Uccella Stefano, Gisone Baldo, Serati Maurizio, Biasoli Sara, Marconi Nicola, Angeretti Gloria, Gallotta Valerio, Cardinale Silvia, Rausei Stefano, Dionigi Gianlorenzo, Scambia Giovanni, Ghezzi Fabio
Department of Woman and Child Health, Fondazione Policlinico Universitario A. Gemelli I.R.C.C.S., Largo Agostino Gemelli, 8, 00168, Roma, Italy.
Department of Obstetrics and Gynecology, University of Insubria, F. Del Ponte Hospital, Varese, Italy.
Arch Gynecol Obstet. 2018 Sep;298(3):639-647. doi: 10.1007/s00404-018-4852-z. Epub 2018 Jul 30.
Radical eradication of deep infiltrating endometriosis (DIE) is associated with a high risk of iatrogenic autonomic denervation and pelvic dysfunction. Our aim was to prospectively analyze peri-operative details and post-operative functional outcomes (in terms of pain relief and bladder, rectal, and sexual function) among women operated for DIE of the posterior compartment with nerve-sparing technique, using the visual analogue scale and validated questionnaires.
All women undergoing laparoscopic nerve-sparing eradicative surgery for DIE nodules of the posterior compartment ≥ 4 cm ± bowel resection were included. Pain scores [using Visual Analogue Scale (VAS) scores] were collected before surgery and 6 and 12 months after surgery. Functional outcomes in terms of bladder, rectal, and sexual function, were evaluated using validated questionnaires (i.e., ICIQ-UISF, NBD score, and FSFI) administered pre-operatively and 6 months after surgery.
A total of 34 patients were included. Twenty-eight (82.4%) of them had already undergone a previous abdominal surgery for endometriosis. Bowel resection was performed in 16 (47.1%) patients. Median VAS score levels of pelvic pain were significantly decreased after surgery both at 6 (median 3, range 0-7 and 2, 0-7, respectively) and at 12 months (3, 0-8 and 2, 0-7), compared to pre-operative levels (9, 1-10 and 3, 0-7, respectively) (p < 0.0001). No differences were found in terms of urinary function between pre- and post-operative ICIQ-SF questionnaires. In no cases, bladder self-catheterization was needed at the 6-and 12-month follow-up. Median NBD score was 3.5 (0-21) pre-operatively and 2 (0-18) after 6 months (p = 0.72). The pre-operative total FSFI score was 19.1 (1.2-28.9) vs. 22.7 (12.2-31) post-operatively (p = 0.004).
The nerve-sparing approach is effective in eradicating DIE of the posterior compartment, with satisfactory pain control, significant improvement of sexual function, and preservation of bladder and rectal function.
根治性切除深部浸润性子宫内膜异位症（DIE）与医源性自主神经去神经支配和盆腔功能障碍的高风险相关。我们的目的是前瞻性分析采用保留神经技术对后盆腔DIE患者进行手术的围手术期细节和术后功能结局（包括疼痛缓解以及膀胱、直肠和性功能），使用视觉模拟评分法和经过验证的问卷。
纳入所有接受腹腔镜下保留神经根治性手术治疗后盆腔DIE结节≥4 cm且伴有肠切除术的女性。在手术前以及术后6个月和12个月收集疼痛评分[使用视觉模拟评分法（VAS）评分]。使用术前和术后6个月发放的经过验证的问卷（即ICIQ-UISF、NBD评分和FSFI）评估膀胱、直肠和性功能方面的功能结局。
共纳入34例患者。其中28例（82.4%）既往已因子宫内膜异位症接受过腹部手术。16例（47.1%）患者进行了肠切除术。与术前水平（分别为9，1 - 10和3，0 - 7）相比，术后6个月（分别为中位数3，范围0 - 7和2，0 - 7）和12个月时（3，0 - 8和2，0 - 7）盆腔疼痛的VAS评分中位数显著降低（p < 0.0001）。术前和术后ICIQ-SF问卷在排尿功能方面未发现差异。在6个月和12个月随访时均无需进行膀胱自我导尿。术前NBD评分中位数为3.5（0 - 21），6个月后为2（0 - 18）（p = 0.72）。术前FSFI总分是19.1（1.2 - 28.9），术后为22.7（12.2 - 31）（p = 0.004）。
保留神经的方法在根治后盆腔DIE方面有效，具有令人满意的疼痛控制效果，性功能显著改善，并且保留了膀胱和直肠功能。
