Delivery and pregnancy outcome in women with bowel resection for deep endometriosis: a retrospective cohort study
Delivery and pregnancy outcome in women with bowel resection for deep endometriosis: a retrospective cohort study
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DOI：
10.1007/s10397-015-0901-9
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发表时间：
2015-11-01
影响因子：
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通讯作者：
Franchi, Massimo Piergiuseppe
中科院分区：
文献类型：
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作者：
Baggio, Silvia;Pomini, Paola;Franchi, Massimo Piergiuseppe
子宫内膜异位症影响育龄妇女，6- 12%的患者可累及肠道。在肠梗阻或深度疼痛的情况下，建议进行根治性腹腔镜下肠梗阻手术联合肠切除术。本研究的目的是分析其受胎率、产科并发症及妊娠结局。这是一项回顾性研究;我们调查了2000年至2007年期间51例接受肠切除手术治疗的深部子宫内膜异位症患者。在30例手术后至少产下一个活胎的患者中，我们仅考虑肠切除术后的首次妊娠，并调查了妊娠障碍的发生率、分娩时的孕龄、婴儿出生体重以及与不同分娩方式相关的并发症。我们将结果与对照组93例既往无腹部手术的患者进行了比较。整组51名患者在手术后试图怀孕，30名妇女至少有一次怀孕，并生下了一个活婴。仅考虑术后首次妊娠，6例（20%）发生妊娠期高血压疾病，3例（10%）发生前置胎盘，6例（20%）发生早产（< 37周），1例（3.3%）发生妊娠期糖尿病。在该组中，平均新生儿体重为3000 +/- 545 g。与对照组相比，曾因深部子宫内膜异位症行肠切除术的妇女发生高血压疾病（p<0.05）、前置胎盘（p< 0.05）和新生儿体重较低（p< 0.05）的风险较高，而与早产和妊娠期糖尿病的相关性无统计学意义。这些患者经历了12次阴道分娩（40%）和18次剖腹产（60%）。与对照组的剖腹产率（29.03%）相比，研究人群中剖腹产的发生率显著较高（p< 0.01），33.3%的分娩是因为既往肠道手术。阴道分娩和剖腹产的严重并发症发生率无差异。完全切除子宫内膜异位症并行肠段切除术似乎可以提高妊娠率，但在这一组中，高血压疾病、前置胎盘和新生儿体重降低的发生率增加。尽管患者数量较少，但我们并未观察到阴道组的并发症多于剖腹产组，因此我们假设先前的根治性手术不应影响分娩方式。
Endometriosis affects women in reproductive age and can involve bowel in 6-12 % of the patients. In case of bowel occlusion or deep pain, radical laparoscopic endometriosic surgery associated with bowel resection is recommended. The purpose of this study was to analyze the conception rate, the obstetric complications, and the pregnancy outcome. This is a retrospective study; we investigated 51 patients with deep endometriosis who underwent surgical treatment with bowel resection during the period between 2000 and 2007. Among the 30 patients who gave birth to at least one live child after surgery, we considered only the first pregnancy following bowel resection and we investigated the incidence of pregnancy disorders, the gestational age at delivery, the baby birth weight, and the complications related to the different ways of delivery. We compared the results with a control group of 93 patients with no previous abdominal surgery. The whole group of 51 patients tried to conceive after surgery, and 30 women had at least one pregnancy with the birth of an alive baby. Considering only the first pregnancies after surgery, 6 (20 %) experienced gestational hypertensive disorders, 3 (10 %) had placenta previa, 6 (20 %) had preterm birth (< 37 weeks), and 1 patient (3.3 %) gestational diabetes. In this group, the average newborn weight was 3000 +/- 545 g. Compared with the control group, women with previous bowel resection for deep endometriosis had a higher risk of hypertensive disorders (p< 0.05), placenta previa (p< 0.05), and lower newborn weight (p< 0.05), while the association with preterm birth and gestational diabetes was not statistically significant. These patients experience 12 vaginal deliveries (40 %) and 18 caesarean sections (60 %). Comparing with the caesarean rate in the control group (29.03 %), the incidence of caesarean section in the study population was substantially higher (p< 0.01) with 33.3 % of the sections performed because of previous bowel surgery. No differences in severe complication rates were observed between vaginal and caesarean deliveries (ns). Complete removal of endometriosis with bowel segmental resection seems to improve the pregnancy rate, but in this group, there is an increased incidence of hypertensive disorders, placenta previa, and lower newborn weight. Despite the small number of patients, we do not observe more complications in the vaginal group than in the caesarean group, so we hypothesize the previous radical surgery should not influence the way of delivery.