Department of Gynecology, Hospital St. John of God, Vienna, Austria; Department of Obstetrics and Gynecology, Medical University of Vienna, Austria.
Department of General Surgery, Hospital St. John of God, Vienna, Austria.
Reprod Biomed Online. 2019 Nov;39(5):845-851. doi: 10.1016/j.rbmo.2019.06.006. Epub 2019 Jun 19.
The study aimed to assess the associations between pre-operative symptoms in patients with deep infiltrating endometriosis (DIE) and intraoperatively determined extent of disease as described by the revised ENZIAN score.
This was a retrospective data analysis of women who underwent surgery for DIE between 2014 and 2018 at the Department of Gynecology, Hospital St. John of God, Vienna (a tertiary referral centre for endometriosis).
Data from 245 women were analysed. Statistically significant associations were found between involvement of ENZIAN compartment B (uterosacral ligaments, parametrium) and presence of dyspareunia (P = 0.002), ENZIAN compartment C (rectum, sigmoid colon) and dyschezia (P < 0.001), and ENZIAN compartment FB (urinary bladder) and dysuria (P < 0.001, Fisher's exact test). Statistically significant correlations were also detected between symptom severity of dyschezia and lesion size in ENZIAN compartment C (r = 0.334, P < 0.001), and severity of dyspareunia and lesion size in ENZIAN compartment B (r = 0.127, P = 0.046). Severity of dysmenorrhoea was correlated with lesion size in ENZIAN compartment A (r = 0.244, P < 0.001) and was associated with the presence of adenomyosis (compartment FA; P = 0.005, Mann-Whitney U-test). Additionally, the number of affected compartments (A, B, C and FA) correlated with the severity of dysmenorrhoea (r = 0.256, P < 0.001) and dyschezia (r = 0.161, P = 0.012).
In contrast to previous studies evaluating disease extent based on the revised American Society for Reproductive Medicine (rASRM) score, disease localization and extent as described by the revised ENZIAN score was associated and correlated with the presence and severity of different pre-operative symptoms. These explorative findings suggest that it may be important to evaluate the extent of DIE using the revised ENZIAN score in addition to the rASRM score.
本研究旨在评估深部浸润性子宫内膜异位症（DIE）患者术前症状与改良后的 ENZIAN 评分所描述的疾病严重程度之间的相关性。
这是一项回顾性数据分析，纳入了 2014 年至 2018 年期间在维也纳圣约翰上帝医院妇产科接受 DIE 手术的女性患者（子宫内膜异位症的三级转诊中心）。
共分析了 245 名女性的数据。发现 ENZIAN 分区 B（子宫骶骨韧带、宫旁组织）受累与性交痛（P=0.002）、ENZIAN 分区 C（直肠、乙状结肠）受累与排便困难（P<0.001）、ENZIAN 分区 FB（膀胱）受累与尿痛（P<0.001，Fisher 确切检验）之间存在统计学显著相关性。还检测到排便困难的严重程度与 ENZIAN 分区 C 中病变大小（r=0.334，P<0.001）和性交痛的严重程度与 ENZIAN 分区 B 中病变大小（r=0.127，P=0.046）之间存在统计学显著相关性。痛经的严重程度与 ENZIAN 分区 A 中的病变大小（r=0.244，P<0.001）相关，且与腺肌病（分区 FA；P=0.005，Mann-Whitney U 检验）相关。此外，受累的分区（A、B、C 和 FA）数量与痛经（r=0.256，P<0.001）和排便困难（r=0.161，P=0.012）的严重程度相关。
与以前评估基于改良美国生殖医学学会（rASRM）评分的疾病严重程度的研究相反，改良后的 ENZIAN 评分描述的疾病定位和严重程度与不同术前症状的存在和严重程度相关。这些探索性发现表明，使用改良后的 ENZIAN 评分来评估 DIE 的严重程度可能很重要，除了 rASRM 评分外。
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