ABSTRACT
OBJETIVO: Avaliar a relação entre a classificação histológica em pacientes operadas de endometriose e a qualidade de vida. MÉTODOS: Estudo observacional transversal, com avaliação de 32 biópsias de intestino, peritônio e ligamento uterossacro em 40 mulheres portadoras de endometriose profunda. Para a análise da qualidade de vida (QV) foi aplicado o questionário SF-36 antes da cirurgia e após 6 e 12 meses. As biópsias foram classificadas histologicamente em estromal puro (EP), glandular diferenciada (GD), indiferenciada (GI) e mista (GM), sendo que ficaram na amostra apenas o GI e GM, relacionadas aos oito domínios do SF-36. RESULTADOS: Observamos a seguinte distribuição de acordo com o tipo histológico: no peritônio 63% GI e 22% GM; no intestino 19% GI e 24% G e no uterossacro 41% GI e 35% GM. Quanto à QV e à classificação histológica, a evolução dos casos com implante no intestino mostrou que apenas o tipo GM apresentou melhora de 0 a 6 meses no aspecto social e no aspecto emocional. Ainda entre esses casos, o GI mostrou que os domínios estado geral da saúde (p=0,01) e aspecto social (p=0,04) têm relação significativa com a melhora da QV de 0 a 6 meses e uma tendência à melhora do estado geral da saúde de 0 a 12 meses. Quanto à dor (p=0,06) e ao aspecto emocional (p=0,05), observamos tendência à melhora na QV de 0 a 6 meses e na capacidade vital (p=0,1) de 0 a 6 e de 0 a 12 meses. No que se refere ao aspecto emocional, foi observado que entre as pacientes com tipo histológico GI, diferente do GM, não houve evolução favorável de 0 a 6 meses. No uterossacro não observamos relações significativas entre tipo histológico e QV. CONCLUSÃO: A melhora da QV em mulheres submetidas ao tratamento cirúrgico laparoscópico de endometriose profunda apresenta associação com grau de diferenciação histológica. Apenas as pacientes com endometriose classificada como indiferenciada e com lesões no peritônio mostraram melhora da QV após a cirurgia. .
PURPOSE: To assess the relationship between the histological classification and the quality of life of patients operated for endometriosis. METHODS: A cross-sectional observational study, with assessment of 32 biopsies of the intestine, peritoneum and uterosacral ligament from 40 women with deep endometriosis. The quality of life (QOL) was determined by applying the SF-36 questionnaire pre-operatively and at 6 and 12 months postoperatively. Biopsies were histologically classified into pure stromal (EP), glandular differentiated (GD), glandular undifferentiated (GI) and mixed (GM), remaining in the sample only GI and GM, which are related to eight domains of the SF-36. RESULTS: According to the histologic type, the following distribution was observed: peritoneum 63% GI and 35% GM; intestine 19% GI and 24% GM; uterosacral ligament with 41% GI and 35% GM. Regarding the QOL and the histological classification, in the intestine only GM was associated with improvement of social and emotional aspects from 0 to 6 months; the domains general health status (p=0.01) and social aspect (p=0.04) were significantly related to improvement of the QOL from 0 to 6 months, and the general health status tended to improve from 0 to 12 months. Regarding pain (p=0.06) and the emotional aspect (p=0.05), the QOL tended to improve from 0 to 6 months and the vital capacity (p=0.1) improved from 0 to 6 months and from 0 to 12 months. Regarding the emotional aspect, evolution of the two histological types was not favorable for improvement in MG from 0 to 6 months. No significant relationships between histologic type and QOL were evident in the uterosacral ligament samples. CONCLUSION: Improvement in the QOL of women undergoing laparoscopic surgery for deep endometriosis is associated with the histologic grade. The peritoneal biopsy of GI revealed improved QOL after surgery. .
Subject(s)
Humans , Colorectal Neoplasms/pathology , Epithelial-Mesenchymal Transition , Neoplastic Cells, Circulating/pathology , Biomarkers, Tumor , PrognosisABSTRACT
[Objective] To study the influence on humoral immunity and ectopic endometrium by infusion of Bushen Tiaojing Decoction (BTD) with the Huoxue Sanjie Suppository (HSS) in anus. [Methods] One hundred and thirty SD rats were allocated to ten groups: normal control (A), model (B), normal dose of HSS (C), normal dose of BTD with HSS (D), 3 doses of BTD (E), 3 doses of BTD with HSS (F), 5 doses of BTD (G), 5 doses of HSS (H), 5 doses of BTD with HSS (I), and Danazol (J) groups. The endometriosis (EM) rats were modeled by endometrium implantation in all groups except those in Group A. Four weeks after the treatment, the contents of immunoglobulin (IgG、IgM、IgA), C_3, C_4 and ALT were tested, and histomorphomological analysis of the thymus, ovary, uterus, EM implants, liver and kidney were performed. [Results] Four weeks after EM implantation, the ectopic endometria were growing well, IgG and C_3 increased, but IgM decreased, and the uterus and ovary significantly enlarged. With the treatment of BTD and HSS or Danazol, the ectopic endometria were atrophied. In Groups F and G, IgG decreased; in Groups H and I, C_3 decreased, and uterus and ovary shrunk in Group I. Danazol can help to prolong the sexual cycle, while BTD and HSS can not. In all the medication groups, no obvious difference was found in ALT of the rats. [Conclusion] Oral administration of BTD with HSS can cause endometrial atrophy and improve humoral immunity in model rats.