子宫内膜瘤手术的精确性：奖学金培训预测卵巢保存和指南依从性

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.2025.09.019

J Clay , A Newark , Y Meng , M Martin , M Billow

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引用次数: 0

摘要

研究目的评估子宫内膜异位瘤手术中外科医生亚专业培训与卵巢保存的关系，并评估其对基于指南的治疗的依从性。设计回顾性多中心队列研究（2012-2024），采用多变量逻辑回归和有序回归。5个站点（学术和区域）；手术通过微创或腹部入路，低位取石定位。人体工程学多样。18 - 50岁组织学证实的子宫内膜瘤患者或参与者（N=319），使用诊断和程序代码确定，并通过图表检查确认。irb批准，使用去识别的数据。统计数据、外科医生培训和围手术期细节被抽象化，包括手术入路、手术步骤、出血量、手术时间、并发症。采用基于ACOG、ASRM和ESHRE的2分综合评分评估指南依从性：微创入路1分；膀胱切除术1分。只有在同一卵巢上有子宫内膜异位瘤囊肿切除术时，卵巢切除术得分为1分。在双侧混合治疗的病例中，评分基于卵巢切除侧。得分越高表明依从性越强。该队列包括MIGS（148）、REI（85）、OBGYN（51）、GynOnc（34）和UROGYN(1)。卵巢保存在REI（88.2%）和MIGS（83.8%）比GynOnc（67.6%）和OBGYN（60.8%）更常见。REI组（1.9）和MIGS组（1.7）的依从性评分高于GynOnc组（1.3）和OBGYN组（1.1）。根据子宫内膜异位症护理方面的共同培训，将MIGS和REI分组进行分析，并与OBGYN、GynOnc联合组进行比较。MIGS/REI训练（aOR 11.65, 95% CI 4.87-27.89）、生育意愿（aOR 5.31）和年龄（aOR 0.90/年）预测卵巢保存；既往手术降低了风险（aOR 0.38）。MIGS/REI训练也预测更高的依从性（OR 1.47），更频繁的输尿管溶解（OR 5.13）和子宫内膜异位症切除术（OR 21.15）。两组患者的人口统计学和并发症无显著差异。模型AUC = 0.90。敏感性分析证实了这些发现。结论migs和REI奖学金培训与更高的卵巢保留率和指南依从性相关。这些发现说明了亚专科培训如何提高子宫内膜异位症护理的准确性，并支持为未来进展和人工智能驱动的临床决策工具开发培训信息指标。

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Precision in Endometrioma Surgery: Fellowship Training Predicts Ovarian Preservation and Guideline Adherence

Study Objective

To evaluate the association between surgeon subspecialty training and ovarian preservation in endometrioma surgery and assess adherence to guideline-based management.

Design

Retrospective multicenter cohort study (2012–2024) with multivariable logistic and ordinal regression.

Setting

Five sites (academic and regional); procedures performed via minimally invasive or abdominal approach, low lithotomy positioning. Ergonomics varied.

Patients or Participants

18–50yo with histologically confirmed endometrioma (N=319), identified using diagnostic and procedural codes and confirmed by chart review. IRB-approved, de-identified data utilized.

Interventions

Demographics, surgeon training, and perioperative details were abstracted, including surgical approach, procedures, blood loss, operative time, complications. Guideline adherence was assessed using a 2-point composite score based on ACOG, ASRM, and ESHRE: 1 point for minimally invasive approach; 1 point for cystectomy. Oophorectomy scored 1 point only if prior endometrioma cystectomy on the same ovary. In bilateral cases with mixed management, scoring was based on the oophorectomy side. Higher scores indicated greater adherence.

Measurements and Primary Results

The cohort included MIGS(148), REI(85), OBGYN(51), GynOnc(34), and UROGYN(1). Ovarian preservation was more common among REI(88.2%) and MIGS(83.8%) vs GynOnc(67.6%) and OBGYN(60.8%). Adherence scores were higher in REI(1.9) and MIGS(1.7) vs GynOnc(1.3) and OBGYN(1.1). MIGS and REI were grouped for analysis based on shared training in endometriosis care and compared to a combined group of OBGYN, GynOnc. MIGS/REI training (aOR 11.65, 95% CI 4.87–27.89), fertility desire(aOR 5.31), and younger age(aOR 0.90/year) predicted ovarian preservation; prior surgery reduced odds(aOR 0.38). MIGS/REI training also predicted higher adherence(OR 1.47), and more frequent ureterolysis(OR 5.13) and endometriosis excision(OR 21.15). There were no significant differences in patient demographics or complications across groups. Model AUC = 0.90. Sensitivity analyses confirmed findings.

Conclusion

MIGS and REI fellowship training are associated with higher rates of ovarian preservation and guideline adherence. These findings illustrate how subspecialty training improves precision in endometriosis care and support the development of training-informed metrics for future progress and AI-driven clinical decision tools.

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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.