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Ultrasound evaluation of pouch of Douglas obliteration and rectal deep endometriosis in women who have had previous combined colorectal and gynaecological laparoscopic surgery for rectal endometriosis: A pilot study.

超声评价既往行结直肠和妇科腹腔镜联合手术治疗直肠子宫内膜异位症的女性道格拉斯袋闭塞和直肠深部子宫内膜异位症: 一项初步研究。

  • 影响因子:1.41
  • DOI:10.1111/ajo.13112
  • 作者列表:"Alhayo S","Leonardi M","Lu C","Gosal P","Reid S","Barto W","Condous G
  • 发表时间:2020-01-09
Abstract

BACKGROUND:Ultrasound has been demonstrated to accurately diagnose rectal deep endometriosis (DE) and pouch of Douglas (POD) obliteration. The role of ultrasound in the assessment of patients who have undergone surgery for rectal DE and POD obliteration has not been evaluated. AIM:To describe the transvaginal ultrasound (TVS) findings of patients who have undergone rectal surgery for DE. MATERIALS AND METHODS:An observational cross-sectional study at a tertiary care centre in Sydney, Australia between January and April 2017. Patients previously treated for rectal DE (low anterior resection vs rectal shaving/disc excision) were recruited and asked to complete a questionnaire on their current symptoms. On TVS, POD state and rectal DE were assessed. Correlating recurrence of POD obliteration and/or rectal DE to surgery type and symptoms was done. RESULTS:Fifty-six patients were contacted; 22/56 (39.3%) attended for the study visit. Average interval of surgery to study visit was 52.8 ± 24.6 months. Surgery type breakdown was as follows: low anterior resection (56%) and rectal shaving/disc excision (44%). The prevalence of POD obliteration was 16/22 (72.7%) intraoperatively and 8/22 (36.4%) at study visit, as per the sliding sign. Nine patients (39.1%) had evidence on TVS of recurrent rectal DE. Recurrence of POD obliteration and rectal DE was not associated with surgery type or symptomatology. CONCLUSION:Despite surgery for rectal DE, many patients have a negative sliding sign on TVS, representing POD obliteration, and rectal DE. Our numbers are too small to correlate with the surgery type or their current symptoms.

摘要

背景: 超声已被证明能准确诊断直肠深部子宫内膜异位症 (DE) 和道格拉斯袋 (POD) 闭塞。尚未评估超声在接受直肠 DE 和 POD 闭塞手术患者评估中的作用。 目的: 描述经阴道超声 (TVS) 在直肠手术中的表现。 材料和方法: 1月至 2017年4月在澳大利亚悉尼一家三级医疗中心进行的一项观察性横断面研究。招募既往接受直肠 DE (低位前切除术 vs 直肠剃须/椎间盘切除术) 治疗的患者,要求其完成关于其当前症状的问卷调查。在 TVS 上,评估 POD 状态和直肠 DE。将 POD 闭塞和/或直肠 DE 的复发与手术类型和症状相关。 结果: 联系了 56 名患者; 22/56 (39.3%) 参加了研究访问。手术至访视的平均间隔时间为 52.8 ± 24.6 个月。手术类型分解如下: 低位前切除术 (56%) 和直肠剃须/椎间盘切除术 (44%)。根据滑动征,术中 POD 闭塞的发生率为 16/22 (72.7%),研究访视时为 8/22 (36.4%)。9 例患者 (39.1%) 有复发性直肠 DE 的 TVS 证据。POD 闭塞和直肠 DE 的复发与手术类型或症状学无关。 结论: 尽管直肠 DE 手术,许多患者在 TVS 上有一个阴性滑动征,代表 POD 闭塞,直肠 DE。我们的数字太小,与手术类型或当前症状无关。

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相关文献
影响因子:1.41
发表时间:2020-01-09
DOI:10.1111/ajo.13112
作者列表:["Alhayo S","Leonardi M","Lu C","Gosal P","Reid S","Barto W","Condous G"]

METHODS:BACKGROUND:Ultrasound has been demonstrated to accurately diagnose rectal deep endometriosis (DE) and pouch of Douglas (POD) obliteration. The role of ultrasound in the assessment of patients who have undergone surgery for rectal DE and POD obliteration has not been evaluated. AIM:To describe the transvaginal ultrasound (TVS) findings of patients who have undergone rectal surgery for DE. MATERIALS AND METHODS:An observational cross-sectional study at a tertiary care centre in Sydney, Australia between January and April 2017. Patients previously treated for rectal DE (low anterior resection vs rectal shaving/disc excision) were recruited and asked to complete a questionnaire on their current symptoms. On TVS, POD state and rectal DE were assessed. Correlating recurrence of POD obliteration and/or rectal DE to surgery type and symptoms was done. RESULTS:Fifty-six patients were contacted; 22/56 (39.3%) attended for the study visit. Average interval of surgery to study visit was 52.8 ± 24.6 months. Surgery type breakdown was as follows: low anterior resection (56%) and rectal shaving/disc excision (44%). The prevalence of POD obliteration was 16/22 (72.7%) intraoperatively and 8/22 (36.4%) at study visit, as per the sliding sign. Nine patients (39.1%) had evidence on TVS of recurrent rectal DE. Recurrence of POD obliteration and rectal DE was not associated with surgery type or symptomatology. CONCLUSION:Despite surgery for rectal DE, many patients have a negative sliding sign on TVS, representing POD obliteration, and rectal DE. Our numbers are too small to correlate with the surgery type or their current symptoms.

翻译标题与摘要 下载文献
影响因子:2.02
发表时间:2020-01-10
DOI:10.1007/s00261-019-02399-0
作者列表:["Burnett TL","Feldman MK","Huang JQ"]

METHODS::Minimally invasive surgery for complex endometriosis requires preoperative planning that intimately connects the gynecologic surgeon to the radiologist. Understanding the surgeon's perspective to endometriosis treatment facilitates a productive relationship that ultimately benefits the patient. We examine minimally invasive surgery for endometriosis and the key radiologic information which enable the surgeon to successfully negotiate patient counseling, preoperative planning, and an interdisciplinary approach to surgery.

影响因子:1.69
发表时间:2020-01-09
DOI:10.1016/j.jmig.2020.01.002
作者列表:["Byun J","Peterson CM","Backonja U","Taylor RN","Stanford JB","Allen-Brady KL","Smith KR","Buck Louis GM","Schliep KC"]

METHODS:STUDY OBJECTIVE:Prior research collectively shows that endometriosis is inversely related to women's adiposity. The aim of this study was to assess whether this inverse relationship holds true by disease severity and typology. DESIGN:Cross sectional study among women with no prior diagnosis of endometriosis. SETTING:Fourteen clinical centers in Salt Lake City, Utah and San Francisco, California. PATIENTS:Four hundred and ninety five women, ages 18-44 years, were enrolled in the operative cohort of the Endometriosis, Natural History, Diagnosis, and Outcomes (ENDO) Study. INTERVENTIONS:Gynecologic laparoscopy/laparotomy, regardless of clinical indication. MEASUREMENTS AND MAIN RESULTS:Participants underwent anthropometric assessments, body composition, and body fat distribution ratios before surgery. Surgeons completed a standardized operative report immediately after surgery to capture revised ASRM staging (I to IV) and typology of disease (superficial [SE], ovarian endometrioma [OE], and deep infiltrating endometriosis [DIE]). Linear mixed models, taking into account within-clinical-center correlation were used to generate least square means (95% confidence intervals) to assess differences in adiposity measures by endometriosis stage (no endometriosis, I-IV) and typology (no endometriosis, SE, DIE, OE, OE + DIE) adjusting for age, race/ethnicity, and parity. While the majority of confidence intervals were wide and overlapping, three general impressions emerged: 1) women with versus without incident endometriosis had the lowest anthropometric/body composition indicators; 2) women with stage I or IV had lower indicators compared to women with stage II or III; and 3) women with OE and/or DIE tended to have the lowest indicators, while women with SE had the highest indicators. CONCLUSION:Our research highlights that the relationship between women's adiposity and endometriosis severity and typology may be more complicated than prior research indicates.

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