目的:比较单纯子宫内膜异位症切除术与子宫切除术联合子宫切除术的效果,有或没有双侧卵巢切除术,子宫内膜异位症相关症状。
方法:多中心前瞻性队列。
方法:86个子宫内膜异位症专科中心。
方法:2009年至2021年期间接受直肠阴道子宫内膜异位症手术的妇女。
方法:我们对患者和中心进行了随机影响的多元回归,控制年龄,BMI,吸烟,腹腔镜与开腹方式及肠道手术类型比较,对随访损失进行敏感性分析。
方法:疼痛评分,肠道症状和生活质量指标。
结果:与单纯子宫内膜异位症切除相比,接受保留卵巢的子宫切除术的女性在非周期性疼痛方面有更大的改善(MD:1.41/10,95%CI:1.03-1.78,p<0.001),性交困难(MD:1.12/10,95%CI:0.71-1.53,p<0.001),术后24个月时背痛(MD:1.29/10,95%CI:0.92-1.67,p<0.001)和生活质量评分(MD:8.77/100,95%CI:5.79-11.75,p<0.001)。接受子宫切除术和双侧卵巢切除术的妇女在非周期性盆腔疼痛方面也有更大的改善(MD:2.22/10,95%CI:1.80-2.63,p<0.001),性交困难(MD:1.05/10,95%CI:0.59-1.52,p<0.001),与单纯子宫内膜异位症切除术相比,24个月时的背痛(MD:1.18/10,95%CI:0.77-1.59,p<0.001)和生活质量(MD:12.41/100,95%CI:9.07-15.74,p<0.001)。与保留卵巢的子宫切除术相比,子宫切除术和双侧卵巢切除术与非周期性盆腔疼痛(MD:0.81/10,95%CI:0.32-1.30,p=0.001)在24个月和生活质量(MD:3.74/100,95%CI:0.56-6.92,p=0.021)的改善有关,尽管这一结果对随访失败很敏感。
结论:与单独行子宫内膜异位症切除术的患者相比,行子宫内膜异位症切除术的患者在疼痛和生活质量方面有更大的改善。双侧卵巢切除术和子宫切除术还有其他好处,尽管由于失去随访,其价值不太明确。
OBJECTIVE: To compare the effectiveness of endometriosis excision alone to excision plus hysterectomy, with and without bilateral oophorectomy, for endometriosis-related symptoms.
METHODS: Multicentre prospective cohort.
METHODS: Eighty-six specialist endometriosis centres.
METHODS: Women undergoing
rectovaginal endometriosis surgery between 2009 and 2021.
METHODS: We performed multivariable regression with random effects for patient and centre, controlling for age, BMI, smoking, laparoscopic versus open approach and type of bowel surgery performed, with sensitivity analysis for loss to follow-up.
METHODS: Pain scores, bowel symptoms and quality-of-life measures.
RESULTS: Compared to endometriosis excision alone, women undergoing hysterectomy with conservation of ovaries had greater improvement in non-cyclical pain (MD: 1.41/10, 95% CI: 1.03-1.78, p < 0.001), dyspareunia (MD: 1.12/10, 95% CI: 0.71-1.53, p < 0.001), back pain (MD: 1.29/10, 95% CI: 0.92-1.67, p < 0.001) and quality-of-life scores (MD: 8.77/100, 95% CI: 5.79-11.75, p < 0.001) at 24 months post-operatively. Women undergoing hysterectomy with bilateral oophorectomy also had greater improvement in non-cyclical pelvic pain (MD: 2.22/10, 95% CI: 1.80-2.63, p < 0.001), dyspareunia (MD: 1.05/10, 95% CI: 0.59-1.52, p < 0.001), back pain (MD: 1.18/10, 95% CI: 0.77-1.59, p < 0.001) and quality of life (MD: 12.41/100, 95% CI: 9.07-15.74, p < 0.001) at 24 months compared to endometriosis excision alone. Compared to hysterectomy with ovarian conservation, hysterectomy with bilateral oophorectomy was associated with greater improvement in non-cyclical pelvic pain (MD: 0.81/10, 95% CI: 0.32-1.30, p = 0.001) at 24 months and quality of life (MD: 3.74/100, 95% CI: 0.56-6.92, p = 0.021) at 12 months, although this result was sensitive to loss to follow-up.
CONCLUSIONS: Patients who undergo endometriosis excision plus hysterectomy experience greater improvement in pain and quality of life compared to those who have endometriosis excision alone. There are additional benefits of bilateral oophorectomy with hysterectomy, although its value is less clear due to loss of follow-up.