Kent Andrew, Shakir Fevzi, Rockall Tim, Haines Pat, Pearson Carol, Rae-Mitchell Wendy, Jan Haider
Royal Surrey County Hospital, Dept. of Gynecology, Guildford, Surrey, United Kingdom.
Royal Surrey County Hospital, Dept. of Gynecology, Guildford, Surrey, United Kingdom.
J Minim Invasive Gynecol. 2016 May-Jun;23(4):526-34. doi: 10.1016/j.jmig.2015.12.006. Epub 2015 Dec 24.
Endometriosis can affect 10% of women at reproductive age. Of those, 5.3% to 12% will have endometriosis affecting the bowel. Although outcomes after surgery for severe endometriosis affecting the bowel have previously been studied and have shown improvement in generic quality of life indices and sexual function, few studies have evaluated bowel function or symptoms specific to endometriosis. Our aim was to determine the quality of life after radical excision of rectovagina endometriosis compromising the bowel.
Single-center prospective cohort study (Canadian Task Force classification II-2).
Specialist referral center for the management of advanced endometriosis.
Women with severe rectovaginal endometriosis compromising the bowel.
Comparison of preoperative data with a 2-, 6-, and 12-month follow-up was made for consecutive patients who underwent surgery for endometriosis with bowel involvement. The main outcome measures were quality of life using the Endometriosis Health Profile 30 and EuroQol-5 dimension questionnaires. Bowel symptoms were measured using the Gastrointestinal Quality of Life Index. Dysmenorrhea, dyspareunia, dyschezia, and chronic pain were measured using a visual analogue scale. To compare preoperative and postoperative scores, a Freidman test was performed followed by a preoperative and 12-month postoperative Wilcoxon signed-rank test. A Mann-Whitney U test was used to compare the results between those who had pelvic clearance and those who did not.
In total, 137 patients had surgery, of which 100 completed follow-up to 12 months. The serious perioperative and postoperative complication rate was 7.3%. The results show significant improvement in almost all variables measured (p < .01). At 12 months patients who had a pelvic clearance (hysterectomy with bilateral salpingo-oophorectomy) had significantly less pain with better bowel function. Additionally, they had higher quality of life scores and greater satisfaction with their treatment. There was no significant difference between any postoperative variables tested regardless of the type of bowel surgery.
Severe rectovaginal endometriosis compromising the bowel can be treated surgically with experienced combined gynecologic and colorectal input with a low serious complication rate. Surgery by an experienced multidisciplinary team results in significant improvement in pain, sexual function, and quality of life up to 1 year postoperatively. Pelvic clearance improves outcome and patients should be counseled accordingly. There is no difference in outcome between the types of bowel surgery undertaken as long as all visible/palpable endometriosis is removed.
子宫内膜异位症可影响10%的育龄女性。其中，5.3%至12%的患者肠道会受到子宫内膜异位症影响。尽管此前已对严重影响肠道的子宫内膜异位症手术后的结果进行了研究，且结果显示一般生活质量指标和性功能有所改善，但很少有研究评估肠道功能或子宫内膜异位症特有的症状。我们的目的是确定根治性切除累及肠道的直肠阴道子宫内膜异位症后的生活质量。
单中心前瞻性队列研究（加拿大工作组分类II-2）。
晚期子宫内膜异位症管理的专科转诊中心。
患有严重直肠阴道子宫内膜异位症且累及肠道的女性。
对连续接受肠道受累的子宫内膜异位症手术的患者，比较术前数据与术后2个月、6个月和12个月的随访数据。主要结局指标是使用子宫内膜异位症健康概况30问卷和欧洲五维健康量表来评估生活质量。使用胃肠道生活质量指数来测量肠道症状。使用视觉模拟量表测量痛经、性交困难、排便困难和慢性疼痛。为比较术前和术后评分，先进行Friedman检验，然后进行术前和术后12个月的Wilcoxon符号秩检验。使用Mann-Whitney U检验比较接受盆腔清除术和未接受盆腔清除术的患者之间的结果。
共有137例患者接受了手术，其中100例完成了12个月的随访。围手术期和术后严重并发症发生率为7.3%。结果显示几乎所有测量变量均有显著改善（p <.01）。在术后12个月时，接受盆腔清除术（子宫切除术加双侧输卵管卵巢切除术）的患者疼痛明显减轻，肠道功能更好。此外，他们的生活质量评分更高，对治疗的满意度也更高。无论肠道手术类型如何，所测试的任何术后变量之间均无显著差异。
严重累及肠道的直肠阴道子宫内膜异位症可通过经验丰富的妇科和结直肠联合治疗进行手术治疗，严重并发症发生率较低。由经验丰富的多学科团队进行手术可使术后1年内疼痛、性功能和生活质量得到显著改善。盆腔清除术可改善结局，应相应地为患者提供咨询。只要切除所有可见/可触及的子宫内膜异位症，所进行的肠道手术类型之间的结局无差异。
