National survey of bladder endometriosis cases in Japan
National survey of bladder endometriosis cases in Japan
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日本膀胱子宫内膜异位症全国调查
DOI：
10.1111/jog.14656
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发表时间：
2021
影响因子：
1.6
通讯作者：
Osuga Yutaka
中科院分区：
文献类型：
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作者：
Hirata Tetsuya;Koga Kaori;Taniguchi Fuminori;Takazawa Naoko;Honda Ritsuo;Tanaka Toshiaki;Kurihara Masatoshi;Nakajima Jun;Yoshimura Kotaro;Kitade Mari;Narahara Hisashi;Kitawaki Jo;Harada Tasuku;Katabuchi Hidetaka;Horie Shigeo;Osuga Yutaka
目的描述膀胱子宫内膜异位症(BE)的临床表现、手术或内科治疗及术后复发情况。抽取经组织学确诊的BE患者，分析其发病年龄、体重指数、症状、影像表现、手术治疗、激素治疗、随访时间、术后复发等因素。80名患者接受了手术，而9名患者没有。34例行经尿道电切术(TUR)，44例行膀胱部分切除术(PC)。TUR组的累积复发率显著高于PC组(p<； 0.05)。腹腔镜组(n=24)复发率高于开腹组(n=20)，但差异无统计学意义(p=0.0879)。在9名非手术患者中，8名接受了激素治疗，1名没有接受治疗。Dienogest、GnRH激动剂和OC的有效率分别为85.7%、66.7%和66.7%。5例BE延伸至输尿管或输尿管口，其中2例行PC+输尿管膀胱吻合术，1例因肾功能丧失而行全肾输尿管切除术。我们发现PC术后的累积复发率明显低于TUR后。延伸到输尿管或输尿管开口是一种非常具有挑战性的情况。BE的优化管理还需要进一步的研究。
AimWe aimed to describe the clinical presentation, operative or medical management, and postoperative recurrence of bladder endometriosis (BE).MethodsWe conducted a national survey to investigate BE cases from 2006 to 2016 in Japan. Histologically diagnosed cases were extracted and then investigated for the following factors: age at diagnosis, body mass index, symptoms, imaging modalities, surgical therapy, hormonal therapy, follow‐up period, and postoperative recurrence.ResultsEighty‐nine patients with pathologically benign BE were identified. Eighty patients underwent surgery, whereas nine did not. Moreover, 34 and 44 patients underwent transurethral resection (TUR) and partial cystectomy (PC), respectively. Cumulative recurrence rates were significantly higher with TUR than with PC (p< 0.05). The recurrence rate tended to be higher after laparoscopic PC (n= 24) than after open PC (n= 20), but the difference was not statistically significant (p= 0.0879). Of the nine nonsurgical patients, eight received hormonal therapy and one did not. Efficacy rates of dienogest, GnRH agonist, and OC were 85.7%, 66.7%, and 66.7%, respectively. Of five patients with BE extending to the ureter or ureteral orifices, two underwent PC and ureteroneocystostomy and one underwent total nephroureterectomy due to renal function loss.ConclusionTo our knowledge, this is the first study to compare the postoperative recurrence of BE after TUR and PC. We found that cumulative recurrence rate is significantly lower after PC than after TUR. BE extending to the ureter or ureteral orifices is a very challenging condition. Further studies are required for the optimal management of BE.