BACKGROUND Rectosigmoid endometriosis is an underdiagnosed disease responsible for abdominal pain, transit disorders and rectal bleeding. Two surgical approaches,rectosigmoid bowel resection(segmental or patch) or int...BACKGROUND Rectosigmoid endometriosis is an underdiagnosed disease responsible for abdominal pain, transit disorders and rectal bleeding. Two surgical approaches,rectosigmoid bowel resection(segmental or patch) or intramuscular layer dissection(shaving), are available.AIM To assess whether the lesion features observed via preoperative rectosigmoid endoscopic ultrasonography(RS-EUS) might predict the need for bowel resection.METHODS This multicentric retrospective study was conducted on patients with rectosigmoid endometriosis who underwent a curative surgical procedure,evaluated by RS-EUS performed by two trained operators, between January 2012 and March 2018. A univariate statistical analysis was performed on nodules' RSEUS features(thickness, width, infiltration of the submucosae, presence of a bump into the digestive lumen and presence of multiple rectosigmoid localizations). A multivariate logistic regression was then performed on the significant results.RESULTS Of the 367 patients, 73 patients with rectosigmoid endometriosis were evaluated by RS-EUS and underwent rectosigmoid surgery. After the univariate analysis was completed, thickness, width and infiltration of the submucosae were identified as potential predictive factors for bowel resection. In a multivariate logistic regression model, only thickness appeared to be a significant [odds ratio(OR) = 1.49, 95% confidence interval(CI): 1.04-2.12, P = 0.028] predictive factor for bowel resection. Receiver operating characteristic analysis performed showed that a thickness over 5.20 mm might be used as cut-off with a sensitivity of 76%, a specificity of 81%, and an area under carve = 0.82. The cut-off values for 100%sensitivity and 100% specificity were 0.90 mm and 10.00 mm, respectively. A trend concerning width to predict the need for resection was also observed(OR1.12, 95%CI: 1.00-1.26, P = 0.054)CONCLUSION The presence of a rectosigmoid nodule of endometriosis greater than 5.20 mm thick on RS-EUS might predict the need for bowel resection.展开更多
【目的】探讨温经止痛方对子宫内膜异位症(EMS)模型大鼠子宫在位/异位内膜自噬基因Beclin-1、LC3表达的影响。【方法】将90只大鼠随机分为假手术组,模型组,中药高、中、低剂量组,西药组等6组,每组15只。中药高、中、低剂量组大鼠给予温...【目的】探讨温经止痛方对子宫内膜异位症(EMS)模型大鼠子宫在位/异位内膜自噬基因Beclin-1、LC3表达的影响。【方法】将90只大鼠随机分为假手术组,模型组,中药高、中、低剂量组,西药组等6组,每组15只。中药高、中、低剂量组大鼠给予温经止痛方(剂量分别为74、37、18.5 g·kg^(-1)·d^(-1))灌胃;西药组大鼠给予孕三烯酮胶囊(剂量为0.5 mg·kg^(-1)·d^(-1))灌胃,每周2次;模型组及假手术组大鼠给予等量生理盐水灌胃。均给药8周。采用苏木素—伊红(HE)染色观察子宫内膜病理学变化,分别采用实时定量PCR(qPCR)法、免疫组化法检测在位、异位内膜中Beclin-1、LC3 m RNA及蛋白的表达。【结果】给药后中药高剂量组及西药组异位病灶较给药前缩小(P<0.05)。模型组在位、异位内膜上Beclin-1、LC3 mRNA及蛋白表达水平低于假手术组(P<0.01)。中药高剂量组及西药组的在位、异位内膜上的LC3及Beclin-1 m RNA及蛋白表达水平高于模型组(P<0.01)。【结论】EMS的发生可能与Beclin-1、LC3表达失调有关。温经止痛方可有效缩小异位灶,调整Beclin-1、LC3的表达,抑制异位内膜生长。展开更多
文摘BACKGROUND Rectosigmoid endometriosis is an underdiagnosed disease responsible for abdominal pain, transit disorders and rectal bleeding. Two surgical approaches,rectosigmoid bowel resection(segmental or patch) or intramuscular layer dissection(shaving), are available.AIM To assess whether the lesion features observed via preoperative rectosigmoid endoscopic ultrasonography(RS-EUS) might predict the need for bowel resection.METHODS This multicentric retrospective study was conducted on patients with rectosigmoid endometriosis who underwent a curative surgical procedure,evaluated by RS-EUS performed by two trained operators, between January 2012 and March 2018. A univariate statistical analysis was performed on nodules' RSEUS features(thickness, width, infiltration of the submucosae, presence of a bump into the digestive lumen and presence of multiple rectosigmoid localizations). A multivariate logistic regression was then performed on the significant results.RESULTS Of the 367 patients, 73 patients with rectosigmoid endometriosis were evaluated by RS-EUS and underwent rectosigmoid surgery. After the univariate analysis was completed, thickness, width and infiltration of the submucosae were identified as potential predictive factors for bowel resection. In a multivariate logistic regression model, only thickness appeared to be a significant [odds ratio(OR) = 1.49, 95% confidence interval(CI): 1.04-2.12, P = 0.028] predictive factor for bowel resection. Receiver operating characteristic analysis performed showed that a thickness over 5.20 mm might be used as cut-off with a sensitivity of 76%, a specificity of 81%, and an area under carve = 0.82. The cut-off values for 100%sensitivity and 100% specificity were 0.90 mm and 10.00 mm, respectively. A trend concerning width to predict the need for resection was also observed(OR1.12, 95%CI: 1.00-1.26, P = 0.054)CONCLUSION The presence of a rectosigmoid nodule of endometriosis greater than 5.20 mm thick on RS-EUS might predict the need for bowel resection.
文摘【目的】探讨温经止痛方对子宫内膜异位症(EMS)模型大鼠子宫在位/异位内膜自噬基因Beclin-1、LC3表达的影响。【方法】将90只大鼠随机分为假手术组,模型组,中药高、中、低剂量组,西药组等6组,每组15只。中药高、中、低剂量组大鼠给予温经止痛方(剂量分别为74、37、18.5 g·kg^(-1)·d^(-1))灌胃;西药组大鼠给予孕三烯酮胶囊(剂量为0.5 mg·kg^(-1)·d^(-1))灌胃,每周2次;模型组及假手术组大鼠给予等量生理盐水灌胃。均给药8周。采用苏木素—伊红(HE)染色观察子宫内膜病理学变化,分别采用实时定量PCR(qPCR)法、免疫组化法检测在位、异位内膜中Beclin-1、LC3 m RNA及蛋白的表达。【结果】给药后中药高剂量组及西药组异位病灶较给药前缩小(P<0.05)。模型组在位、异位内膜上Beclin-1、LC3 mRNA及蛋白表达水平低于假手术组(P<0.01)。中药高剂量组及西药组的在位、异位内膜上的LC3及Beclin-1 m RNA及蛋白表达水平高于模型组(P<0.01)。【结论】EMS的发生可能与Beclin-1、LC3表达失调有关。温经止痛方可有效缩小异位灶,调整Beclin-1、LC3的表达,抑制异位内膜生长。
