腹腔镜卵巢子宫内膜异位囊肿保守性手术后复发的相关因素分析

目的：分析卵巢子宫内膜异位囊肿(卵巢巧克力囊肿)行腹腔镜保守性手术后复发的相关因素。方法：收集郑州大学第三附属医院310例因子宫内膜异位症行腹腔镜保守性手术患者的临床资料,进行回顾性队列研究,分析患者年龄、症状和体征、既往史、妇科检查情况、术前孕产次、合并症、术中美国生殖医学学会(American Society for Reproductive Medicine,ASRM)评分及分期、术后辅助药物治疗、术后孕产次等25项指标,通过logistic回归分析复发的相关因素。结果：经单变量分析,危险性相关因素为既往内异症手术史、既往宫腔操作史、后穹窿触痛结节、双侧盆腔病变、多房样囊肿、术中ASRM评分、合并子宫腺肌病及手术时间(P<0.05);保护性相关因素为术后孕次、术后辅助药物治疗、术前孕次及年龄(P<0.05)。多变量logistic回归分析显示危险性相关因素为既往内异症手术史、既往宫腔操作史、后穹窿触痛结节、双侧盆腔病变、多房样囊肿及术中ASRM评分高(P<0.05);保护性相关因素为术后孕次、术后辅助药物治疗、术前孕次及年龄(P<0.01)。结论：既往内异症手术史、既往宫腔操作史、后穹窿触痛结节、双侧盆腔病变、多房样囊肿及术中ASRM评分高为卵巢巧克力囊肿术后复发的危险性因素;而术前术后孕次、术后辅助药物治疗及年龄则为卵巢巧克力囊肿术后复发的保护性因素。

Analysis of relevant factors for recurrence of ovarian endometriosis after conservative laparoscopic surgery

Objective: To analyze relevant factors for recurrence of ovarian endometriosis after conservative surgery.Methods: A cohort study was performed on 310 patients who had performed conservative surgery for ovarian endometriosis. All patients underwent clinical interview. The relevant factors included: age at surgery, clinical symptom and signs, medical history, gynecologic examination, preoperative gravidity, complication, adenomyosis, American Society for Reproductive Medicine (ASRM) scores, post-operative drug therapy, post-operative gravidity and so on. The logistic regression analysis was performed to determine the predictive factors for recurrence of endometriosis.Results: The relevant factors by univariate analysis were determined. The history of endometriosis surgery, history of intrauterine operation, tenderness nodule at cal-de-sal, bilateral endometrioma, multilocular cyst, intraoperative ASRM scores, complication of adenomyosis and operation time were the risk factors; whereas pre- and post-operative gravidity, post-operative drug therapy, and age at surgery were the protective factors. Meanwhile, the relevant factors by multivariate analysis were also confirmed. The history of endometriosis surgery, history of intrauterine operation, tenderness nodule at cal-de-sal, bilateral endometrioma, multilocular cyst, and intraoperative ASRM scores were the risk factors; whereas post-operative gravidity, post-operative drug therapy, pre-operative gravidity, and age at surgery were the protective factors.Conclusion: The risk factors for recurrence of ovarian endometriosis are history of endometriosis surgery, history of intrauterine operation, tenderness nodule at cal-de-sal, bilateral endometrioma, multilocular cyst, intraoperative ASRM scores, whereas the protective factors are pre- and post-operative gravidity, post-operative drug therapy and age at surgery.