Department of Obstetrics and Gynecology, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Germany; Department of Obstetrics and Gynecology, Klinikum Bayreuth, Germany.
Department of Obstetrics and Gynecology, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Germany.
Eur J Obstet Gynecol Reprod Biol. 2019 Aug;239:21-29. doi: 10.1016/j.ejogrb.2019.05.007. Epub 2019 May 10.
To analyze preoperative and postoperative sexual function following surgery for deeply infiltrating endometriosis (DIE) with and without bowel involvement.
Patients with DIE who underwent surgery between 2001 and 2011 with segmental bowel resection (WB) or without segmental bowel resection (WOB) were surveyed using the German version of the Massachusetts General Hospital Sexual Functioning Questionnaire (KFSP). Responses were given on a six-point scale for the items sexual interest, sexual arousal, orgasm, lubrication, and general sexual satisfaction. As there are no cut-off values for the existence of sexual function disorders, a control group with no history of endometriosis was evaluated. Differences between the preoperative and postoperative results, as well as between WB, WOB, and a control group, were compared using the Wilcoxon test, Mann-Whitney U test, and Fisher's exact test.
Eighty-nine patients without bowel resection (mean age 34.3 years; mean follow-up 63.2 months), 87 patients with bowel resection (mean age 37.7 years; mean follow-up 69.6 months), and 100 control patients aged 21-58 years (mean age 35.0 years) were evaluated. Preoperatively, both treatment groups had significantly poorer scores in all categories in comparison with the control group. The WOB group improved significantly in all categories postoperatively, with no further significant differences from the control group. No significant postoperative improvement was observed in the WB group, and the group had significantly poorer scores in comparison with the control group. The number of previous operations is associated with significantly poorer postoperative KFSP results. Sterility and age > 40 years are associated with significantly less improvement in the KFSP, although with lower initial values.
Patients with DIE with or without bowel involvement have significantly impaired sexual function preoperatively. Complete resection of endometriosis in the WOB group was able to improve sexual function, as the women had sexual scores similar to those in the healthy control group postoperatively. Possible explanations for the lack of postoperative improvement of sexual function after segmental bowel resection include the type of surgery carried out, or injury to the affected nerves resulting from the endometriosis.
分析深部浸润型子宫内膜异位症（DIE）伴或不伴肠受累患者手术后的术前和术后性功能情况。
对 2001 年至 2011 年间接受手术治疗且行肠段切除术（WB）或不行肠段切除术（WOB）的 DIE 患者进行问卷调查，使用德国版马萨诸塞州总医院性功能问卷（KFSP）进行调查。患者对性欲、性唤起、性高潮、润滑和总体性满意度等项目进行六点制评分。由于性功能障碍的存在没有明确的截断值，因此评估了无子宫内膜异位症病史的对照组。使用 Wilcoxon 检验、Mann-Whitney U 检验和 Fisher 确切检验比较术前和术后结果，以及 WB、WOB 和对照组之间的差异。
无肠切除术患者 89 例（平均年龄 34.3 岁；平均随访 63.2 个月）、行肠切除术患者 87 例（平均年龄 37.7 岁；平均随访 69.6 个月）和 100 例年龄在 21-58 岁的对照组患者（平均年龄 35.0 岁）进行了评估。术前，与对照组相比，两组治疗患者的所有项目评分均明显较差。WOB 组术后所有项目评分均显著改善，与对照组无显著差异。WB 组术后未见明显改善，且与对照组相比评分明显较差。既往手术次数与术后 KFSP 评分明显较差相关。不孕和年龄＞40 岁与 KFSP 评分改善明显较少相关，尽管初始值较低。
DIE 伴或不伴肠受累患者术前性功能明显受损。WOB 组子宫内膜异位症完全切除可改善性功能，术后女性性功能评分与健康对照组相似。肠段切除术后性功能无改善的可能原因包括手术类型或子宫内膜异位症导致的受累神经损伤。
