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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_207_библиотеки_им_акад_М_И_Перельмана
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PEARLS AND PITFALLS
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OUTCOMES
In the case of intrinsic bladder endometriosis, segmental bladder resection resolves a majority of patient symptoms.
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COMPLICATIONS
Postoperative vesicle hematoma and vesicovaginal fistula formation, although rare, can occur.
12
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KEY REFERENCES
1. Stanley KE Jr, Utz DC, Dockerty MB. Clinically significant endometriosis of the urinary tract. Surg Gynecol Obstet.
1965;120:491–498.
2. Abeshouse BS, Abeshouse G. Endometriosis of the urinary tract: a review of the literature and a report of four cases of
vesical endometriosis. J Int Coll Surg. 1960;34:43–63.
3. Yohannes P. Ureteral endometriosis. J Urol. 2003;170:20–25.
4. Knabben L, Imboden S, Fellman B, et al. Urinary tract endometriosis in patients with deep infiltrating endometriosis:
prevalence, symptoms, management, and proposal for a new clinical classification. Fertil Steril. 2015;103:147–152.
5. Goncalves MO, Dias JA Jr, Podgaec S, et al. Transvaginal ultrasound for diagnosis of deeply infiltrating endometriosis. Int
J Gynaecol Obstet. 2009;104:156–160.
6. Nezhat C, Nezhat F. Laparoscopic segmental bladder resection for endometriosis: A report of two cases. Obstet
Gynecol. 1993;81(5):882–884.
7. Nezhat CH, Malik S, Osias J, et al. Laparoscopic management of 15 patients with infiltrating endometriosis of the bladder
and a case of primary intravesical endometrioid adenosarcoma. Fertil Steril. 2001; 78:872–875.
8. Hilaris GE, Payne CK, Osias J, et al. Synchronous rectovaginal, urinary bladder, and pulmonary endometriosis. JSLS.
2005;9(1):78–82.
9. Kovoor E, Nassif J, Miranda-Mendoza I, et al. Endometriosis of bladder: outcomes after laparoscopic surgery. J Minim
Invasive Gynecol. 2010;17(5):600–604.
10. Greenberg JA. The use of barbed sutures in obstetrics and gynecology. Rev Obstet Gynecol. 2010;3(3):82–91.
11. Chamsy D, Lee T. The use of barbed suture in bladder and bowel surgery. Surg Technol Int. 2013;23:153–159.
12. Chapron C, Bourret A, Chopin N, et al. Surgery for bladder endometriosis: long-term results and concomitant management
of associated posterior deep lesions. Hum Reprod. 2010;25(4):884–889.
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Chapter 6.5
Video-Assisted Thoracoscopic Surgery for Endometriosis
Azade h Nezhat, Cam ran Nezhat
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GENERAL PRINCIPLES
Definition
Thoracic endometriosis is an uncommon condition characterized by the presence of functioning endometrial tissue in pleura,
lung parenchyma, diaphragm, and airways with an overwhelming occurrence in the right hemithorax (88% to 100%).
1
,
2
Bilateral thoracic endometriosis is exceedingly rare but has been reported.
3
The exact pathophysiology of thoracic endometriosis remains unclear, but the Sampson theory of retrograded menstruation
is the most supported theory of the dissemination of endometrial cells into the peritoneal cavity.
4
Thoracic endometriosis syndrome (TES) encompasses mainly of four clinical entities: catamenial pneumothorax (80%),
catamenial hemothorax (14%), catamenial hemoptysis (5%), and lung nodules.
5,6
The symptoms of thoracic endometriosis are typically catamenial, occurring within 72 hours of the onset of menstruation
(rarely 96 hours).
2
Chest pain is the most common symptom, occurring in 90% of patients, while dyspnea occurs in approximately one-third.
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These symptoms and signs are intermittent and can occur around the time of menses.
Patients may also present with recurrent catamenial pneumothorax, hemothorax, or hemoptysis.
Endometriosis implants can be seen grossly as raised red or as purple, gray, black lesions. They can be single or multiple
lesions that vary in size from 1 to 3 mm and up to 10 mm on pleurodiaphragmatic, pericardial, and tracheobronchial
surfaces.
2,7,8
Histologically endometrial glands and stroma that stain positively with estrogen and/or progesterone receptors are presents
in tissue samples. These often contain fibrous tissue, blood, and cysts.
2,7,8
Diaphragmatic perforations are also usually seen grossly at the central tendon as circular or elliptical defects in various sizes
with implants at the edges of perforations.
2,7,8
Concurrent pelvic endometriosis is seen in approximately 50% to 80% of cases.
5,9
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Differential Diagnosis
Malignancy, infection, and other pathology such as lymphangioleiomyomatosis (LAM), which usually presents with
characteristic cysts and angiomyolipoma in young females should be ruled out.
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Medical Management
Medical management of thoracic endometriosis has long been considered the first step in the management.
Danazol, progestins, oral contraceptive pills, and gonadotropin releasing hormone (GnRH) analogs have all been widely
used.
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IMAGING AND OTHER DIAGNOSTICS
Diagnosis of thoracic endometriosis is mainly based on clinical suspicion, when women with history pelvic endometriosis
present with catamenial or noncatamenial pneumothorax.
Chest radiograph, computerized tomography (CT), magnetic resonance imaging (MRI), thoracocentesis, and bronchoscopy
are useful in patients presenting with pneumothorax, hemothorax hemoptysis, or a lung nodule. These procedures help rule
out malignancy, infection and other pathology.
10,11
Serum cancer antigen 125 (CA 125) and CA19–9 concentrations may be elevated in patients with thoracic endometriosis
but are poorly sensitive and nonspecific diagnostically.
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PREOPERATIVE PLANNING
Contrast-enhanced computerized tomography (CCT) done while patient is symptomatic (i.e., during menses) helps locate
the lesions prior to surgery and rule out other etiologies.
A multidisciplinary team of cardiothoracic surgeons, laparoscopic surgeons and an anesthesiologist are needed for the
successful surgical treatment.
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