Reh Lena Maria, Darici Ezgi, Montanari Eliana, Keckstein Joerg, Senft Birgit, Dauser Bernhard, Hudelist Gernot
Department of Gynecology, Center for Endometriosis, Hospital St. John of God, Vienna, Austria.
Brussels IVF, Centre for Reproductive Medicine Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Av. du Laerbeek 101, 1090, Jette, Belgium.
Wien Klin Wochenschr. 2022 Nov;134(21-22):772-778. doi: 10.1007/s00508-022-02088-x. Epub 2022 Oct 10.
Patients suffering from colorectal deep endometriosis (DE) experience gastrointestinal symptoms with almost the same frequency as gynecological pain symptoms. Preoperatively existing gastrointestinal symptoms may translate into pathological gastrointestinal quality of life index (GIQLI) and low anterior resection syndrome scores (LARS). This prospective questionnaire-based case control study aims to assess the prevalence of gastrointestinal complaints reflected by changes in LARS and GIQLI scores in patients with colorectal deep endometriosis prior to surgical treatment and compare those to a healthy control group.
The study was conducted at the Hospital St. John of God in Vienna and included a total of 97 patients with histologically confirmed colorectal DE with radical surgical treatment and 96 women in whom DE was excluded via transvaginal sonography (TVS) or visually. Gastrointestinal symptoms reflected by LARS and GIQLI scores were evaluated presurgically and in controls.
A total of 193 premenopausal patients were included in this study. A mean GIQLI of 90.7 ± 22.0 and 129.4 ± 11.1 was observed among patients and controls, respectively, showing a significantly higher morbidity concerning gastrointestinal symptoms and decreased quality of life (QoL) compared to healthy controls (p < 0.001). The LARS score results demonstrated that 18.6% of the patients with bowel DE presented with a major LARS and 27.8% with a minor LARS presurgically compared to 2.1% and 9.4% of control patients, respectively (p < 0.001).
Patients with colorectal DE experience a quality of gastrointestinal symptoms translating into a decreased QoL and pathological GIQLI and LARS scores already presurgically. As a consequence, these instruments should be interpreted with caution.
患有结直肠深部子宫内膜异位症（DE）的患者出现胃肠道症状的频率与妇科疼痛症状几乎相同。术前存在的胃肠道症状可能转化为病理性胃肠道生活质量指数（GIQLI）和低位前切除综合征评分（LARS）。这项基于问卷的前瞻性病例对照研究旨在评估手术治疗前结直肠深部子宫内膜异位症患者中，由LARS和GIQLI评分变化所反映的胃肠道不适的患病率，并将其与健康对照组进行比较。
该研究在维也纳的上帝之约翰医院进行，共纳入97例经组织学确诊为结直肠DE并接受根治性手术治疗的患者，以及96例经阴道超声检查（TVS）或肉眼检查排除DE的女性。术前对患者和对照组评估由LARS和GIQLI评分所反映的胃肠道症状。
本研究共纳入193例绝经前患者。患者组和对照组的GIQLI平均得分分别为90.7±22.0和129.4±11.1，与健康对照组相比，患者的胃肠道症状发病率显著更高，生活质量（QoL）降低（p<0.001）。LARS评分结果显示，术前肠道DE患者中18.6%表现为重度LARS，27.8%表现为轻度LARS，而对照组患者分别为2.1%和9.4%（p<0.001）。
结直肠DE患者在术前就经历了胃肠道症状，这导致生活质量下降以及病理性GIQLI和LARS评分。因此，对这些指标的解读应谨慎。
