliteration, whereas no correlation was found between endometrioma size and DIE. Determining appropriate management, whether clinical or surgical, is critical for ovarian endometriomas and concomitant adhesions, endometriosis, and adenomyosis in patients desiring future fertility. 相似文献2.
Vito Chiantera Marco Petrillo Elene Abesadze Giulio Sozzi Margherita Dessole Mariano Catello Di Donna Giovanni Scambia Jalid Sehouli Sylvia Mechsner 《Journal of minimally invasive gynecology》2018,25(7):1217-1223
Study Objective
To evaluate the clinical presentation and surgical outcome in patients with deep lateral pelvic endometriosis (dLPE).Design
A retrospective multicentric study (Canadian Task Force classification II-2).Setting
University tertiary referral centers.Patients
One hundred forty-eight women with deep infiltrating endometriosis (DIE).Interventions
Laparoscopic excision of DIE. Disease distribution was classified as follows: central pelvic endometriosis (CPE) when DIE involved 1 of the following anatomic sites: cervix, vagina, uterosacral ligaments, rectum, bladder, or pelvic peritoneum; superficial lateral pelvic endometriosis when parametria, ureters, or hypogastric plexus were involved; and dLPE in the presence of sacral plexus and/or sciatic nerve infiltration.Measurements and Main Results
All patients showed CPE. LPE was detected in 116 cases (78.4%); among these, we observed dLPE in 41 patients (35.3%). dLPE occurred in 40% of women with CPE and in 72.7% of patients with hypogastric plexus involvement. Thirty women with dLPE (73.2%) received gastrointestinal or urologic resection in addition to gynecologic procedures compared with 40 patients (57.1%) without dLPE (p?=?.001). No differences were observed in terms of perioperative complications according to the presence of dLPE. According to univariate/multivariate analysis, chronic pelvic pain was the only predictor of dLPE (odds ratio?=?3.041, p?=?.003). The median preoperative visual analog scale for dysmenorrhea (median?=?8, range, 0–10) and dyspareunia (median?=?5; range, 0–10) dropped to 0 after surgery. The median follow-up was 36 months (range, 6–66 months) with a recurrence rate of 8.8%.Conclusions
dLPE is not a rare event in women with DIE. Complete laparoscopic removal of endometriosis seems to ensure benefit in terms of recurrence rate without increased surgical morbidities. 相似文献3.
Elisa Bertocchi Giuliano Barugola Marco Benini Paolo Bocus Roberto Rossini Marcello Ceccaroni Giacomo Ruffo 《Journal of minimally invasive gynecology》2019,26(1):100-104
Study Objective
To evaluate the incidence, risk factors, and treatment of colorectal anastomotic stenosis in patients who undergo rectosigmoid resection for deep infiltrating endometriosis (DIE).Design
Retrospective analysis of a prospective database (Canadian Task Force classification III).Setting
Public medical center.Patients
All women who underwent laparoscopic rectosigmoid resections for DIE at our hospital between January 2002 and December 2016.Intervention
All patients were evaluated clinically and endoscopically at 1 month and 3 months after bowel resection. Stenosis was defined as a lack of passage through the anastomosis of a 12-mm proctoscope. Symptomatic stenosis was defined as the presence of endoscopically confirmed stricture accompanied by at least 2 of the following symptoms: constipation, need to push, tenesmus, and ribbon stools. Only patients with symptomatic stenosis were studied. Demographic data, surgical techniques, and postoperative complications were recorded prospectively. Treatments and outcomes of anastomotic symptomatic strictures were analyzed.Measurements and Main Results
A total of 1643 patients underwent laparoscopic rectosigmoid resection at our hospital between January 2002 and December 2016. Among these, 104 patients (6.3%) presented with symptomatic anastomotic stenosis. The median patient age was 27 years (range, 23–44 years), and the median interval between diagnosis and the onset of symptomatic stenosis was 57 days (range, 21–64 days). The only statistically significant predictors of anastomotic stenosis were the presence of ileostomy (p?=?.01) and previous pelvic surgery (p?=?.002). Treatment of choice was always conservative. Of the 104 patients in the study cohort, 90 (86.5%) underwent 3 endoscopic dilatations. No patient required reoperation.Conclusion
The anastomotic stricture is a recognized complication in patients following intestinal resection for DIE, and protective ileostomy is the sole modifiable factor related to anastomotic stenosis. Endoscopic dilatation is a valid option to treat this complication. 相似文献4.
Louis Marcellin Pietro Santulli Sara Bortolato Cécile Morin Anne Elodie Millischer Bruno Borghese Charles Chapron 《Journal of minimally invasive gynecology》2018,25(5):896-901
Study Objective
To evaluate the association between bladder deep infiltrating endometriosis (DIE) and anterior focal adenomyosis of the outer myometrium (aFAOM) diagnosed by preoperative magnetic resonance imaging (MRI).Design
An observational, cross-sectional study using prospectively collected data (Canadian Task Force classification II-2).Setting
Single university tertiary referral center.Patients
All nonpregnant women younger than 42 years who had undergone complete surgical exeresis of endometriotic lesions. For each patient a standardized questionnaire was completed during a face-to-face interview conducted by the surgeon during the month preceding the surgery. Only women with preoperative standardized uterine MRI were retained for this study.Interventions
Thirty-nine women with histologically proven bladder DIE and an available preoperative MRI were enrolled in the study. Patients were divided into 2 groups: women with aFAOM (aFAOM (+), n?=?19) and women without aFAOM (aFAOM (–), n?=?20). Both groups were compared for general characteristics, medical history, MRI findings, and disease severity.Measurements and Main Results
Nineteen patients (48.7%) with bladder DIE had aFAOM at preoperative MRI. The rate of associated diffuse adenomyosis was similar in the 2 groups (63.2% [n?=?12] vs 73.7% [n?=?14]; p?=?.48). The rate of an associated ovarian endometrioma (OMA) was significantly lower in the aFAOM (+) group (10.5% [n?=?2] vs 40.0% [n?=?8]; p?=?.03). There were fewer associated intestinal DIE lesions in the aFAOM (+) group compared with the aFAOM (–) group (26.3% vs 75.0%; p?=?.02), with lower involvement of the pouch of Douglas (26.3% vs 70%; p?<?.01). Total American Society for Reproductive Medicine score was significantly lower in the aFAOM (+) group (13.8?±?12.2 vs 62.2?±?46.2; p?<?.01).Conclusion
aFAOM is present in only half of women with bladder DIE and appears to be associated with lower associated posterior DIE. 相似文献5.
Francesco Cosentino Giuseppe Vizzielli Luigi Carlo Turco Anna Fagotti Stefano Cianci Virginia Vargiu Gian Franco Zannoni Gabriella Ferrandina Giovanni Scambia 《Journal of minimally invasive gynecology》2018,25(7):1249-1254
Study Objective
To evaluate near-infrared radiation imaging with intravenous indocyanine green (NIR-ICG) during laparoscopic intervention to identify endometriosis lesions.Design
A single-center, prospective, single-arm pilot study (Canadian Task Force classification II-2).Setting
An academic tertiary care and research center.Patients
Twenty-seven patients with symptomatic endometriosis were enrolled.Interventions
Patients underwent laparoscopic surgery using a laparoscopic system prototype with NIR-ICG.Measurements and Main Results
A total of 116 suspected endometriosis lesions were removed from 27 patients. One hundred lesions had already been visualized in white light imaging by an expert surgeon; the remaining 16 were detected and removed using NIR-ICG. A total of 111 specimens were positive for endometriosis pathology. Positive predictive value of 95% and 97.8% and negative predictive value of 86.2% and 82.3% were found by white light imaging and NIR-ICG, respectively, with sensitivity of 85.6% and 82% and specificity of 95.2% and 97.9%, respectively.Conclusion
NIR-ICG may be a tool for intraoperative diagnosis, confirmation of visible endometriosis lesions, and a marker for identifying occult endometriosis. Further prospective studies with a larger population sample are warranted to validate these encouraging preliminary results. 相似文献6.
Togas Tulandi Christian Sirois Hussein Sabban Aviad Cohen Ally Murji Sukhbir S. Singh Innie Chen Liane Belland 《Journal of minimally invasive gynecology》2018,25(3):480-483
Study Objective
To evaluate the clinical characteristics of women presenting with catamenial pneumothorax and compare them with those with noncatamenial pneumothorax.Design
A case-control study (Canadian Task Force II-2).Setting
A multicenter study.Patients
Forty-two women with pneumothorax: 21 women had catamenial pneumothorax (study group), and 21 were age-matched women with noncatamenial pneumothorax (control group).Interventions
All patients underwent video-assisted thoracoscopy and pleural biopsy. We also evaluated the presence and stage of pelvic endometriosis in 16 women with catamenial pneumothorax who had undergone laparoscopic surgery.Measurements and Main Results
The number of known episodes of catamenial pneumothorax before treatment was between 2 and 8 episodes. Symptoms were mainly chest pain and shortness of breath; 1 patient had hemoptysis. The prevalence of right-sided pneumothorax was 95.2% in the study group and 57.1% in the control group (p?=?.004). Besides 2 cases with complete collapse of the right lung, most of the cases in the study group had apical pneumothorax. Pelvic endometriosis was found in 15 of 16 women (93.7%), mainly stage 3 or 4, and thoracic endometriosis in 12 of 20 women (60%). None of the patients in the control group had thoracic endometriosis.Conclusion
Thoracic endometriosis is found in over half of women with catamenial pneumothorax but absent in those with noncatamenial pneumothorax. Right apical pneumothorax is predominant in women with catamenial pneumothorax. Endometriosis plays an important role in the mechanism of catamenial pneumothorax. 相似文献7.
8.
Maria Grazia Porpora Valeria Vinci Corrado De Vito Giuseppe Migliara Emanuela Anastasi Adele Ticino Serena Resta Carlo Catalano Pierluigi Benedetti Panici Lucia Manganaro 《Journal of minimally invasive gynecology》2018,25(4):661-669
Objectives
To evaluate the sacral nerve root features by the means of magnetic resonance imaging–diffusion tensor imaging (MRI-DTI) tractography in women with endometriosis and/or adenomyosis, and to analyze the correlations among DTI abnormalities, pain symptoms, and endometriotic lesions found at surgery.Design
A cross-sectional, observational study (Canadian Task Force classification II-2).Setting
University hospital.Patients
Women (n?=?76) with clinical suspicion of endometriosis.Interventions
Before surgery, dysmenorrhea, deep dyspareunia, and noncyclic pelvic pain (NCPP) were assessed using a 10-point visual analog scale. MRI enabled a 3-dimensional reconstruction of S1, S2, and S3. Fractional anisotropy was calculated for each root. Laparoscopic treatment of endometriosis was performed in 56 patients.Measurements and Main Results
Our findings revealed correlations among sacral root reconstruction by MRI-DTI, pain symptoms, and laparoscopic findings. DTI of sacral roots revealed a regular and homogeneous appearance in 17 patients (25.8%) and abnormalities in microstructure reconstruction, with fiber irregularities and disorganization and loss of the simple unidirectional course, in 44 patients (66.7%). At laparoscopy, ovarian endometriomas were found in 82.1% of the patients, and deeply infiltrating endometriosis (DIE) were found in 57.1%. Endometriosis was staged according to the revised American Society for Reproductive Medicine classification. Pathological DTI findings were significantly associated with the severity of dysmenorrhea and NCPP, pain duration, presence of tubo-ovarian and cul-de-sac adhesions, and DIE.Conclusion
The presence of pathological DTI findings of the sacral nerve roots correlates with the type of pain, adhesions, and DIE. At present, DTI can be useful for providing a better understanding of pain; however, DTI could become a useful tool in therapeutic planning for patients with endometriosis. 相似文献9.
Jenny-Claude Millochau Emanuela Stochino-Loi Basma Darwish Carole Abo Julien Coget Rachid Chati Jean-Jacques Tuech Horace Roman 《Journal of minimally invasive gynecology》2018,25(1):139-146
Study Objective
To report postoperative outcomes after dual digestive resection for deep endometriosis infiltrating the rectum and the colon.Design
A retrospective study using data prospectively recorded in the CIRENDO database (Canadian Task Force classification II-2).Setting
A university tertiary referral center.Patients
Twenty-one patients managed for multiple colorectal deep endometriosis infiltrating nodules.Interventions
Concomitant disc excision and segmental resection of both the rectum and sigmoid colon.Measurements and Main Results
The assessment of postoperative outcomes was performed. Rectal nodules were managed by disc excision and segmental resection in 20 patients and 1 patient, respectively. Sigmoid colon nodules were removed by short segmental resection and disc excision in 15 and 6 patients, respectively. The rectal nodule diameter was between 1 and 3?cm and over 3?cm in 33% and 67% of patients, respectively. Associated vaginal infiltration requiring vaginal excision was recorded in 76.2% of patients. The mean diameter of the rectal disc removed averaged 4.6?cm, and the mean height of the rectal suture was 5.8?cm. The length of the sigmoid colon specimen and the height of the anastomosis were 7.3?cm and 18.5?cm, respectively. The mean operative time was 290 minutes, and the mean postoperative follow-up averaged 30 months. Clavien-Dindo 3 complications occurred in 28% of patients, including 4 with rectal fistulae (19%). The pregnancy rate was 67% among patients with pregnancy intention.Conclusion
Our data suggest that combining disc excision and segmental resection to remove multiple deep endometriosis nodules infiltrating the rectum and the sigmoid colon can preserve the healthy bowel located between 2 consecutive nodules. However, the rate of postoperative complications is high, particularly in patients with large low rectal nodules. 相似文献10.
Alexandra Badescu Horace Roman Iulia Barsan Valentin Soldea Serban Nastasia Moutaz Aziz Lucian Puscasiu Simona Stolnicu 《Journal of minimally invasive gynecology》2018,25(3):522-527.e9
Study Objective
To document the presence of bowel invisible microscopic endometriosis implants and their relationship with deep endometriosis macronodule infiltrating the bowel.Design
A series of consecutive patients with deep endometriosis infiltrating the rectum and/or sigmoid colon (Canadian Task Force classification II-2).Settings
A university referral center.Patients
Ten patients managed by colorectal resection.Interventions
A microscopic study of endometriotic foci of the bowel involving 3272 microsection slides was established using a unique method of step serial sections using combined transverse and longitudinal macrosection. Two-dimensional reconstruction based on slide scanning highlighted the presence and localization of the deep endometriosis macronodule in contrast with bowel invisible microscopic endometriosis microimplants.Measurements and Main Results
The distance separating the microimplants and the nodule and their histologic characteristics. The mean length of the colorectal specimens was 91?±?19?mm. The maximum distance between the farthest microimplants was 7.2?cm. The maximum distance from the macroscopic nodule limit to the farthest microimplant was 31?mm. Bowel invisible microscopic endometriosis microimplants presented with similar features independently of the type of spread. They had an active appearance including stroma and glands, were sometimes decidualized, and were free of fibrosis. They were found on the distal/rectal limit of the specimen in 3 patients and on both limits (distal/rectal and proximal/sigmoid colon) in 1 patient.Conclusion
Invisible microscopic endometriosis implants surround the bowel macroscopic endometriosis nodule at variable distances, suggesting that complete surgical microscopic removal may be a challenging goal. These results may help to reconsider the principles and feasibility of the surgical management of bowel endometriosis. 相似文献11.
Claudia Mehedințu Lăcrămioara Aurelia Brîndușe Elvira Brătilă Michele Monroc Ebticem Lemercier Olivier Suaud Cecile Collet-Savoye Horace Roman 《Journal of minimally invasive gynecology》2018,25(6):1009-1017
Study Objective
To evaluate whether combining computed tomography–based virtual colonoscopy (CTC) with magnetic resonance imaging (MRI) improves preoperative assessment of colorectal endometriosis.Design
Retrospective study using prospectively recorded data (Canadian Task Force classification II-2).Setting
University tertiary referral center.Patients
Seventy-one women treated for colorectal endometriosis managed between June 2015 and May 2016.Interventions
Patients included in our study underwent colorectal surgery for deep endometriosis infiltrating the rectum or the sigmoid colon and had preoperative assessment using MRI and CTC. To establish the correlation between preoperative and intraoperative findings, the concordance kappa index was used.Measurements and Main Results
Preoperative data provided by MRI, CTC, and a combination of both were compared with intraoperative findings. All 71 patients had a total of 105 endometriotic intestinal lesions intraoperatively confirmed. Some 71.2% of rectal nodules and 60.0% of sigmoid nodules infiltrated the muscularis propria of the intestinal wall, with most infiltrating between 25% and 50% of the rectal circumference; 73% of rectal nodules and 96% of sigmoid nodules led to varying degrees of stenosis. The concordance between intraoperative and preoperative findings concerning the presence of rectal nodules was high, at .88 when associating CTC with MRI, whereas each imaging technique taken individually provided lower concordance coefficients. In our study 80.3% of patients underwent the procedure that had been preoperatively planned.Conclusion
Our study suggests that associating MRI with CTC leads to improved accuracy in preoperative assessment of colorectal endometriosis and in subsequent preoperative choice of surgical procedures on the digestive tract. 相似文献12.
Kristin A. Riley Andrea S. Benton Timothy A. Deimling Allen R. Kunselman Gerald J. Harkins 《Journal of minimally invasive gynecology》2019,26(1):71-77
Study Objective
To compare surgical excision and ablation of endometriosis for treatment of chronic pelvic pain.Design
Randomized clinical trial with 12-month follow-up (Canadian Task Force classification I).Setting
Single academic tertiary care hospital.Patients
Women with minimal to mild endometriosis undergoing laparoscopy.Interventions
Excision or ablation of superficial endometriosis at the time of robot-assisted laparoscopy.Measurements and Main Results
Primary outcome was visual analog scale (VAS) scoring at baseline and 6 and 12 months for menstrual pain, nonmenstrual pain, dyspareunia, and dyschezia. Secondary outcomes included survey results at baseline and 6 and 12 months from the Short Form Health Survey, Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire, and the International Pelvic Pain Assessment. From December 2013 to October 2014, 73 patients were randomized intraoperatively to excision (n?=?37) or ablation (n?=?36) of endometriosis. Patients were followed at 6 and 12 months to evaluate the above outcomes. After ablation of endometriosis, dyspareunia (VAS scores) improved at 6 months (mean change [MC], ?14.07; 95% confidence interval [CI], ?25.93 to ?2.21; p?=?.02), but improvement was not maintained at 12 months. Dysmenorrhea improved at 6 months (MC, ?26.99; 95% CI, ?41.48 to ?12.50; p?<?.001) and 12 months (MC, ?24.15; 95% CI, 39.62 to ?8.68; p?=?.003) with ablation. No significant changes were seen in VAS scores after excision at 6 or 12 months. When comparing ablation and excision, the only significant difference was a change in dyspareunia at 6 months (MC, ?22.96; 95% CI, ?39.06 to ?6.86; p?=?.01).Conclusion
Treatment with ablation improved dysmenorrhea at 6 and 12 months and improved dyspareunia at 6 months as compared with preoperative data. However, only dyspareunia demonstrated a significant difference between ablation and excision. Excision and ablation showed similar effectiveness for the treatment of pain associated with superficial endometriosis, with ablation showing more significant individual changes. Careful patient counseling regarding expectations of surgical intervention is vital in the management of endometriosis. 相似文献13.
Hiroyuki Kanao Tsuyoshi Hisa Makiko Omi Minoru Nagashima Shuhei Okamoto Yoichi Aoki Terumi Tanigawa Maki Matoda Sanshiro Okamoto Hidetaka Nomura Kohei Omatsu Kazuyoshi Kato Kuniko Utsugi Nobuhiro Takeshima 《Journal of minimally invasive gynecology》2019,26(1):34-35
Study Objective
To show total laparoscopic complete resection of a recurrent low-grade endometrial sarcoma.Design
Step-by-step demonstration of the technique of laparoscopic anterior pelvic exenteration with super radical parametrectomy, including the explanation of detailed pelvic anatomy (Canadian Task Force classification III).Setting
Low-grade endometrial stromal sarcoma (LGESS) is a rare malignancy that makes up around 0.2% of all uterine malignancies [1]. Total abdominal hysterectomy and bilateral salpingo-oophorectomy is a standard treatment; however, the recurrence risk is quite high [2]. For a recurrent LGESS that is resistant to hormone therapy and chemotherapy, complete resection with negative surgical margins (R0 resection) can be the most promising method [3].Patient
The patient had undergone total abdominal hysterectomy and bilateral salpingo-oophorectomy because of a LGESS. Almost 20 years later, a recurrent LGESS was detected at the vaginal stump, and the patient underwent several rounds of chemotherapy and hormonal therapy. These treatments were inefficacious, and the recurrent tumor progressed. An abdominal computed tomographic scan revealed that the recurrent tumor occupied the vaginal stump, involved the bladder and the left ureter, and extended to the left pelvic sidewall.Interventions
Anterior pelvic exenteration with super radical parametrectomy was performed laparoscopically with no blood transfusion. R0 resection could be achieved without any intraoperative and postoperative complications. Without any adjuvant treatment, there has been no sign of recurrence during the 12 months that have passed since the surgery. This video obtained institutional review board approval through our local ethics committee in the Cancer Institutional Hospital (institutional review board number 2016-1007).Conclusion
The good visualization and meticulous dissection provided during laparoscopic surgery can make the approach advantageous and may contribute to R0 achievement. 相似文献14.
Aude Jayot Krystel Nyangoh Timoh Sofiane Bendifallah Marcos Ballester Emile Darai 《Journal of minimally invasive gynecology》2018,25(3):440-446
Study Objective
Our primary endpoint was to compare the intra- and postoperative complications, whereas secondary endpoints were the occurrence of voiding dysfunction and evaluation of the quality or life of segmental and discoid resection in patients with colorectal endometriosis.Design
Retrospective study (Canadian Task Force classification II-2).Setting
Tenon University Hospital in Paris.Patients
Thirty-one 31 patients who underwent a conservative surgery and 31 patients who underwent.Interventions
The 2 groups were compared using propensity score matching (PSM) analysis, with a median follow-up of 247 days (8.2 months).Measurements and Main Results
Discoid colorectal resection was associated with a shorter operating time (155 vs 180 minutes, p?=?.03) and hospital stay (7 vs 8 days, p?=?.002) than segmental colorectal resection; however, a similar intra- and postoperative complication rate was found. A higher rate of postoperative voiding dysfunction was observed in the segmental resection group (19% vs 45%, p?=?.03) as well as duration of voiding dysfunction requiring bladder self-catheterization longer than 30 days (0 vs 22%, p?=?.005).Conclusion
Our PSM analysis suggests the advantages of discoid resection because it results in a similar surgical complication rate to segmental resection but with advantages in operating time, hospital stay, and voiding dysfunction. 相似文献15.
Krystel Nyangoh Timoh Zelda Stewart Mikhael Benjoar Selma Beldjord Marcos Ballester Marc Bazot Isabelle Thomassin-Naggara Emile Darai 《Journal of minimally invasive gynecology》2018,25(4):697-705
Study Objective
To prospectively determine the accuracy of magnetic resonance enterography (MRE) compared with conventional magnetic resonance imaging (MRI) for multifocal (i.e., multiple lesions affecting the same digestive segment) and multicentric (i.e., multiple lesions affecting several digestive segments) bowel endometriosis.Design
A prospective study (Canadian Task Force classification II-2).Setting
Tenon University Hospital, Paris, France.Patients
Patients with MRI-suspected colorectal endometriosis scheduled for colorectal resection from April 2014 to February 2016 were included.Interventions
Patients underwent both 1.5-Tesla MRI and MRE as well as laparoscopically assisted and open colorectal resections.Measurements and Main Results
The diagnostic performance of MRI and MRE was evaluated for sensitivity, specificity, positive and negative predictive values, accuracy, and positive and negative likelihood ratios (LRs). The interobserver variability of the experienced and junior radiologists was quantified using weighted statistics. Forty-seven patients were included. Twenty-two (46.8%) patients had unifocal lesions, 14 (30%) had multifocal lesions, and 11 (23.4%) had multicentric lesions. The sensitivity, specificity, positive LR, and negative LR for the diagnosis of multifocal lesions were 0.29 (6/21), 1.00 (23/24), 15.36, and 0.71 for MRI and 0.57 (12/21), 0.89 (23/25), 4.95, and 0.58 for MRE. The sensitivity, specificity, positive LR, and negative LR for the diagnosis of multicentric lesions were 0.18 (1/11), 1.00 (1/1), 15, and 0.80 for MRI and 0.46 (5/11), 0.92 (33/36), 5.45, and 0.60 for MRE. Lower accuracies for MRI compared with MRE to diagnose multicentric (p?=?.01) and multifocal lesions (p?=?.004) were noted. The interobserver agreement for MRE was good for both multifocality (κ?=?0.80) and multicentricity (κ?=?0.61).Conclusion
MRE has better accuracy for diagnosing multifocal and multicentric bowel endometriosis than conventional MRI. 相似文献16.
Alessandra Di Giovanni Lucia Casarella Marina Coppola Domenico Iuzzolino Marianna Rasile Mario Malzoni 《Journal of minimally invasive gynecology》2018,25(7):1231-1240
Study Objective
To assess the sensitivity and accuracy of combined transvaginal/ transabdominal ultrasonography (TV/TA US) for evaluation of deep infiltrating bowel endometriosis nodules measured after surgery.Design
Prospective study (Canadian Task Force classification II.1).Setting
A center for advanced endoscopic gynecologic surgery.Patients
All women undergoing laparoscopic surgery and scheduled for segmental resection for clinically suspected bowel endometriosis between January 2014 and December 2016.Interventions
In all women with clinically suspected bowel endometriosis, a US scan was performed before surgery to detect and measure the 3 diameters of bowel endometriotic lesions: longitudinal, anteroposterior, and transverse. These diameters were compared with those obtained by direct measurement on a fresh specimen. The sensitivity and specificity values of US evaluation were calculated, with 95% confidence intervals.Measurements and Main Results
The sensitivity and specificity of TV/TA US in the 328 patients of this study were 100% when rectal endometriotic lesions were investigated. The specificity was 100%, whereas the sensitivity decreased to 91.4% when sigmoid lesions were investigated. Bowel muscularis infiltration was histologically confirmed in all cases in which endometriotic lesions were detected by US (284 of 284; 100%). All missed sigmoid lesions (12 of 296) were located >25?cm from the anal verge. The mean diameters of endometriotic nodules calculated by US evaluation and by direct measurement on the fresh specimen were 43.19?×?19.87?×?10.79?mm and 42.76?×?19.64?×?10.62?mm, respectively, with no statistically significant differences between the 2 methods.Conclusion
We believe that US can be considered an accurate diagnostic technique for the evaluation of deep infiltrating bowel endometriosis when performed by a dedicated experienced sonographer in a specialized center. 相似文献17.
18.
Akarawit Jitchanwichai Karanrat Soonthornpun 《Journal of minimally invasive gynecology》2019,26(1):110-116
Study Objective
To assess the effect of hyoscine-N-butylbromide (HBB) as premedication on the rate of proximal tubal obstruction during hysterosalpingography (HSG).Design
A randomized, double-blind controlled trial (Canadian Task Force classification I).Setting
The Infertility Clinic of Songklanagarind Hospital.Patients
One hundred and forty-six infertile women indicated for HSG investigation.Interventions
Between May 1, 2016, and March 31, 2017, patients were assigned at random to receive either oral HBB 20?mg or placebo 30 minutes before the HSG procedure. If proximal tubal obstruction was found, participants were be assigned to undergo a second confirming HSG or laparoscopy with chromopertubation within 6 months.Measurements and Main Results
The primary outcome was the rate of proximal tubal obstruction. The secondary outcome was the false-positive result of proximal tubal occlusion from HSG. Proximal tubal obstruction was found in 6 of 70 patients in the HBB group and in 16 of 71 in the placebo group. The rate of proximal tubal obstruction was significantly lower in the HBB group than in the placebo group (8.6% vs 22.5%; p?=?.04; absolute difference, 13.9%; 95% confidence interval [CI], 0.02–0.26; relative risk, 0.38; 95% CI, 0.16–0.92). After the second HSG or laparoscopy was performed (n?=?22), the rate of false occlusion was 20% (1 of 6 patients) in the HBB group, compared with 69.2% (9 of 16 patients) in the placebo group.Conclusion
Premedication with HBB before HSG can reduce the rate of diagnosis of proximal tubal obstruction and false occlusion. 相似文献19.
Hisao Osada Shokichi Teramoto Hirotsune Kaijima Tomoya Segawa Osamu Miyauchi Masaji Nagaishi Makio Shozu Keiichi Kato Victor Gomel 《Journal of minimally invasive gynecology》2019,26(1):129-134
Study Objective
To evaluate the efficacy of a nonsurgical treatment for cervical pregnancy (CP) and cesarean section scar pregnancy (CSP).Design
Retrospective clinical study (Canadian Task Force classification III).Setting
Private assisted reproductive technology practice.Patients
Nineteen women with CP (n?=?16) or CSP (n?=?3), including 6 patients with positive fetal heartbeat.Intervention
Transvaginal local injection of absolute ethanol (AE) into the hyperechoic ring (lacunar space) around the gestational sac under ultrasound guidance.Measurements and Main Results
Serum beta-human chorionic gonadotropin (β-hCG) was measured at frequent intervals, and ultrasound and/or magnetic resonance imaging was used to observe the gestational sac. In 9 patients, the serum β-hCG level was effectively reduced with a single AE injection at 2 hours. In the remaining 10 patients, the level decreased but then increased in 4 and slowly decreased in the other 6; all of these 10 patients required 2 to 5 repeat AE injections. In all patients, serum β-hCG level was reduced by 50% within 3 days and decreased to <10% of the initial level within 14 days. In 18 patients (95%), the level was decreased to 1.0 mIU/mL within 40 days. Seven patients were treated on an outpatient basis. Twelve patients received no anesthesia. Five patients subsequently became pregnant, and each had a live birth. There was no recurrent CP or CSP. The procedure was successful in all 19 patients.Conclusion
This procedure is an effective treatment for CP or CSP that could be used in place of conventional surgical interventions and medical treatment using MTX. 相似文献20.
Angelos G. Vilos Cici Zhu Basim Abu-Rafea Helen C. Ettler Michele M. Weir George A. Vilos 《Journal of minimally invasive gynecology》2019,26(1):105-109