基于超声波的子宫内膜异位症分期系统在预测腹腔镜手术复杂性方面的价值。

IF 6.6 1区 医学 Q1 OBSTETRICS & GYNECOLOGY
Mahbod Ebrahimi, Sholeh Naghdi, Fatemeh Davari-Tanha, Behnaz Moradi, Elham Feizabad, Kiana Majidi
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引用次数: 0

摘要

目的评估基于超声的子宫内膜异位症术前分期系统(UBESS)在预测腹腔镜手术的复杂性以优化患者咨询和治疗方面的有效性:前瞻性观察队列研究:患者: 157 名出现慢性盆腔疼痛的妇女157名患有慢性盆腔疼痛和/或有子宫内膜异位症病史的妇女在2019年6月至2023年5月期间接受腹腔镜手术:符合条件的妇女在腹腔镜手术前接受经阴道超声检查:根据超声结果进行UBESS分期。随后,在腹腔镜手术过程中,使用澳大利亚和新西兰皇家妇产科医学院/澳大利亚妇科内镜和手术(RANZCOG/AGES)系统对必要的手术技能水平进行评估。该研究旨在评估 UBESS 三个阶段与 RANZCOG/AGES 六个腹腔镜技能等级之间的相关性。主要目标是UBESS如何准确预测子宫内膜异位症腹腔镜手术的复杂程度:UBESS分期系统将9名患者(5.9%)分为UBESSI期,61名患者(40.1%)分为UBESS II期,82名患者(53.9%)分为UBESS III期。UBESSI 预测 RANZCOG/AGES 1/2 级的准确性、敏感性、特异性、阳性和阴性预测值以及阳性和阴性似然比分别为:99.3%、90%、90%、90%:99.3%、90%、100%、100%、99.3%、不适用和 0.1%。UBESSII 预测 RANZCOG/AGES 3/4 级的结果分别为:96.7%、95.1%、97.7%、96.7%、96.7%、0.92 和 0.04,UBESSIII 预测 RANZCOG/AGES 6 级的结果分别为:97.3%、98.7%、98.7%、0.92 和 0.04:分别为 97.3%、98.7%、95.8%、96.3%、98.5%、0.94 和 0.01。根据RANZCOG/AGES的腹腔镜技术水平,UBESS在预测腹腔镜手术的复杂程度方面准确率很高,总体准确率为96.7%,科恩卡帕值为0.94,这意味着两者的吻合程度接近完全一致。考虑到大量 UBESS II 和 UBESS III 患者及其较高的准确性、敏感性和特异性,该分期系统是预测中重度子宫内膜异位症的有效工具:该研究表明,UBESS 可作为一种高效、无创、便捷且经济的工具,用于估计子宫内膜异位症的严重程度,并根据 RANZCOG/AGES 手术技能等级预测腹腔镜手术的复杂程度。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Value of ultrasound-based endometriosis staging system in anticipating complexity of laparoscopic surgery.

Objective: To evaluate the effectiveness of the preoperative ultrasound-based endometriosis staging system (UBESS) in anticipating the complexity of laparoscopic surgery for optimal patient counseling and treatment.

Design: A prospective observational cohort study.

Setting: A tertiary teaching hospital.

Patient(s): A total of 157 women presenting with chronic pelvic pain and/or a history of endometriosis underwent laparoscopic surgery between June 2019 and May 2023.

Intervention(s): Eligible women underwent transvaginal ultrasound before laparoscopic surgery.

Main outcome measure(s): The UBESS staging was conducted based on ultrasound results. Subsequently, the necessary surgical skill levels were assessed, during the laparoscopic procedure, using the Royal Australian and New Zealand College of Obstetricians and Gynecologists/Australasian Gynecological Endoscopy and Surgery (RANZCOG/AGES) system. The study aimed to evaluate the correlation between the three UBESS stages and the six RANZCOG/AGES laparoscopic skill levels. The primary objective was how accurately the UBESS predicts the complexity of endometriosis laparoscopic surgery.

Result(s): The UBESS staging system classified nine patients (5.9%) as UBESS I, 61 patients (40.1%) as UBESS II, and 82 patients (53.9%) as UBESS III. The accuracy, sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios of the UBESS I for anticipating RANZCOG/AGES levels 1/2 were: 99.3%, 90%, 100%, 100%, 99.3%, not applicable, and 0.1%. For UBESS II to anticipate RANZCOG/AGES levels 3/4 were 96.7%, 95.1%, 97.7%, 96.7%, 96.7%, 0.92, and 0.04, and for UBESS III to anticipate RANZCOG/AGES level 6 were 97.3%, 98.7%, 95.8%, 96.3%, 98.5%, 0.94, and 0.01, respectively. Ultrasound-based endometriosis staging system was highly accurate in anticipating the complexity of laparoscopic surgery based on RANZCOG/AGES laparoscopic skill levels, with an overall accuracy of 96.7% and a Cohen's kappa value of 0.94, which implies an approximately complete level of agreement. Considering the significant number of UBESS II and UBESS III patients and their high accuracy, sensitivity, and specificity, this staging system is an effective tool for predicting moderate-to-severe endometriosis.

Conclusion(s): The study indicated that UBESS could serve as an efficient, noninvasive, accessible, and cost-effective tool for estimating the severity of endometriosis and predicting the complexity level of laparoscopic surgery based on the RANZCOG/AGES surgical skill levels.

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来源期刊
Fertility and sterility
Fertility and sterility 医学-妇产科学
CiteScore
11.30
自引率
6.00%
发文量
1446
审稿时长
31 days
期刊介绍: Fertility and Sterility® is an international journal for obstetricians, gynecologists, reproductive endocrinologists, urologists, basic scientists and others who treat and investigate problems of infertility and human reproductive disorders. The journal publishes juried original scientific articles in clinical and laboratory research relevant to reproductive endocrinology, urology, andrology, physiology, immunology, genetics, contraception, and menopause. Fertility and Sterility® encourages and supports meaningful basic and clinical research, and facilitates and promotes excellence in professional education, in the field of reproductive medicine.
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