在低直肠子宫内膜异位症的细分切除或盘状切除后的胃肠功能和疼痛结果
Ezgi Darici1, Attila Bokor1, Dominika Miklos1
1Department of Obstetrics and Gynecology, Semmelweis University, Budapest, Hungary.
Wiener klinische Wochenschrift
|September 24, 2024
概括
神经血管节约直肠切除 (NVSSR) 和全厚 discoid 切除 (FTDR) 均可改善深层子宫内膜异位症患者的胃肠功能. 这些用于下直肠子宫内膜异位症的手术技术在并发症,疼痛和生活质量方面提供了相似的结果.
科学领域:
- 妇科外科手术 妇科外科
- 结肠直肠手术 结肠直肠手术
- 子宫内膜异位症研究研究
背景情况:
- 深度子宫内膜异位症 (DE) 在受影响的女性中显著影响胃肠道 (GI) 功能.
- 症状较低的直肠DE需要手术干预,可使用不同的技术.
- 评估手术结果对于管理DE及其相关的胃肠道功能障碍至关重要.
研究的目的:
- 为了比较修改后,有限的神经血管节省细分肠切除 (NVSSR) 和全厚 discoid 切除 (FTDR) 对低直肠DE的疗效.
- 评估这些手术技术对患者报告的胃肠道功能,疼痛和生活质量的影响.
- 在高风险的手术群体中分析与NVSSR和FTDR相关的并发症率.
主要方法:
- 一项前性多中心队列研究,涉及63名绝经前患者,他们有症状的直肠下部DE.
- 患者接受了NVSSR或FTDR.
- 术前和术后的评估包括低前切除综合征 (LARS) 评分,GI生活质量指数 (GIQLI),疼痛评分 (VAS) 和子宫内膜异位症健康状况 (EHP-30).
主要成果:
- 两个NVSSR (n=49) 和FTDR (n=14) 组在GIQLI分数中显示出显著的术后改善 (p<0.001).
- 在FTDR组中,LARS症状显著下降 (p=0.049),在NVSSR组中呈现趋势 (p=0.077).
- 在NVSSR (12.2%) 和FTDR (21.4%) 组 (p=0.26) 之间没有观察到重大并发症率 (III级) 的显著差异. 疼痛和EHP-30分数在两个队列中都显著改善.
结论:
- 无论是NVSSR还是FTDR都是有效的手术选择,用于管理低直肠深层子宫内膜异位症,从而改善胃肠道功能和生活质量.
- 这些技术在重大并发症,疼痛减轻和患者整体幸福感方面表现出可比的结果.
- 这些发现支持使用NVSSR或FTDR在接受深直肠子内膜异位症手术的高风险患者中.
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