Division of Gynecological Oncology, Department for the Protection of Women's and Children's Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy.
Division of Gynecology and Human Reproduction Physiopathology, Department of Medical and Surgical Sciences (DIMEC), IRCCS, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
Int J Gynaecol Obstet. 2022 Oct;159(1):152-159. doi: 10.1002/ijgo.14089. Epub 2022 Jan 20.
To evaluate the functional outcomes of nerve-sparing surgery for deep infiltrating endometriosis (DIE) with or without posterolateral parametrectomy.
A multicenter, observational, retrospective, cohort study was performed including all symptomatic women who underwent nerve-sparing laparoscopic excision of DIE and preoperative and postoperative assessment of functional outcomes through validated questionnaires between April 2019 and March 2020. Women with posterolateral parametrial DIE (P-group) and women with no parametrial involvement (NP-group) were compared in terms of preoperative and postoperative functional outcomes related to pelvic organs assessed through validated questionnaires (KESS and GIQLI for bowel function, BFLUTS for urinary function, and FSFI for sexual function); pain symptoms at 3-month follow up assessed through an 11-point visual analogue scale (VAS) for dyschezia, dysmenorrhea, dyspareunia and chronic pelvic pain; surgical outcomes; and rate of urinary voiding dysfunction at 3-month follow up.
One-hundred patients were included: 69 in the P-group and 31 in the NP-group. Preoperative and postoperative values of questionnaires, pain symptoms, and postoperative complication rates were comparable between the two groups, except for postoperative dyspareunia and sexual dysfunction, which were statistically higher in the P-group. Only patients in the P-group experienced urinary voiding dysfunction, but no statistical significance was reached (P = 0.173).
Posterolateral parametrectomy for DIE appears to be associated with a higher risk of postoperative dyspareunia and sexual dysfunction.
评估神经保留手术治疗深部浸润型子宫内膜异位症（DIE）伴或不伴后外侧子宫旁切除术的功能结局。
这是一项多中心、观察性、回顾性队列研究，纳入了所有因深部浸润型子宫内膜异位症接受神经保留腹腔镜切除术且在 2019 年 4 月至 2020 年 3 月期间通过验证问卷进行术前和术后功能结局评估的有症状女性。比较后外侧子宫旁受累（P 组）和无子宫旁受累（NP 组）女性的术前和术后盆腔器官功能结局（通过验证问卷评估，包括肠功能的 KESS 和 GIQLI、尿功能的 BFLUTS 和性功能的 FSFI）、术后 3 个月随访时通过 11 分视觉模拟量表（VAS）评估的排便困难、痛经、性交痛和慢性盆腔痛症状、手术结局以及术后 3 个月随访时排尿功能障碍的发生率。
共纳入 100 例患者：P 组 69 例，NP 组 31 例。两组间问卷、疼痛症状和术后并发症发生率的术前和术后值相似，但术后性交痛和性功能障碍在 P 组的统计学更高。仅 P 组的患者发生排尿功能障碍，但无统计学意义（P=0.173）。
DIE 的后外侧子宫旁切除术与术后性交痛和性功能障碍的风险增加相关。
