Metzemaekers J, Blikkendaal M D, V Nieuwenhuizen K E, Bronsgeest K, Rhemrev J P T, Smeets M J G H, English J, Jansen F W, Both S, Twijnstra A R H
Facts Views Vis Obgyn. 2022 Sep;14(3):245-253. doi: 10.52054/FVVO.14.3.034.
Deep Endometriosis (DE) classification studies with Enzian never compared solitary compartments (A, B, C, F), and combinations of anatomical locations (A&B, A&C, B&C, A&B&C), in correlation to pain. Therefore, the results of these studies are challenging to translate to the clinical situation.
We studied pain symptoms and their correlation with the solitary and combinations of anatomical locations of deep endometriosis lesion(s) classified by the Enzian score.
A prospective multi-centre study was conducted with data from university and non-university hospitals. A total of 419 surgical DE cases were collected with the web-based application called EQUSUM (www.equsum.org).
Preoperative reported numeric rating scale (NRS) were collected along with the Enzian classification. Baseline characteristics, pain scores, surgical procedure and extent of the disease were also collected.
In general, more extensive involvement of DE does not lead to an increase in the numerical rating scale for pain measures. However, dysuria and bladder involvement do show a clear correlation AUC 0.62 (SE 0.04, CI 0.54-0.71, p< 0.01). Regarding the predictive value of dyschezia, we found a weak, but significant correlation with ureteric involvement; AUC 0.60 (SE 0.04, CI 0.53-0.67, p< 0.01).
Pain symptoms poorly correlate with anatomical locations of deep endometriosis in almost all pain scores, with the exception of bladder involvement and dysuria which did show a correlation. Also, dyschezia seems to have predictive value for DE ureteric involvement and therefore MRI or ultrasound imaging (ureter and kidney) could be recommended in the preoperative workup of these patients.
WHAT'S NEW?: Dyschezia might have a predictive value in detecting ureteric involvement.
使用恩齐安分类法对深部子宫内膜异位症（DE）进行的分类研究从未将单独的腔室（A、B、C、F）以及解剖位置组合（A&B、A&C、B&C、A&B&C）与疼痛进行相关性比较。因此，这些研究结果难以应用于临床实际情况。
我们研究了疼痛症状及其与根据恩齐安评分分类的深部子宫内膜异位症病变的单独及组合解剖位置之间的相关性。
开展了一项前瞻性多中心研究，收集了来自大学医院和非大学医院的数据。通过名为EQUSUM（www.equsum.org）的基于网络的应用程序共收集了419例手术治疗的DE病例。
收集术前报告的数字评分量表（NRS）以及恩齐安分类。还收集了基线特征、疼痛评分、手术方式和疾病范围。
总体而言，DE累及范围更广并不会导致疼痛测量数字评分量表升高。然而，排尿困难和膀胱受累确实显示出明显的相关性，曲线下面积（AUC）为0.62（标准误0.04，95%置信区间0.54 - 0.71，p < 0.01）。关于排便困难的预测价值，我们发现其与输尿管受累存在微弱但显著的相关性；AUC为0.60（标准误0.04，95%置信区间0.53 - 0.67，p < 0.01）。
除膀胱受累和排尿困难显示出相关性外，几乎在所有疼痛评分中，疼痛症状与深部子宫内膜异位症的解剖位置相关性较差。此外，排便困难似乎对DE输尿管受累具有预测价值，因此在这些患者的术前检查中可推荐进行MRI或超声成像（输尿管和肾脏）检查。
排便困难在检测输尿管受累方面可能具有预测价值。
