{"id":230,"title":"Nerve-Sparing Surgery for Parametrial Endometriosis","title_zh":"保留神经手术用于宫旁子宫内膜异位症：29 例病例系列的功能结局","url":"https://pubmed.ncbi.nlm.nih.gov/42985560","doi":"10.4293/jsls.2026.00109","pmid":"42985560","journal":"JSLS","kind":"paper","lang":"en","published_at":"2026-11-04T00:00:00+00:00","fetched_at":"2026-11-08T03:44:00+00:00","authors":["Moustafa S","Zaradna A","Uzianbaeva L","Mehdizadeh A","Fan D","Wang P"],"primary_topic":"endometrium","topics":[{"slug":"endometrium","score":4.0,"hits":["endometriosis"]}],"topic_score":4.0,"preference_score":0.0,"preference_labels":[],"llm_score":60.0,"final_score":60.0,"score_dims":{"novelty":50,"rigor":48,"impact":45,"relevance":55,"translation":58},"recommend_reason":"为宫旁深部内异症保留神经术式提供了具体术式组合与短期功能结局数据，对外科与合并不孕患者的生育力保留决策有参考价值；但属单中心小样本回顾性病例系列，无对照与长期功能/妊娠结局，证据等级有限。","keywords":["宫旁子宫内膜异位症","保留神经手术","深部浸润型内异症","盆腔自主神经","术后功能结局"],"selected":1,"story_id":88,"llm_provider":"deepseek","llm_model":"deepseek-flash","llm_effort":"low","source_key":"pubmed-uterus-pregnancy","source_name":"PubMed · 内膜/植入/早孕","source_tier":1,"mention_count":1,"has_interpretation":false,"journal_key":null,"journal_tier":"unknown","journal_if":null,"is_mock":false,"summary_zh":"该回顾性病例系列纳入 29 例接受保留神经手术的重度宫旁子宫内膜异位症患者，其中 AAGL III 期 7 例、IV 期 22 例；手术方式为腹腔镜 17 例、机器人 10 例、中转开腹 2 例，全部行保留神经的根治性病灶切除，并常合并输尿管松解（100%）、肠粘连松解（65.5%）等附加操作。平均手术时间 284 分钟，估计出血量 201 mL；出现 1 例术中、3 例术后并发症，1 例排尿不尽（残余尿<100 mL）与 1 例排便次数增多均在 1 周至 1 月内自行缓解。作者认为保留神经对减少排尿与排便功能损害至关重要，但样本量小、缺少对照与长期随访。","summary":"BACKGROUND: Surgical excision of parametrial endometriosis carries a risk of postoperative bladder, bowel, or sexual dysfunction due to pelvic autonomic nerve injury. Nerve-sparing surgery reduces these adverse effects and improves quality of life. However, experience remains limited, and further studies are needed to evaluate its feasibility and functional outcomes. METHODS: This retrospective case series included 29 patients with advanced parametrial endometriosis who underwent nerve-sparing surgery. The primary objective was to evaluate postoperative urinary and defecatory function; the secondary objective was to assess surgical complications. RESULTS: Among 29 patients, 7 (24.1%) had stage III disease and 22 (75.9%) had stage IV disease per American Association of Gynecologic Laparoscopists (AAGL) criteria. Surgical approaches included laparoscopy in 17 (58.6%), robotic surgery in 10 (34.5%), and conversion to laparotomy in 2 (6.9%). All cases involved nerve-sparing radical excision of endometriosis. Additional procedures included ureterolysis in all 29 patients (100%), enterolysis in 19 (65.5%), bowel shaving in 9 (31.0%), discoid resection in 5 (17.2%), segmental resection in 3 (10.3%), diaphragm excision in 2 (6.9%), partial cystectomy in 2 (6.9%), appendectomy in 3 (10.3%), and abdominal wall excision in 1 (3.4%). Operative time was 284 ± 99.3 min; estimated blood loss was 201 ± 216 mL. There was 1 intraoperative and 3 postoperative complications. One patient reported incomplete voiding with a postvoid residual under 100 mL, resolving within 1 week. Another reported increased bowel frequency that resolved within 1 month. CONCLUSION: Nerve-sparing is critical in the surgical treatment of parametrial endometriosis to minimize compromise of urinary and defecatory function.","interpretation_basis":null,"fulltext_status":null,"interpretation":null,"fulltext":{"available":false,"status":null,"reason":"尚未抓取全文（未入选、分数未达阈值，或还没跑 fulltext 步骤）","pmcid":null,"license":null,"chars":0,"source":null,"fetched_at":null}}