General Surgery Department, University Hospital La Paz, Madrid, Spain.
Obstetrics and Gynecology Department, University Hospital La Paz, Madrid, Spain.
Langenbecks Arch Surg. 2022 Dec;407(8):3671-3679. doi: 10.1007/s00423-022-02705-3. Epub 2022 Oct 14.
Deep endometriosis (DE) is defined by the presence of ectopic endometrial glands, with rectal involvement ranging from 5.3 to 12%. The prevalence of low anterior resection-like syndrome (LARS) in patients with DE, how it affects quality of life (QoL), and its evolution after surgery is unclear. The objective of this study was to assess the gastrointestinal functional outcomes and QoL in patients who underwent surgery for DE.
A prospective study was conducted from 2017 to 2019, recruiting patients who underwent DE surgery with and without rectal resection. Patients completed LARS and SF-36 questionnaires before, at 6 months and at 1 year after surgery.
Eighty-two patients were enrolled. Rectal segmental resection was required in 16 (19.5%) patients, shaving in 16 (19.5%) and discoid resection in 8 (9.8%). All 8 domains of the SF-36 questionnaire showed improvement during follow-up, reflecting improved QoL after surgery (p ≤ 0.05) in all patients. Mean LARS scores for patients without rectal surgery were 7.5 ± 10.4 before and 13.7 ± 14.2 1 year after surgery; rectal surgery was 13.6 ± 13.6 and 14.6 ± 13.1, respectively (p = 0.17). No significant differences were found in the rectal surgery patients' postoperative LARS score among the 3 rectal DE surgical techniques (p = 0.97), and the SF-36 scores improved independent of the technique performed.
Patients with DE present a LARS-like syndrome before surgery that does not appear to be negatively affected after rectal surgery, independent of the technique performed. Rectal surgery improves the QoL of patients with DE patients as measured by the SF-36 questionnaire at 1 year of follow-up.
深部子宫内膜异位症（DE）的定义是存在异位子宫内膜腺体，直肠受累范围为 5.3%至 12%。DE 患者低位前切除术样综合征（LARS）的患病率、其对生活质量（QoL）的影响以及手术后的演变尚不清楚。本研究的目的是评估 DE 手术患者的胃肠功能结局和 QoL。
前瞻性研究于 2017 年至 2019 年进行，招募接受 DE 手术且无直肠切除术的患者。患者在手术前、术后 6 个月和 1 年完成 LARS 和 SF-36 问卷。
共纳入 82 例患者。16 例（19.5%）患者需要直肠节段切除术，16 例（19.5%）患者需要直肠切除术，8 例（9.8%）患者需要盘状切除术。所有患者的 SF-36 问卷的 8 个领域在随访期间均有所改善，反映了手术后 QoL 的改善（p≤0.05）。无直肠手术患者的平均 LARS 评分分别为术前 7.5±10.4 和术后 1 年 13.7±14.2；直肠手术分别为 13.6±13.6 和 14.6±13.1（p=0.17）。3 种直肠 DE 手术技术中，直肠手术患者术后 LARS 评分无显著差异（p=0.97），SF-36 评分改善与手术技术无关。
DE 患者术前存在 LARS 样综合征，直肠手术后似乎不受影响，与手术技术无关。直肠手术可改善 DE 患者的 QoL，1 年后随访时 SF-36 问卷显示。
