Yang Yong-Ping, Yu Ling-Yun, Shi Jian, Li Jian-Nan, Wang Min, Liu Tong-Jun
Department of General Surgery, the Second Hospital of Jilin University.
Department of Ear Nose and Throat Surgery, the First Hospital of Jilin University, Changchun, China.
Medicine (Baltimore). 2020 Nov 20;99(47):e23309. doi: 10.1097/MD.0000000000023309.
Laparoscopic anterior resection of rectum (AR) is one of surgical approaches for deeply infiltrating endometriosis (DIE). Up to date, no clinical trials have clearly analyzed the short-term and long-term complications post-surgically, indications or feasibilities for surgical procedure, or post-operative recovery. The aims of this trial were to evaluate the indications for laparoscopic AR, the short-term and long-term complications post-surgically, post-operative recovery.We conducted a prospective study of 29 patients. They were divided into 2 groups. The period of follow-up was 12 months post-surgery. In our study, we recruited patents with laparoscopic AR experiencing failure of medical treatment (3 months) or associated infertility (>2cycles). The operative data and short term and long term complications were recorded. The outcomes of laparoscopic AR group were assessed by questionnaires, such as NRS (numeric rating scale), KESS (Knowles-Eccersley-Scott Symptom Questionnaire), VAS (visual analogue scale), WCS (Wexner constipation score) and ABS (Abdominal Bloating Score), which were compared with the outcomes of medicine group at set time points of baseline, 3 months, 6 months, 9 months and 12 months. The overall outcomes of the two groups were assessed with 5-point Likert Scale.Patients in surgery group were recovery rapidly without serious short term or long term complications. All of NRS, KESS, VAS, WCS, and ABS in surgery group were getting better greatly than that in medicine group (3.04 ± 1.91 vs 5.41 ± 3.01, 5.64 ± 1.54 vs 7.01 ± 1.03, 0.50 ± 0.38 vs 3.58 ± 2.01, 4.43 ± 1.02 vs 8.92 ± 2.45, and 0.61 ± 0.34 vs 1.42 ± 0.71) at 3 months post-operation. However, the advantage of surgery group was almost vanished at 12 months (4.02 ± 2.53 vs 5.99 ± 2.31, 7.42 ± 3.17 vs 10.98 ± 2.53, 1.59 ± 1.3 vs 2.23 ± 1.59, 6.01 ± 2.53 vs 7.90 ± 3.25, and 1.31 ± 1.05 vs 1.39 ± 1.02). Furthermore, we compared the overall outcomes between the 2 groups with 5-point Likert Scale, with confirmation of the advantage at 3 months post-surgically. Additionally, we compared these questionnaires, with the finding that VAS and 5-point Likert Scale of surgery group had the same changes. Finally, a table of indications for laparoscopic AR were tabulated according our clinical experience.Patients can receive benefit from both medicine and laparoscopic AR. However, laparoscopic AR has obvious advantage of rapid symptom relief. Further studies and clinical data collections are required for indications and feasibility of combined therapy.
腹腔镜直肠前切除术（AR）是深度浸润型子宫内膜异位症（DIE）的手术治疗方法之一。迄今为止，尚无临床试验对该手术的短期和长期并发症、手术适应症或可行性以及术后恢复情况进行明确分析。本试验的目的是评估腹腔镜AR的适应症、术后短期和长期并发症以及术后恢复情况。我们对29例患者进行了一项前瞻性研究。他们被分为两组。术后随访期为12个月。在我们的研究中，我们招募了因药物治疗失败（3个月）或伴有不孕症（>2个周期）而接受腹腔镜AR的患者。记录手术数据以及短期和长期并发症。通过问卷调查评估腹腔镜AR组的结果，如数字评分量表（NRS）、诺尔斯-埃克斯利-斯科特症状问卷（KESS）、视觉模拟量表（VAS）、韦克斯纳便秘评分（WCS）和腹胀评分（ABS），并在基线、3个月、6个月、9个月和12个月的设定时间点与药物组的结果进行比较。用5级李克特量表评估两组的总体结果。手术组患者恢复迅速，无严重的短期或长期并发症。术后3个月时，手术组的所有NRS、KESS、VAS、WCS和ABS评分均比药物组有显著改善（分别为3.04±1.91对5.41±3.01、5.64±1.54对7.01±1.03、0.50±0.38对3.58±2.01、4.43±1.02对8.92±2.45、0.61±0.34对1.42±0.71）。然而，手术组的优势在12个月时几乎消失（分别为4.02±2.53对5.99±2.31、7.42±3.17对10.98±2.53）。此外，我们用5级李克特量表比较了两组的总体结果，证实了术后3个月时手术组的优势。此外，我们比较了这些问卷，发现手术组的VAS和5级李克特量表有相同的变化。最后，根据我们的临床经验列出了腹腔镜AR的适应症表。患者可以从药物治疗和腹腔镜AR中获益。然而，腹腔镜AR在快速缓解症状方面具有明显优势。联合治疗的适应症和可行性还需要进一步的研究和临床数据收集。
