Preoperative Sonographic Evaluation of Deep Infiltrating Endometriosis

IF 3.5 2区 医学 Q1 OBSTETRICS & GYNECOLOGY
S Parikh, V Brown, RS Barbaresso, RP Pasic
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引用次数: 0

Abstract

Study Objective

To demonstrate the utility of preoperative sonographic evaluation for deep infiltrating endometriosis (DIE) and correlate ultrasound and intraoperative findings through a clinical scenario.

Design

A stepwise demonstration and comparison of ultrasound and intraoperative evaluation of DIE with narrated video footage.

Setting

A tertiary, academic hospital with an experienced endometriosis sonographer and high-volume MIGS specialist.

Patients or Participants

A 25-year-old presented with chronic pelvic pain and history of endometriosis after failing multiple medical therapies.

Interventions

DIE occurs in 4-37% of patients with endometriosis. Ultrasound is recommended as a first-line imaging for evaluation and has high sensitivity and specificity for DIE. At our institution, same day preoperative ultrasound is performed for patients based on the IDEA group consensus on the systematic approach to sonographic evaluation of endometriosis. This evaluation includes a basic assessment of the uterus and adnexa, soft markers such as sliding sign, and the anterior and posterior compartments of the pelvis.

Measurements and Main Results

In this patient, ultrasound illustrated an immobile uterus with a 3 cm right ovarian endometrioma and two hypoechoic lesions in the posterior cul-du-sac, indicating adhesive disease and advanced-stage endometriosis. The patient had a laparoscopic resection of endometriosis, right ovarian cystectomy, bilateral ureterolysis, adhesiolysis and enterolysis, rectal shaving, and an appendectomy. Sonographic results correlated accurately with intraoperative findings, and the pathology was consistent with endometriosis.

Conclusion

Ultrasound is imperative for assessing patients with suspected or confirmed advanced-stage endometriosis. A structured pelvic ultrasound should be completed in a manner that assesses for uterine and adnexal mobility and endometriosis lesions or nodules in the anterior and/or posterior compartments of the pelvis. This type of evaluation allows for appropriate surgical planning and counseling, especially for advanced laparoscopic procedures. However, there needs to be more specialized sonographic training to improve the accuracy of preoperative sonographic evaluation of endometriosis.
深部浸润性子宫内膜异位症的术前超声评估
研究目的通过一个临床场景展示深部浸润性子宫内膜异位症(DIE)术前超声评估的实用性,并将超声和术中发现关联起来.设计通过解说视频录像逐步展示和比较 DIE 的超声和术中评估.患者或参与者一名25岁的患者,因慢性盆腔疼痛和子宫内膜异位症病史而就诊,经多种药物治疗无效。超声波被推荐为评估的一线影像学检查,对 DIE 具有很高的敏感性和特异性。在我院,根据 IDEA 小组就子宫内膜异位症超声评估的系统方法达成的共识,对患者进行当天的术前超声检查。在该患者中,超声显示子宫不能移动,右侧卵巢有一个3厘米长的子宫内膜异位瘤,后骶骨有两个低回声病灶,提示粘连性疾病和晚期子宫内膜异位症。患者接受了腹腔镜子宫内膜异位症切除术、右卵巢囊肿切除术、双侧输尿管溶解术、粘连溶解术和肠溶解术、直肠剃除术以及阑尾切除术。超声检查结果与术中发现准确相关,病理结果与子宫内膜异位症一致。在完成结构化盆腔超声检查时,应评估子宫和附件的活动度以及盆腔前部和/或后部的子宫内膜异位症病灶或结节。通过这种评估,可以制定适当的手术计划并提供咨询,尤其是对于先进的腹腔镜手术而言。不过,还需要进行更专业的声学培训,以提高子宫内膜异位症术前声学评估的准确性。
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来源期刊
CiteScore
5.00
自引率
7.30%
发文量
272
审稿时长
37 days
期刊介绍: The Journal of Minimally Invasive Gynecology, formerly titled The Journal of the American Association of Gynecologic Laparoscopists, is an international clinical forum for the exchange and dissemination of ideas, findings and techniques relevant to gynecologic endoscopy and other minimally invasive procedures. The Journal, which presents research, clinical opinions and case reports from the brightest minds in gynecologic surgery, is an authoritative source informing practicing physicians of the latest, cutting-edge developments occurring in this emerging field.
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