Department of Obstetrics and Gynecology, Acibadem University Faculty of Medicine, Istanbul, Turkey.
Endometriosis Center, Acibadem Fulya Hospital, Istanbul, Turkey.
Arch Gynecol Obstet. 2020 Jul;302(1):165-172. doi: 10.1007/s00404-020-05583-6. Epub 2020 May 23.
This is a retrospective cohort study that evaluates the postoperative pain findings of a consecutive series of laparoscopic surgeries for deep endometriosis (DE).
This multi-center retrospective cohort study was carried out in university hospitals (Istanbul, Turkey). Sixty-five patients diagnosed through bimanual gynecologic examination, gynecologic ultrasound or magnetic resonance imaging-confirmed endometrioma and DE together; who underwent a laparoscopic surgery between 2013 and 2019 by a team of gynecologists, colorectal surgeons, and a urologist were retrospectively evaluated. The data were collected in a specific database and analyzed for postoperative pain outcomes through a comparison with preoperative symptoms scored using a visual analogue score (VAS), and the British Society of Gynecologic Endoscopy (BSGE) pelvic pain questionnaire.
Sixty-five patients who met the criteria were included. The mean age of all patients was 35.0 ± 6.3 (range 22-50) years. The mean operative time was 121.3 ± 50.2 (range, 60-270) minutes. Preoperative and postoperative comparison of VAS scores for dysmenorrhea (8.57 vs. 2.91), dyspareunia (6.62 vs. 1.66), dyschezia (7.46 vs. 2.43), dysuria (5.67 vs. 1.34), chronic pelvic pain (4.11 vs. 1.22), and BSGE score (40.98 vs. 11.00) showed significantly reduced pain scores, respectively (p < 0.01).
Laparoscopic management of DE is a valid treatment option in terms of reduced postoperative pain and increased quality of life according to pain score outcomes. To have more robust conclusions, a prospective cohort study with a larger sample size which evaluates patients who had segmental bowel resection and those who did not have segmental bowel resection is necessary.
本研究为回顾性队列研究，旨在评估一系列腹腔镜深部子宫内膜异位症（DE）手术的术后疼痛发现。
该多中心回顾性队列研究在土耳其伊斯坦布尔的大学医院进行。65 例患者通过双合诊妇科检查、妇科超声或磁共振成像确诊为卵巢子宫内膜异位囊肿和 DE，由妇科医生、结直肠外科医生和泌尿科医生组成的团队在 2013 年至 2019 年期间进行腹腔镜手术。通过比较术前使用视觉模拟评分（VAS）和英国妇科内镜学会（BSGE）盆腔疼痛问卷评分对术后疼痛结果进行评估。
符合标准的 65 例患者纳入研究。所有患者的平均年龄为 35.0±6.3（22-50 岁）岁。平均手术时间为 121.3±50.2（60-270 分钟）。术前和术后痛经（8.57 对 2.91）、性交痛（6.62 对 1.66）、排便困难（7.46 对 2.43）、尿痛（5.67 对 1.34）、慢性盆腔疼痛（4.11 对 1.22）和 BSGE 评分（40.98 对 11.00）的 VAS 评分比较显示疼痛评分显著降低（均 p<0.01）。
根据疼痛评分结果，腹腔镜治疗 DE 可减少术后疼痛和提高生活质量，是一种有效的治疗选择。为了得出更有力的结论，需要进行一项前瞻性队列研究，纳入有节段肠切除和无节段肠切除的患者，并扩大样本量。
