MIGS亚专科培训对子宫内膜异位症手术护理的影响

IF 3.3 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Journal of minimally invasive gynecology Pub Date : 2025-10-22 DOI:10.1016/j.jmig.2025.09.032

M Barker , R Schneyer , C Thrift , K Fitzsimmons , A Manliguez , R Odum , O Ezike , KM Hamilton , K Ciesielski , M Siedhoff , K Wright

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引用次数: 0

摘要

研究目的比较接受过或未接受过MIGS亚专科培训的外科医生在子宫内膜异位症手术中的手术处理技术和疗效。设计回顾性队列研究。在加州洛杉矶设立四级医疗机构。在2013年1月11日至2023年10月31日期间接受过MIGS外科医生、普通妇产科医生（OB/GYN）或妇科肿瘤学家手术治疗子宫内膜异位症的患者或参与者，并有子宫内膜异位症的手术或病理记录。妇产科和妇科肿瘤科病例被归为“非migs”。干预措施：主要结局是治疗子宫内膜异位症的电灼率。次要结局包括子宫内膜异位症残留率、研究期间子宫内膜异位症重复手术率、子宫或卵巢切除术率、围手术期并发症和术中会诊率。测量和主要结果纳入1481例患者。1311名（88.5%）患者接受了MIGS外科医生的手术，170名（11.5%）患者接受了非MIGS外科医生的手术。与MIGS外科医生相比，非MIGS外科医生的以下发生率更高：子宫内膜异位症电气化而不是切除（70.6% vs. 0.7%；调整优势比[aOR] 353.3, 95%可信区间[CI] 168.2-742.2），残留的，未经治疗的子宫内膜异位症（33.5% vs. 0.6%; aOR 197.7, 95% CI 81.9-477.2），研究期间需要重复子宫内膜异位症手术（23.5% vs. 6.4%; aOR 4.03, 95% CI 2.44-6.67），以及非计划术中咨询（4.7% vs. 1.3%, p=.001）。卵巢切除术的发生率在两组间无显著差异（3.5% vs. 7.0%; aOR 0.55, 95% CI 0.21-1.45），然而，非migs组患者较少接受子宫切除术（1.8% vs. 17.1%; aOR 0.09, 95% CI 0.03-0.29）。尽管MIGS组手术复杂性更高（p < 0.01）， III/IV期子宫内膜异位症发生率更高（41.8% vs. 30.6%, p= 0.006），但两组间围手术期复合并发症发生率无差异（5.9% vs. 7.2%; aOR 1.03, 95% CI 0.51-2.04）。结论与非migs外科医生相比，migs外科医生更倾向于切除子宫内膜异位症，而不是电灼治疗。他们的病人需要更少的再手术，尽管手术过程的复杂性增加了，但围手术期并发症没有增加。

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The Impact of MIGS Subspecialty Training on Surgical Care for Endometriosis

Study Objective

To compare surgical management techniques and outcomes of endometriosis surgery between surgeons with or without subspecialty training in MIGS.

Design

Retrospective cohort study.

Setting

Quaternary care institution in Los Angeles, California.

Patients or Participants

Patients who underwent surgery for endometriosis with a fellowship-trained MIGS surgeon, general obstetrician/gynecologist (OB/GYN), or gynecologic-oncologist from 11/1/2013 to 10/31/2023, and had surgical or pathologic documentation of endometriosis were included. OB/GYN and gynecologic-oncologist cases were grouped as “non-MIGS.”

Interventions

The primary outcome was the rate of fulguration for treatment of endometriosis. Secondary outcomes included rates of residual endometriosis, repeat endometriosis surgery during study period, rate of hysterectomy or oophorectomy, perioperative complications, and rate of intra-operative consultation.

Measurements and Primary Results

1,481 patients were included. 1,311 (88.5%) underwent surgery with MIGS surgeons and 170 (11.5%) with non-MIGS surgeons. Compared to MIGS surgeons, non-MIGS surgeons had higher rates of the following: fulguration rather than excision of endometriosis (70.6% vs. 0.7%; adjusted odds ratio [aOR] 353.3, 95% confidence interval [CI] 168.2-742.2), residual, untreated endometriosis (33.5% vs. 0.6%; aOR 197.7, 95% CI 81.9-477.2), need for repeat endometriosis surgery within the study period (23.5% vs. 6.4%; aOR 4.03, 95% CI 2.44-6.67), and unplanned intraoperative consultation (4.7% vs. 1.3%, p=.001). Rates of oophorectomy did not differ significantly between groups (3.5% vs. 7.0%; aOR 0.55, 95% CI 0.21-1.45), however patients were less likely to undergo hysterectomy in non-MIGS group (1.8% vs. 17.1%; aOR 0.09, 95% CI 0.03-0.29). Rate of composite perioperative complications did not differ between groups (5.9% vs. 7.2%; aOR 1.03, 95% CI 0.51-2.04), despite higher surgical complexity (p<.001) and higher rates of Stage III/IV endometriosis in MIGS group (41.8% vs. 30.6%, p=.006).

Conclusion

MIGS surgeons were more likely to optimally treat endometriosis with excision, rather than fulguration compared to non-MIGS surgeons. Their patients also needed fewer re-operations, and despite the increased complexity of the surgical procedures, did not have increased perioperative complications.

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来源期刊

Journal of minimally invasive gynecology 医学-妇产科学

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.