Prospektív vizsgálat a sigmoideoscopia diagnosztikai érzékenységének meghatározására vastagbelet infiltráló endometriosisban | Prospective study to determine the diagnostic sensitivity of sigmoidoscopy in bowel endometriosis

Absztrakt: Bevezetes es celkitűzes: A colorectalis rendszert erintő endometriosis ellatasa multidiszciplinaris laparoszkopos teammel javasolt. A belinfiltracio preoperativ felismerese ehhez elengedhetetlen. Betegek es modszer: 2009–2015 kozott prospektiven 383, endometriosissal diagnosztizalt betegnel tortent sigmoideoscopia. Intraluminalis endometriosis, fali infiltraciora jellemző masodlagos jelek (falmerevseg, benyomat, megtoretes, vizsgalat alatti fajdalom, suffusio) kerultek feldolgozasra. Műteti indikacio eseten a pozitiv esetek multidiszciplinaris, a negativ esetek nőgyogyasz altal vegzett műteten estek at. Eredmenyek: 224 (58,49%) pozitivnak talalt beteg kozul 108-nal multidiszciplinaris műtet tortent, a negativnak bizonyult esetek kozul 135 ginekologiai műteten esett at. 108-bol 103 betegnel a műtet soran is igazolodott a bel erintettsege, mig a negativ esetek kozul nyolc esetben volt jelentős belinfiltracio. Teljes sigmoideoscopias vizsgalat 43,4%-ban volt kivitelezhető. Intraluminalis endometriosis 4,91%-ban, fali merevseg 38,39%-ban, benyomat 45,54%-ban, megtoretes 57,14%-ban, fajdalom (narkozis nelkul vegzett vizsgalatoknal) 26,06%-ban, suffusio 3,82%-ban fordult elő. A sigmoideoscopia szenzitivitasa: 92,8%, specificitasa: 96,2% volt. Kovetkeztetes: A sigmoideoscopia – tapasztalt endoszkopos eseteben – kiemelkedő szenzitivitasu eszkoz a belet infiltralo endometriosis igazolasaban. Orv. Hetil., 2017, 158(7), 264–269. | Abstract: Introduction and aim: In the treatment of colorectal endometriosis a multidisciplinary laparoscopic resection is suggested, for this reason the correct selection of bowel infiltration is essential before surgery. Patients and method: Between 2009 and 2015, 383 sigmoidoscopies were performed in patients with endometriosis. Where mucosal invasion was absent secondary signs (wall rigidity, impression, kinking, pain during the examination, suffusion) were analysed. In endoscopically confirmed cases multidisciplinary surgery was performed, the remaining patients were operated by a gynecologic team only. Results: Endometriosis was endoscopically confirmed in 224 patients (58.49%), 108 of them underwent multidisciplinary operation, the negative 135 cases received gynaecological surgery. Bowel endometriosis was confirmed in 103 out of 108 cases intraoperatively, while in 8 cases of the sigmoidoscopically negative patients bowel infiltration was diagnosed intraoperatively by the gynaecological team. Complete sigmoidoscopy was performed in 43.47% of the cases. Intraluminal endometriosis was found in 4.91%, secondary signs as rigidity in 38.39%, impression in 45.54%, kinking in 57.14%, pain (in cases of examination without narcosis) in 26.06% and suffusion in 3.82% of the cases was found during sigmoidoscopy. Sigmoidoscopic examination has a 92.8% specificity and 96.2% sensitivity in cases of bowel endometriosis. Conclusion: Sigmoidoscopy performed by an experienced gastroenterologist is a highly sensitive examination for the diagnosis of bowel endometriosis. Orv. Hetil., 2017, 158(7), 264–269.