Quality of life after laparoscopic colorectal resection for endometriosis

BACKGROUND: Indications of colorectal resection for endometriosis remain controversial because of the risk of major complications. Therefore, the aims of the current study were to evaluate the efficacy of laparoscopic segmental colorectal resection for endometriosis on quality of life and gynaecologic and digestive symptoms, and its complications. METHODS: After magnetic resonance imaging and rectal endoscopic sonographic evaluation of symptomatic colorectal endometriosis, 58 consecutive women requiring colorectal resection were included in this study. Symptom questionnaires and the short-form (SF)-36 Health Status and the quality of life score were completed. Linear intensity scores for several gynaecologic and digestive symptoms and perioperative complications were also recorded. RESULTS: Fifty-one women (88%) underwent laparoscopic segmental colorectal resection and seven required laparoconversion. Major complications occurred in nine cases (15.5%), including six rectovaginal fistulae (10.3%), and the three remaining complications corresponded to a haemoperitoneum, a uroperitoneum and a pelvic abscess. Median follow-up after colorectal resection was 22.5 months (2-55 months). A significant improvement in dysmenorrhoea (P < 0.0001), dysparaeunia (P < 0.0001), bowel movement pain or cramping (P < 0.0001), pain on defecation (P < 0.0001), diarrhoea (P < 0.016), lower back pain (P < 0.0001) and asthaenia (P < 0.0002) was observed. Tenesmus, rectorrhagia and constipation were not improved. All the items of the SF-36 Health Status and the quality of life score were improved after colorectal resection for endometriosis. CONCLUSION: Laparoscopic segmental colorectal resection for endometriosis significantly improves quality of life and gynaecologic and digestive symptoms. However, women have to be informed on the risk of complications including rectovaginal fistula.     

Laparoscopic excision of posterior vaginal fornix in the treatment of patients with deep endometriosis without rectum involvement: surgical treatment and long-term follow-up

BACKGROUND: The objective of the study is to evaluate the short- and long-term efficacy of complete laparoscopic excision of deep endometriosis, without rectum involvement, with the opening and partial excision of the posterior vaginal fornix. METHODS: Thirty-one patients were included in the study with symptomatic extensive disease including involvement of the cul-de-sac, rectovaginal space and posterior vaginal fornix without rectum involvement. Endoscopic surgery was performed with complete separation of rectovaginal space and in-block resection of the diseased tissue, opening and partial excision of the posterior vaginal fornix and vaginal closure either by laparoscopic or by vaginal route. Patients filled in questionnaires on pain before and 12, 24, 36, 48 and 60 months after surgical treatment. RESULTS: No intraoperative complications were observed; 65% were free of analgesic on post-operative day 2, 38% had total remission of chronic pain and 22% were improved; 38% had total remission of dysmenorrhoea and 22% were improved; 45% had total remission of dyspareunia and 25% were improved. Follow-up improvement of symptoms was statistically significant and was maintained for 5 years without recurrence of the disease or repeated surgery (P < 0.001). CONCLUSION: Complete surgical resection of deep infiltrative endometriosis with excision of the adjacent tissue of the posterior vaginal fornix improves quality of life with persistence of results for long time in patients not responsive to medical treatment.     

Pregnancy after laparoscopic partial cystectomy for bladder endometriosis

We report a case of partial laparoscopic cystectomy in a 31-year-oldinferile patient presenting vesical endometriosis. This patienthad suffered severe dysmenorrhoea for 10 years previously togetherwith repeated episodes of urinary infection, mostly occurringduring the menstrual period. A diagnostic laparoscopy performedin another centre diagnosed a stage IV endometriosis. Gonadotrophin-releasinghormone agonists were prescribed for 9 months. After failureof this treatment, the patient came to consult us. A solid massin the left supratrigone was detected by pelvic ultrasonographyand confirmed by cystoscopy. Transurethral resection was carriedout. A recurrence of the symptoms 9 months later prompted operativelaparoscopy under cystoscopic control. This confirmed recurrenceof a 3.5 cm endometriotic nodule. Laparoscopic partial cystectomywas performed using the monopolar electrode. The bladder wasthen sutured via laparoscopy. No complications occurred. Nopostoperative treatment was given. Second-look cystoscopy 2months later revealed that healing was perfect. Eight monthslater, the patient is well and has a normal intra-uterine pregnancy.     

Recurrence of ovarian endometrioma after laparoscopic excision

BACKGROUND: To analyse risk factors that influence the recurrence of endometrioma after laparoscopic excision. METHODS: A total of 224 patients who had a minimum of 2 years of post-operative follow-up after laparoscopic ovarian endometrioma excision were studied retrospectively. Recurrence was defined as the presence of endometrioma more than 2 cm in size, detected by ultrasonography within 2 years of surgery. Fourteen variables (age, presence of infertility, pain, uterine myoma, adenomyosis, previous medical treatment of endometriosis, previous surgery for ovarian endometriosis, single or multiple cysts, the size of the largest cyst at laparoscopy, unilateral or bilateral involvement, co-existence of deep endometriosis, revised American Society for Reproductive Medicine (ASRM) score, post-operative medical treatment and post-operative pregnancy) were evaluated to assess their independent effects on the recurrence using logistic regression analysis. RESULTS: The overall rate of recurrence was 30.4% (68/224). Significant factors that were independently associated with higher recurrence were previous medical treatment of endometriosis [odds ratio (OR) = 2.324, 95% confidence interval (95% CI) = 1.232-4.383, P = 0.0092) and larger diameter of the largest cyst (OR = 1.182, 95% CI = 1.004-1.391, P = 0.0442). Post-operative pregnancy was associated with lower recurrence (OR = 0.292, 95% CI = 0.028-0.317, P = 0.0181). CONCLUSIONS: Previous medical treatment of endometriosis or large cyst size was a significant factor that was associated with higher recurrence of the disease. Post-operative pregnancy is a favourable prognostic factor.     

Use of the SF-36 questionnaire to predict quality-of-life improvement after laparoscopic colorectal resection for endometriosis

BACKGROUND: Laparoscopic colorectal resection for endometriosis can improvequality of life (QOL), but the results vary widely from onewoman to another. The aim of this study was to determine whetherthe preoperative results on the Physical Component Summary (PCS)and Mental Component Summary (MCS) subscales of the SF-36 questionnairecould predict the improvement in QOL after surgery. METHODS: The predictive value of the subscales was first evaluated ona training set of 57 patients. A mathematical model, quantifiedwith respect to discrimination and calibration was then appliedto the validation set of 36 patients. RESULTS: Women with preoperative PCS and MCS scores below 37.5 and 44.5,respectively, had 80.7% and 84.2% probabilities of seeing theirscores improve after surgery, whereas women with preoperativescores above 46.5 and 47.5, respectively, had probabilitiesof 0% and 10.7% to improve their scores. CONCLUSIONS: With our mathematical model, the postoperative improvement inQOL can be reliably predicted. This model should help to identifythose women who are most likely to benefit from this major surgery.     

Effects of 3 month therapy with danazol after laparoscopic surgery for stage III/IV endometriosis: a randomized study.

The effect of treatment with danazol was evaluated with respect to expectant management after laparoscopic conservative surgery. All patients conservatively operated at laparoscopy for stage III-IV endometriosis from July 1994 to October 1996 were requested to enter the study. Patients who underwent surgery for recurrent endometriosis were excluded from the study, as well as patients who had taken hormonal therapies before laparoscopy. Informed consent was obtained from 77 women who were randomized after surgery to treatment with danazol 600 mg daily for 3 months (n = 36) or to expectant management (n = 41). All patients were regularly followed up every 6 months for evaluation of fertility, recurrence of pain symptoms and disease. During the follow-up, six (55%) of the 11 infertile women allocated to danazol and eight (50%) of the 16 given no treatment became pregnant (not significant). Moderate/severe pelvic pain recurred during follow-up in seven (23%) of the 31 women with pelvic pain allocated to the danazol group and nine (31%) of the 29 allocated to no treatment; the respective cumulative pain recurrence rates at 12 months were 26 and 34% (log rank test, not significant). Three women (8.3%) treated with danazol and six (15%) who received no treatment had disease recurrence as demonstrated by gynaecological examination and/or pelvic ultrasonography (not significant). Our results do not demonstrate a significant advantage of 3 month danazol therapy after laparoscopic surgery for stage III-IV endometriosis with respect to postoperative expectant management.     

Laparoscopic treatment of deep endometriosis located on the uterosacral ligaments

The goal of this study was to assess the efficiency of laparoscopicsurgical treatment of pain for patients presenting deep endometriosislocated on the uterosacral ligaments. To this end we analyseda continuous series of 21 patients treated by laparoscopic surgerybetween January 1993 and June 1994. In all these cases treatmentconsisted of resection of all the uterosacral ligament(s) presentingdeep endometriotic lesions together with exeresis of all otherendometriotic lesions. No complications were observed per- orpost-operatively. The results were assessed for all the patientswith a minimnm follow-up of one year. The efficiency of thetreatment varied according to the symptoms. Patients who presenteddysmenorrhoea (19 cases) improved in 84.2% of cases (16 patients).Out of the 17 patients who presented deep dyspareunia, improvementwas evident for 94.1% of cases (16 patients). The chronic pelvicpain suffered improved in seven out of nine cases (77.7%). Patientswho benefited from an improvement rated it excellent or satisfactoryin over 80% of cases. These results demonstrate that, providedthe surgeon is highly skilled in laparoscopy, laparoscopic surgeryis efficient for the treatment of patients presenting painfulsymptoms related to deep endometriotic implants located on theuterosacral ligaments.     

Endometriosis: Evaluation of endometriosis in uterosacral ligaments by transrectal ultrasonography

Uterosacral ligaments are one of the common targets of pelvicendometriosis, which is usually clinically rather than surgicallydiagnosed. This study was performed to determine if uterosacralligaments infiltrated by endometriosis could be detected bytransrectal ultrasonography. Uterosacral ligaments in non-endometriosissubjects (n±64) were observed as low echoic homogeneousarcs in both sides of the uterine cervix. Patients who had endometriosis(n±29) on the ligaments showed thick and irregularly-shapeduterosacral ligaments by the transrectal ultrasound examination.The results also suggested that the thickness of uterosacralligaments was associated with the clinical symptoms. Transrectalultrasonography may provide quantitative information to managepatients with inilitrat ing endometriosis.     

The effects and effectiveness of laparoscopic excision of endometriosis: a prospective study with 2-5 year follow-up

BACKGROUND: This study investigates the outcomes for women up to 5 years after laparoscopic excision of endometriosis. METHODS: In this prospective observational cohort study, 254 women with chronic pelvic pain were referred to two units specializing in minimal access surgical management of endometriosis. Of these, 216 women underwent surgical assessment and 176 were confirmed to have endometriosis. Questionnaires and visual analogue scale (VAS) scores for dysmenorrhoea, non-menstrual pelvic pain, dyspareunia and dyschesia as well as quality of life instruments; the EQ-5Dindex and EQ-5Dvas, Short-Form 12 (SF-12) and sexual activity questionnaires were completed pre-operatively. Intra-operative details of revised American Fertility Society (rAFS) stage, site of disease, associated tests, duration of surgery and complications were noted. Follow-up was performed by postal questionnaire and chart review. For women who had further surgery, rAFS stage, site of disease, other procedures and histology were all recorded. RESULTS: Pain scores were all significantly reduced at 2-5 years for dysmenorrhoea (median VAS baseline versus follow-up 2-5 years); 9 versus 3.3 (P < 0.0001), non-menstrual pelvic pain 8 versus 3 (P < 0.0001), dyspareunia 7 versus 0 (P < 0.0001) and dyschesia 7 versus 2 (P < 0.0001). Quality of life was improved for the EQ-5Dindex (P = 0.008 and the EQ-5Qvas (P = 0.03) and for sexual function with pleasure (P = 0.001) and habit (P = 0.012) being improved and discomfort being decreased (P = 0.001). The chance of requiring further surgery as determined by the Kaplan-Meier survival curve was 36%. A rAFS score of >70 was predictive of requiring further surgery (P = 0.03). Of women who had further surgery, endometriosis was found histologically in 68%. CONCLUSIONS: Laparoscopic excision of endometriosis significantly reduces pain and improves quality of life for up to 5 years. The probability of requiring further surgery is 36%. Return of pain following laparoscopic excision is not always associated with clinical evidence of recurrence.     

Magnetic resonance imaging characteristics of deep endometriosis

The aim of this study was to describe magnetic resonance (MR) imaging findings in histopathologically proven deep endometriosis infiltrating the uterosacral ligaments, the pouch of Douglas, the rectum or the bladder. Twenty patients presenting with a clinical suspicion of deep endometriosis underwent preoperative MR imaging. Sagittal and axial fast T2- and axial T1-weighted spin echo MR sequences were performed. Four patients had post-contrast images. MR results, including morphology and signal intensity of each lesion, were compared to intraoperative gross appearance and histopathology. Histopathology diagnosed 24 lesions of deep endometriosis in the uterosacral ligaments (n = 12), the pouch of Douglas (n = 2), the rectum (n = 3), the bladder (n = 7). Uterosacral ligaments with deep endometriosis were statistically different from normal uterosacral ligaments for proximal nodularity (P = 0.001). There was no difference in signal intensity between normal and abnormal uterosacral ligaments. Contrast-enhanced SE images in four patients with detrusor invasion showed an interruption of the hypointense detrusor by the enhancing bladder endometriosis. Rectal endometriosis was missed in two of three patients and showed non-specific rectal wall thickening in one patient. It is concluded that MR imaging can diagnose deep endometriosis of uterosacral ligaments, the bladder and the pouch of Douglas, but lacks sensitivity in detecting rectal endometriosis without rectal distension.     

Lack of endometriosis in patients with repeated abortion

Laparoscopy was performed in 25 consecutive patients with twoor more (range 2-6, mean 2.8) histologicaDy documented firsttrimesterabortions in whom the well established causes for recurrentmiscarriages had been excluded. Endometriosis could not be diagnosedin any of the 25 women. Thus our results are against endometriosisas a cause of repeated abortion and do not support the routineinclusion of laparoscopy in the evaluation of the patient withrecurrent abortions     

Transvaginal sonography and rectal endoscopic sonography for the assessment of pelvic endometriosis: a preliminary comparison

BACKGROUND: Endometriosis and possible rectal involvement are difficult to assess by physical examination. Previous studies have shown the diagnostic value of magnetic resonance imaging and rectal endoscopic sonography (RES) in this setting, but not that of transvaginal sonography (TVS). The aims of this study were to compare the accuracy of TVS and RES for the diagnosis of pelvic endometriosis, and to compare the results with histological findings. PATIENTS AND METHODS: In a prospective study, 30 consecutive patients referred with clinical signs of endometriosis underwent TVS and RES; the images were interpreted blindly with regard to physical findings. RESULTS: Endometriosis was confirmed histologically in 28 (93%) of the 30 patients. Endometriomas were also present in 67% of cases. For the diagnosis of uterosacral endometriosis, the sensitivity, specificity, and positive and negative predictive values of TVS and RES were 75 and 75%, 83 and 67, 95 and 90%, and 45 and 40% respectively. For the diagnosis of rectosigmoid endometriosis, the sensitivity, specificity, and positive and negative predictive values of TVS and RES were 95 and 82%, 100 and 88%, 100 and 95%, and 89 and 64% respectively. CONCLUSION: Despite the large proportion of our patients who had intestinal endometriosis, representing a possible source of bias, our results suggest that TVS is as efficient as RES for detecting posterior pelvic endometriosis and should therefore be used as the first-line examination.     

Post-operative GnRH analogue treatment after conservative surgery for symptomatic endometriosis stage III-IV: a randomized controlled trial.

BACKGROUND: In order to decrease endometriosis recurrence after surgical therapy, it has been proposed to use a post-surgical oestrogen-lowering medical treatment. Results from previous trials on this topic are contradictory. METHODS: A total of 89 women were randomized, by computer-generated list, after laparoscopic conservative surgery for symptomatic endometriosis stage III-IV to receive monthly i.m. injections of gonadotrophin-releasing hormone (GnRH) analogue, leuprolide acetate depot (3.75 mg) for 3 months (n = 44) or to an expectant management (n = 45). All patients were followed up every 6 months for evaluation of pain symptoms, fertility and objective disease recurrence. RESULTS: During the follow-up, which ranged from 6-36 months, five (33%) of the 15 women who wanted children and who were allocated the GnRH analogue and six (40%) of the 15 given no treatment became pregnant (not significant). Moderate/severe pelvic pain recurred during the follow-up in 10 (23%) of the women allocated the GnRH analogue and 11 (24%) of those allocated no treatment; the cumulative pain recurrence rates at 18 months were 23 and 29% respectively (not significant). Four women (9%) treated with GnRH analogue and four women (9%) who received no treatment had objective disease recurrence as demonstrated by gynaecological examination and/or pelvic ultrasonography. CONCLUSIONS: This study does not support the routine post-operative use of a 3 month course of GnRH analogue in women with symptomatic endometriosis stage III-IV.     

Sigmoid endometriosis and ovarian stimulation

In-vitro fertilization (IVF) and ovarian stimulation are frequently performed in patients with endometriosis. Although endometriosis is a hormone-dependent disease, the rate of IVF complications related to endometriosis is low. We report four cases of severe digestive complications due to the rapid growth of sigmoid endometriosis under ovarian stimulation. In three patients, sigmoid endometriosis was diagnosed at laparoscopy for sterility. Because of the absence of digestive symptoms or repercussion on the bowel, no bowel resection was performed before ovarian stimulation. All patients experienced severe digestive symptoms during ovarian stimulation, and a segmental sigmoid resection had to be performed. Analysis of endoscopic and radiological data demonstrated that bowel lesions of small size may rapidly enlarge and become highly symptomatic under ovarian stimulation. At immunohistochemistry, these infiltrating lesions displayed high populations of steroid receptors and a high proliferative index (Ki-67 activity), suggesting a strong dependence on circulating ovarian hormones and a potential for rapid growth under supraphysiological oestrogen concentrations. Clinicians should be aware of this rare but severe digestive complication of ovarian stimulation. The early diagnosis of such lesions may help the patients to avoid months of morbidity falsely attributed to ovarian stimulation side effects. Further experience is necessary to determine the optimal attitude when diagnosing a small and asymptomatic endometriotic bowel lesion before ovarian stimulation.     

Low-dose danazol after combined surgical and medical therapy reduces the incidence of pelvic pain in women with moderate and severe endometriosis.

The most effective therapy for endometriosis is a matter for debate. The aim of the present randomized study was to evaluate the efficacy of low doses of danazol on recurrence of pelvic pain in patients with moderate or severe endometriosis, who had undergone laparoscopic surgery and 6 months of gonadotrophin-releasing hormone analogue (GnRHa) therapy. After surgery, 28 patients with moderate or severe endometriosis underwent therapy for 6 months with GnRHa i. m. every 4 weeks. They were then randomized into two groups: group A (14 subjects) was treated with 100 mg/day danazol for 6 months; group B (14 subjects, control) did not receive any type of therapy. After 12 months of treatment, group A had a significantly (P < 0.01) lower pain score than group B. There was no significant difference between the groups in oestrogen concentrations, bone mineral density or side-effects. The results suggest that low-dose danazol therapy reduces recurrence of pelvic pain in patients with moderate or severe endometriosis, treated surgically, and has few or no metabolic side-effects.     

Association rate between deep peritoneal endometriosis and other forms of the disease: pathogenetic implications

BACKGROUND: It has been suggested recently that deep endometriosis and the other forms of the disease do not share a common pathogenetic mechanism. In this study, we hypothesize that, if this is true, deep peritoneal endometriosis and the other forms should not be significantly associated. METHODS: Clinical and surgical records of all women who were referred to the Department of Obstetrics and Gynecology, Clinica 'L.Mangiagalli' between January 1995 and June 2002 and who were diagnosed with deep peritoneal pelvic endometriosis at the time of surgery were retrieved. The concomitant presence of superficial endometriotic implants, endometriomas and pelvic adhesions was evaluated. A binomial probability distribution model was used to calculate the 95% confidence interval (95% CI) of the association rates. RESULTS: Ninety-three women with deep peritoneal endometriosis were identified. The presence of superficial endometriotic implants, endometriomas and pelvic adhesions was documented in 61.3% (95% CI 51.4-71.2%), 50.5% (95% CI 40.3-60.7%) and 74.2% (95% CI 65.3-83.1%) of patients with deep endometriotic nodules, respectively. Overall, deep peritoneal endometriosis was the only form of the disease in only 6.5% (95% CI 2.8-12.3%) of cases. No relevant differences regarding these associations were observed according to the location and the size of the deep endometriotic nodules. CONCLUSIONS: Results from this study do not support the hypothesis that deep endometriosis should be considered as a distinct entity of the disease.     

The relationship between endometriosis and semen analysis: a review of 490 consecutive laparoscopies

Laparoscopy was carried out on 490 infertile women whose partners had semen analyses showing a minimum of 5 X 10(6) motile spermatozoa/ml. Patients were divided into two groups using WHO criteria: those in whom the semen parameters were normal and those in whom there was any abnormality. The overall incidence of endometriosis was the same in both groups. Among women with primary infertility, mild endometriosis was significantly more common in the abnormal semen group. Thus among couples in whom there is an explanation for continuing sub-fertility, mild endometriosis is more common. This finding calls into question the causal relationship between endometriosis and primary infertility and suggests that in susceptible women, infertility may predispose towards the occurrence of endometriosis.     

Accuracy of magnetic resonance imaging and rectal endoscopic sonography for the prediction of location of deep pelvic endometriosis

BACKGROUND: We compared the accuracy of magnetic resonance imaging (MRI) and rectal endoscopic sonography (RES) for the diagnosis of deep pelvic endometriosis (DPE), with respect to surgical and histological findings. METHODS: Longitudinal study of 88 consecutive patients referred for surgical management of DPE, who underwent both MRI and RES pre operatively. The diagnostic criteria were identical for MRI and RES and were based on visualization of hypointense/hypoechoic areas in specific locations. DPE was diagnosed when at least one site was involved. We calculated the sensitivity, specificity, predictive values, accuracy and 95% confidence interval of MRI and RES for DPE. RESULTS: DPE and endometriomas were present in 97.7 and 39.7% of women, respectively. The sensitivity, specificity and positive and negative predictive values of MRI and RES, respectively, were 84.8 and 45.6%, 88.8 and 40%, 98.5 and 87.8% and 40 and 8.5% for uterosacral endometriosis; 77.7 and 7.4%, 70% and 100, 85.3 and 100% and 89.7 and 70.9% for vaginal endometriosis and 88.3 and 90%, 92.8 and 89.3%, 96.4 and 94.7% and 78.8 and 80.6% for colorectal endometriosis. CONCLUSIONS: MRI is more accurate than RES for the diagnosis of uterosacral and vaginal endometriosis, whereas the two methods are similarly accurate for colorectal endometriosis.     

Endometriosis: Increased prevalence and recurrence of retrograde menstruation in baboons with spontaneous endometriosis

This study was done to test the hypothesis that the incidenceand recurrence of retrograde menstruation is higher in baboonswith spontaneous endometriosis than in those without. A totalof 399 laparoscopies was performed on 113 female baboons. Group1 consisted of 84 animals with a normal pelvis (includIng 23that later underwent Induction of endometriosis and were assignedto group 4), group 2 comprised nine baboons with spontaneousendometriosis acquired during the last 2 years of the study,group 3 had 18 baboons with long-term spontaneous disease, andgroup 4 comprised 25 animals with induced endometriosis. Retrogrademenstruation was defined by the presence of blood-stained peritonealfluid (red or dark brown) during menses. Recurrence of retrogrademenstruation was analysed during the first two laparoscopiesin 13 baboons. Peritoneal fluid was 10 thnes more frequentlyblood-stained during menses (62%) than during non-menstrualphases (6%). Retrograde menstruation was observed more frequentlyin animals with spon taneous disease (groups 2 and 3,83%) thanin animals with a normal pelvis (group 1, 51%). Recurrence ofretrograde menstruation was observed more frequently in baboonswith spontaneous endometriosis (5/5) than in those without (3/8).The results of this study demonstrate that retrograde menstruationis common in baboons, with a higher prevalence and recurrencein animals with spontaneous endometriosis than in those without.     

腹腔镜手术联合GnRH-a类药物治疗子宫内膜异位症伴不孕的疗效观察

目的探讨腹腔镜术后联合GnRH-a治疗子宫内膜异位症伴不孕的疗效及与r-AFS分期的相关性分析。方法106例子宫内膜异位症伴不孕患者经腹腔镜卵巢子宫内膜异位囊肿剔除、异位灶烧灼、粘连分离、输卵管整形及通液等手术治疗，术中行子宫内膜异位症的r-AFS分期，Ⅰ期21例，Ⅱ期25例，Ⅲ期36例，Ⅳ期24例，Ⅰ、Ⅱ期为轻度组，Ⅲ、Ⅳ为重度组。轻、重度组再分单纯腹腔镜手术治疗组和联合GnRH-a治疗组，并行随访1年的临床疗效比较，分析各组的症状缓解率、年复发率和妊娠率等情况。结果轻度子宫内膜异位症组的单纯腹腔镜手术治疗组的症状缓解率、年复发率和妊娠率与联合GnRH-a治疗组差别无显著性。重度子宫内膜异位症组的单纯腹腔镜手术治疗组的症状缓解率与联合GnRH-a治疗组差别无显著性。但年复发率及妊娠率差别有显著性。结论重度子宫内膜异位症组的腹腔镜手术治疗后有必要加用药物巩固治疗，GnRH-a巩固治疗的疗效明显优于单纯腹腔镜手术治疗，术后联合GnRH-a药物治疗可降低年复发率和提高妊娠率。