子宫内膜异位症手术改善生活质量的主要领域：系统评价和荟萃分析。
Surgery for Endometriosis Improves Major Domains of Quality of Life: A Systematic Review and Meta-Analysis.
机构信息
Endometriosis Section, Gynecologic Division (Drs. Vieira Lins Arcoverde, de Paula Andres, Moysés Borrelli, and Simões Abrão), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil.
Endometriosis Section, Gynecologic Division (Drs. Vieira Lins Arcoverde, de Paula Andres, Moysés Borrelli, and Simões Abrão), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil; Gynecologic Division (Drs. de Paula Andres, de Almeida Barbosa, and Simões Abrão), BP-A Beneficencia Portuguesa de Sao Paulo, Sao Paulo, Brazil, and.
出版信息
J Minim Invasive Gynecol. 2019 Feb;26(2):266-278. doi: 10.1016/j.jmig.2018.09.774. Epub 2018 Sep 20.
Because surgery for endometriosis can involve severe complications, it is important to determine if the patient's quality of life (QOL) is indeed improved after surgery. A systematic review and meta-analysis, when appropriate, was conducted and included 38 studies that assessed the QOL using validated questionnaires administered before and after surgery. Results were grouped according to the type of endometriosis reported: all types endometriosis, deep infiltrative endometriosis (DIE), and bowel endometriosis. Quantitative analysis was performed on 17 homogeneous studies. Pooled response mean differences between the 36-Item and 12-Item Short Form Survey (SF-36 and SF-12) showed significant improvement in Mental Component Score (MCS) after surgery for all types of endometriosis (.21; 95% confidence interval [CI], .04-.38); significant improvement after surgical treatment for DIE in Vitality (.67; 95% CI, .41-.94), Social Functioning (.59; 95% CI, .18-.99), Role Emotional .49; 95% CI, .02-.97), Mental Health (.39; 95% CI, .03-.74), Physical Functioning (.93; 95% CI, .49-1.38), Bodily Pain (1.23; 95% CI, .47-1.99), General Health (.57; 95% CI, .02-1.12), MCS (.55; 95% CI, .10-1.00), and Physical Component Score (PCS; .73; 95% CI, .27-1.18); and significant improvement after surgery for bowel endometriosis for all 8 domains (Vitality [1.00; 95% CI, .56-1.43], Social Functioning [.97; 95% CI, .57-1.37], Role Emotional [1.17; 95% CI, .7-1.63], Mental Health [.94; 95% CI, .5-1.38], Physical Functioning [.74; 95% CI, .3-1.18], Role Physical [1.25; 95% CI, .75-1.76], Bodily Pain [1.39; 95% CI, .79-1.98], General Health [.84; 95% CI, 1.46-1.22]), MCS (.93; 95% CI, .47-1.40), PCS (.82; 95% CI, .40-1.23), and total score (1.15; 95% CI, .48-1.83). Only 1 study assessed patients with minimal disease and showed significant improvement in PCS (p = .002) and MCS (p <.001). This systematic review reveals that surgery for endometriosis resulted in overall improvement in most health domains of health-related QOL, with the greatest improvement found in the Bodily Pain domain.
由于子宫内膜异位症的手术可能涉及严重的并发症，因此确定手术后患者的生活质量（QOL）是否确实得到改善非常重要。我们进行了系统的回顾和荟萃分析，酌情纳入了 38 项使用手术前后经过验证的问卷评估 QOL 的研究。结果根据报告的子宫内膜异位症类型进行分组：所有类型的子宫内膜异位症、深部浸润性子宫内膜异位症（DIE）和肠子宫内膜异位症。对 17 项同质研究进行了定量分析。36-Item 和 12-Item Short Form Survey（SF-36 和 SF-12）的汇总反应均值差异表明，所有类型的子宫内膜异位症手术后精神成分评分（MCS）均有显著改善（.21；95%置信区间[CI]，.04-.38）；DIE 手术后手术治疗后，活力（.67；95%CI，.41-.94）、社会功能（.59；95%CI，.18-.99）、情绪角色（.49；95%CI，.02-.97）、心理健康（.39；95%CI，.03-.74）、身体机能（.93；95%CI，.49-1.38）、躯体疼痛（1.23；95%CI，.47-1.99）、一般健康状况（.57；95%CI，.02-1.12）、MCS（.55；95%CI，.10-1.00）和身体成分评分（PCS；.73；95%CI，.27-1.18）有显著改善；肠子宫内膜异位症手术后所有 8 个领域（活力[1.00；95%CI，.56-1.43]、社会功能[.97；95%CI，.57-1.37]、情绪角色[1.17；95%CI，.7-1.63]、心理健康[.94；95%CI，.5-1.38]、身体机能[.74；95%CI，.3-1.18]、身体角色[1.25；95%CI，.75-1.76]、躯体疼痛[1.39；95%CI，.79-1.98]、一般健康状况[.84；95%CI，1.46-1.22]）、MCS（.93；95%CI，.47-1.40）、PCS（.82；95%CI，.40-1.23）和总分（1.15；95%CI，.48-1.83）有显著改善。只有 1 项研究评估了疾病程度最低的患者，结果显示 PCS（p=0.002）和 MCS（p<.001）有显著改善。这项系统评价揭示，子宫内膜异位症手术总体上改善了与健康相关的生活质量的大多数健康领域，躯体疼痛领域的改善最大。
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