Darici Ezgi, Bokor Attila, Miklos Dominika, Pashkunova Daria, Rath Anna, Hudelist Gernot
Department of Obstetrics and Gynecology, Semmelweis University, Budapest, Hungary.
Rudolfinerhaus Private Clinic and Campus, Vienna, Austria.
Wien Klin Wochenschr. 2024 Sep 24. doi: 10.1007/s00508-024-02448-9.
This study aims to examine the effect of full thickness discoid resection (FTDR) and modified, limited nerve-vessel sparing segmental bowel resection (NVSSR) in symptomatic patients with low rectal deep endometriosis (DE) within 7 cm from the anal verge. Presurgical and postsurgical evaluation of gastrointestinal (GI) function reflected by low anterior resection syndrome (LARS) and gastrointestinal function-related quality of life index (GIQLI) scores, complication rates, pain scores/visual analog scale (VAS) and endometriosis health profile (EHP-30) was performed.
In this prospective multicenter cohort study, 63 premenopausal patients with symptomatic low (within 7 cm from the anal verge) colorectal endometriosis, undergoing low modified limited nerve vessel sparing rectal segmental bowel resection (NVSSR) and full thickness discoid resection (FTDR) were evaluated. Presurgery and postsurgery lower anterior resection syndrome (LARS) scores, gastrointestinal function-related quality of life index (GIQLI), pain symptoms, endometriosis health profile (EHP-30) parameters compared between two groups.
Out of 63 women, 49 (77.8%) underwent NVSSR while 14 (22.2%) underwent FTDR. LARS-like symptoms were observed presurgically in 24/63 (38.1%) patients. Postsurgical LARS was observed in 14/63 (22.2%) of the patients (10/49, 20.4% in NVSSR vs. 4/14, 28.5% in the FTDR group). The LARS-like symptoms significantly decreased following surgery in the FTDR group (p = 0.049) and showed a trend for decrease in the NVSSR group (p = 0.077). Postsurgical de novo LARS was only observed in 5/63 (8%) of the patients (NVSSR 4/49, 8.1%, FTDR 1/14, 7.1%). Postsurgical GIQLI scores improved in both groups (p < 0.001) with comparable changes in the NVSSR and FTDR cohorts (p = 0.490). Postoperative grade III complication rates between NVSSR and FTDR did not vary significantly (6/49, 12.2% vs. 3/14, 21.4% p = 0.26). Pain/VAS scores and EHP-30 scores significantly decreased after a mean follow-up of 29.6 ± 11 months and 30.6 ± 11 months in the NVSSR and FTDR groups, respectively (EHP-30; p < 0.001; dysmenorrhea, dyspareunia, dyschezia all p < 0.05 for both cohorts).
When comparing low colorectal surgery by either NVSSR or FTDR in a high-risk group for surgical complications, both techniques confer improvement of GI function reflected by LARS and GIQLI with non-significant differences in major complication rates, reduced pain and EHP-30 scores.
本研究旨在探讨全层盘状切除术（FTDR）和改良的、保留神经血管的有限节段性肠切除术（NVSSR）对距肛缘7厘米以内有症状的低位直肠深部子宫内膜异位症（DE）患者的影响。通过低位前切除综合征（LARS）和胃肠功能相关生活质量指数（GIQLI）评分、并发症发生率、疼痛评分/视觉模拟量表（VAS）以及子宫内膜异位症健康状况（EHP - 30）对手术前后的胃肠（GI）功能进行评估。
在这项前瞻性多中心队列研究中，对63例有症状的绝经前低位（距肛缘7厘米以内）结直肠子宫内膜异位症患者进行了评估，这些患者接受了低位改良保留神经血管的直肠节段性肠切除术（NVSSR）和全层盘状切除术（FTDR）。比较两组手术前后的低位前切除综合征（LARS）评分、胃肠功能相关生活质量指数（GIQLI）、疼痛症状、子宫内膜异位症健康状况（EHP - 30）参数。
63例女性中，49例（77.8%）接受了NVSSR，14例（22.2%）接受了FTDR。术前24/63例（38.1%）患者出现类似LARS的症状。术后63例患者中有14例（22.2%）出现LARS（NVSSR组10/49例，20.4%；FTDR组4/14例，28. 5%）。FTDR组术后类似LARS的症状显著减轻（p = 0.049），NVSSR组有减轻趋势（p = 0.077）。术后新发LARS仅在5/63例（8%）患者中观察到（NVSSR组4/49例，8.1%；FTDR组1/14例，7.1%）。两组术后GIQLI评分均有所改善（p < 0.001），NVSSR组和FTDR组变化相当（p = 0.490）。NVSSR组和FTDR组术后Ⅲ级并发症发生率无显著差异（6/49例，12.2%对3/14例，21.4%，p = 0.26）。NVSSR组和FTDR组分别平均随访29.6±11个月和30.6±11个月后，疼痛/VAS评分和EHP - 30评分显著降低（EHP - 30；p < 0.001；痛经、性交困难、排便困难在两组中均p < 0.05）。
在手术并发症高危组中，比较NVSSR或FTDR进行的低位结直肠手术时，两种技术均能改善LARS和GIQLI所反映的胃肠功能，主要并发症发生率无显著差异，疼痛减轻，EHP - 30评分降低。
