Impacto do tratamento cirúrgico para endometriose profunda: perfil metabólico e qualidade de vida

Abstract

Introduction: Introduction: Endometriosis is a chronic gynecological disorder, affecting about 10% of women in menacme. It has been associated with increased oxidative stress, inflammatory response and atherogenic lipid profile, which may predispose patients to a greater spectrum of comorbidities. Endometriosis has a negative impact on quality of life, reproductive function and psychological morbidity. Objectives: To evaluate the effects of surgical treatment for deep endometriosis on the metabolic profile, quality of life, psychological aspects of anxiety and depression in women diagnosed with the disease, comparing two moments, preoperatively and after 6 months of surgical treatment. Methods: This is a prospective observational study, carried out at the Endometriosis outpatient clinic of Maternidade Escola Assis Chateaubriand, Fortaleza-CE, from October/2020 to September 2022. It included women between 23 and 50 years old, with a mean age of 38.5 ( ±7.1) years, with clinical and imaging diagnosis of deep endometriosis, with surgical indication for laparoscopy. Patients initially responded to standardized instruments preoperatively, with questions aimed at quality of life (Endometriosis Health Profile 30 - EHP30), aspects of anxiety and depression (Hospital Anxiety and Depression Scale - HADS) and assessment of pain score by visual scale numeric (EVN). Then, they were evaluated for metabolic parameters (hypertension, dyslipidemia, dysglycemia and obesity), through physical examination and laboratory tests. The same procedure was performed 6 months after videolaparoscopy. Statistical analysis was performed in two moments, preoperatively and after 6 months of surgical treatment, with the Wilcoxon test for quantitative variables, and the results presented as mean, median and standard deviation. Qualitative variables were displayed in frequencies and percentages. P values < 0.05 indicated statistical significance. Results: A total of 30 patients participated in the study, after meeting the inclusion and exclusion criteria. There was a significant improvement in the scores of 7 domains of the EHP-30: pain, control and impotence, emotional well-being, social support, self-image, work life and sexual relations, thus improving quality of life. When evaluating the correlation between the EHP-30 domains and the HADS score, a statistically significant negative correlation was found between depression and the preoperative intercourse score. One can also add a change in mental health status, with significant improvement after surgery (14 patients who had depression in the preoperative period and no longer have it in the postoperative period). Regarding the metabolic profile, the patients had lower mean levels of Total Cholesterol (TC), Low Density Cholesterol (LDL-c), Triglycerides (TGC) and Fasting Glycemia (FG) after the surgical procedure. The mean TC level was 8.2% lower after the surgical procedure, LDL-c was 12.8% lower, TGC 10.9% lower, GJ 7.3% lower. A difference was also observed in the analysis of High Density Cholesterol (HDL-c) measurements, which were 9.9% higher after surgery. The results showed a statistically significant difference for all these parameters (p < 0.001). Of the total, 60% (18) were overweight, and 40% (12) grade 1 obese, not including patients with grade 2 or 3 obesity. There were no patients with family or personal history of systemic arterial hypertension (SAH) or diabetes mellitus (DM ). Conclusions: It is concluded that surgical treatment for deep endometriosis improves the patients' quality of life, in addition to anxiety and depression aspects. The lipid profile of the patients after videolaparoscopy was favorable compared to the preoperative lipid profile, with a significant improvement in the mean levels of LDL-c, HDL-c, TC, TGC and GJ. Long-term follow-up studies are needed to determine whether surgical treatment for endometriosis can improve.