子宫内膜异位症及其在育儿袋患者中的作用：配对分析

IF 2.7 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Colorectal Disease Pub Date : 2025-07-28 DOI:10.1111/codi.70183

Jessica Stockheim, Mikhael Belkovsky, Lukas Schabl, Stefan D. Holubar, Scott R. Steele, Tracy Hull, Hermann Kessler

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引用次数: 0

摘要

需要回肠袋（IPAA）的患者多为育龄妇女。有子宫内膜异位症的育儿袋患者的预后尚未报道。本研究旨在评估子宫内膜异位症与盆腔育儿袋功能、生活质量和育儿袋存活率的关系。材料与方法回顾性分析1985年至2022年间子宫内膜异位症患者的IPAA，并根据性别、诊断、眼袋类型、眼袋形成年龄、BMI和ASA评分按1:3的比例进行匹配。结果22例子宫内膜异位症合并IPAA患者与66例无子宫内膜异位症患者相匹配，溃疡性结肠炎是两组中最常见的诊断（86%）。45.5%的病例有子宫内膜异位症的组织病理学证实。除子宫内膜异位症组血栓栓塞发生率较高（18% vs. 3%, p = 0.04）外，两组间术中变量和手术相关术后并发症相似。荷囊炎的发生率无显著差异（73% vs. 46%, p = 0.06），而子宫内膜异位症患者的荷囊功能障碍发生率明显更高(18% vs. 3%, p = 0.03；OR 7.11, 1.53-33.10, p = 0.01)。45%的子宫内膜异位症患者进行了子宫切除术，合并或不合并输卵管卵巢切除术，主要是由于子宫内膜异位症和疼痛，最常见的是（90%）在IPAA后。诊断子宫内膜异位症的时间（IPAA之前或之后）对围手术期结果没有显著影响。两组患者的总体生活质量均较好（0.7 vs 0.8, p = 0.35）。结论子宫内膜异位症患者的育儿袋功能较差，但总体生活质量相当。子宫内膜异位症发生的时间似乎不是一个重要因素。子宫内膜异位症不应被视为IPAA的禁忌症。多学科的方法解决疼痛管理，不孕症治疗和潜在的子宫切除术应考虑在早期的病人护理。

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Endometriosis and its role in pouch patients: A matched-pair analysis

Introduction

Patients requiring ileoanal pouch (IPAA) are often women of reproductive age. Outcomes in pouch patients with endometriosis have not been described. This study aimed to assess the association of endometriosis on pelvic pouch function, quality of life and pouch survival.

Materials and Methods

Patients who underwent IPAA between 1985 and 2022 with endometriosis were retrospectively reviewed and matched in a 1:3 ratio based on gender, diagnosis, pouch type, age at pouch creation, BMI and ASA score.

Results

Twenty-two patients with endometriosis and IPAA were matched with 66 patients without endometriosis, with ulcerative colitis being the most common diagnosis in both groups (86%). Histopathological verification of endometriosis was available in 45.5% of cases. Intraoperative variables and surgery-related postoperative complications were similar between groups, except for a higher incidence of thromboembolism in the endometriosis group (18% vs. 3%, p = 0.04). There was no significant difference in pouchitis (73% vs. 46%, p = 0.06), while pouch dysfunction occurred significantly more frequently in endometriosis patients (18% vs. 3%, p = 0.03; OR 7.11, 1.53–33.10, p = 0.01). Hysterectomy, with or without salpingo-oophorectomy, was performed in 45% of endometriosis patients, primarily due to endometriosis and pain and most commonly (90%) following IPAA. The timing of endometriosis diagnosis (before or after IPAA) did not significantly influence perioperative outcomes. Overall quality of life was favourable in both groups (0.7 vs. 0.8, p = 0.35).

Conclusion

Pouch function was inferior in endometriosis patients, yet with a comparable overall quality of life. The timing of endometriosis did not appear to be a significant factor. Endometriosis should not be considered a contraindication for IPAA. A multidisciplinary approach addressing pain management, infertility treatment and potential hysterectomy should be considered early in patient care.

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来源期刊

Colorectal Disease 医学-胃肠肝病学

CiteScore

6.10

自引率

11.80%

发文量

406

审稿时长

1.5 months

期刊介绍： Diseases of the colon and rectum are common and offer a number of exciting challenges. Clinical, diagnostic and basic science research is expanding rapidly. There is increasing demand from purchasers of health care and patients for clinicians to keep abreast of the latest research and developments, and to translate these into routine practice. Technological advances in diagnosis, surgical technique, new pharmaceuticals, molecular genetics and other basic sciences have transformed many aspects of how these diseases are managed. Such progress will accelerate. Colorectal Disease offers a real benefit to subscribers and authors. It is first and foremost a vehicle for publishing original research relating to the demanding, rapidly expanding field of colorectal diseases. Essential for surgeons, pathologists, oncologists, gastroenterologists and health professionals caring for patients with a disease of the lower GI tract, Colorectal Disease furthers education and inter-professional development by including regular review articles and discussions of current controversies. Note that the journal does not usually accept paediatric surgical papers.