Jonathan Lewin, Arvind Vashisht, Martin Hirsch, Bassel H. Al-Wattar, Ertan Saridogan
{"title":"比较子宫内膜异位症切除术和子宫切除术治疗子宫内膜异位症相关疼痛的效果:一项多中心前瞻性队列研究。","authors":"Jonathan Lewin, Arvind Vashisht, Martin Hirsch, Bassel H. Al-Wattar, Ertan Saridogan","doi":"10.1111/1471-0528.17910","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Objective</h3>\n \n <p>To compare the effectiveness of endometriosis excision alone to excision plus hysterectomy, with and without bilateral oophorectomy, for endometriosis-related symptoms.</p>\n </section>\n \n <section>\n \n <h3> Design</h3>\n \n <p>Multicentre prospective cohort.</p>\n </section>\n \n <section>\n \n <h3> Setting</h3>\n \n <p>Eighty-six specialist endometriosis centres.</p>\n </section>\n \n <section>\n \n <h3> Population</h3>\n \n <p>Women undergoing rectovaginal endometriosis surgery between 2009 and 2021.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>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.</p>\n </section>\n \n <section>\n \n <h3> Main Outcome Measures</h3>\n \n <p>Pain scores, bowel symptoms and quality-of-life measures.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>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, <i>p</i> < 0.001), dyspareunia (MD: 1.12/10, 95% CI: 0.71–1.53, <i>p</i> < 0.001), back pain (MD: 1.29/10, 95% CI: 0.92–1.67, <i>p</i> < 0.001) and quality-of-life scores (MD: 8.77/100, 95% CI: 5.79–11.75, <i>p</i> < 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, <i>p</i> < 0.001), dyspareunia (MD: 1.05/10, 95% CI: 0.59–1.52, <i>p</i> < 0.001), back pain (MD: 1.18/10, 95% CI: 0.77–1.59, <i>p</i> < 0.001) and quality of life (MD: 12.41/100, 95% CI: 9.07–15.74, <i>p</i> < 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, <i>p</i> = 0.001) at 24 months and quality of life (MD: 3.74/100, 95% CI: 0.56–6.92, <i>p</i> = 0.021) at 12 months, although this result was sensitive to loss to follow-up.</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>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.</p>\n </section>\n </div>","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"131 13","pages":"1793-1804"},"PeriodicalIF":4.7000,"publicationDate":"2024-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.17910","citationCount":"0","resultStr":"{\"title\":\"Comparing the treatment of endometriosis-related pain by excision of endometriosis or hysterectomy: A multicentre prospective cohort study\",\"authors\":\"Jonathan Lewin, Arvind Vashisht, Martin Hirsch, Bassel H. Al-Wattar, Ertan Saridogan\",\"doi\":\"10.1111/1471-0528.17910\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div>\\n \\n \\n <section>\\n \\n <h3> Objective</h3>\\n \\n <p>To compare the effectiveness of endometriosis excision alone to excision plus hysterectomy, with and without bilateral oophorectomy, for endometriosis-related symptoms.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Design</h3>\\n \\n <p>Multicentre prospective cohort.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Setting</h3>\\n \\n <p>Eighty-six specialist endometriosis centres.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Population</h3>\\n \\n <p>Women undergoing rectovaginal endometriosis surgery between 2009 and 2021.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Methods</h3>\\n \\n <p>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.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Main Outcome Measures</h3>\\n \\n <p>Pain scores, bowel symptoms and quality-of-life measures.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Results</h3>\\n \\n <p>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, <i>p</i> < 0.001), dyspareunia (MD: 1.12/10, 95% CI: 0.71–1.53, <i>p</i> < 0.001), back pain (MD: 1.29/10, 95% CI: 0.92–1.67, <i>p</i> < 0.001) and quality-of-life scores (MD: 8.77/100, 95% CI: 5.79–11.75, <i>p</i> < 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, <i>p</i> < 0.001), dyspareunia (MD: 1.05/10, 95% CI: 0.59–1.52, <i>p</i> < 0.001), back pain (MD: 1.18/10, 95% CI: 0.77–1.59, <i>p</i> < 0.001) and quality of life (MD: 12.41/100, 95% CI: 9.07–15.74, <i>p</i> < 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, <i>p</i> = 0.001) at 24 months and quality of life (MD: 3.74/100, 95% CI: 0.56–6.92, <i>p</i> = 0.021) at 12 months, although this result was sensitive to loss to follow-up.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Conclusions</h3>\\n \\n <p>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.</p>\\n </section>\\n </div>\",\"PeriodicalId\":50729,\"journal\":{\"name\":\"Bjog-An International Journal of Obstetrics and Gynaecology\",\"volume\":\"131 13\",\"pages\":\"1793-1804\"},\"PeriodicalIF\":4.7000,\"publicationDate\":\"2024-07-15\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.17910\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Bjog-An International Journal of Obstetrics and Gynaecology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://onlinelibrary.wiley.com/doi/10.1111/1471-0528.17910\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"OBSTETRICS & GYNECOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Bjog-An International Journal of Obstetrics and Gynaecology","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1111/1471-0528.17910","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"OBSTETRICS & GYNECOLOGY","Score":null,"Total":0}
Comparing the treatment of endometriosis-related pain by excision of endometriosis or hysterectomy: A multicentre prospective cohort study
Objective
To compare the effectiveness of endometriosis excision alone to excision plus hysterectomy, with and without bilateral oophorectomy, for endometriosis-related symptoms.
Design
Multicentre prospective cohort.
Setting
Eighty-six specialist endometriosis centres.
Population
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.
Main Outcome Measures
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.
期刊介绍:
BJOG is an editorially independent publication owned by the Royal College of Obstetricians and Gynaecologists (RCOG). The Journal publishes original, peer-reviewed work in all areas of obstetrics and gynaecology, including contraception, urogynaecology, fertility, oncology and clinical practice. Its aim is to publish the highest quality medical research in women''s health, worldwide.