Clinical features and long-term prognosis of ovarian endometrioma with deep infiltrating endometriosis patients / 中国综合临床

ABSTRACT

Objective:To analyze the clinical features and long-term prognosis of ovarian endometrioma (OMA) with deep infiltrating endometriosis (DIE).Methods:A retrospective analysis was conducted on the clinical data of 178 OMA patients admitted to the Northern Theater General Hospital from January 2014 to January 2017. All patients received laparoscopic ovarian cyst removal. There were 83 patients with OMA (control group) and 95 patients with OMA combined with DIE (observation group) diagnosed by postoperative pathology.The general clinical data of patients were collected, including age, number of pregnancies, body mass index (BMI), duration and severity of dysmenorrhea, levels of carbohydrate antigen 125 (CA125), type of infertility, and other pain symptoms.The surgical related indicators of patients were collected, including the operation time, intraoperative bleeding, cyst diameter and location, whether combined with adenomyosis, severe pelvic adhesion, and the grading and staging of the American Fertility Society's revised staging standard for Endometriosis (rAFS). The postoperative follow-up indicators of patients were collected, including postoperative medication, medication regimen, medication time, pregnancy outcome, recurrence status, and type of recurrence (pain recurrence, cyst recurrence). The measurement data was represented by xˉ± s, and independent sample t-test was used for inter group comparison.The counting data was represented by example(%), and χ 2 test was used for inter group comparison. Results:The age, VAS score, moderate and severe dysmenorrhea, chronic pelvic pain, and CA125 elevation in the observation group were higher than those in the control group [(33.8±5.5) years vs (32.0±5.2) years, (5.4±1.2) points vs (4.3±0.9) points, 72.6% (69/95) vs 55.4% (46/83),24.2%(23/95) vs 8.4%(7/83), 80.0% (76/95) vs 65.1% (54/83)], the differences between the two groups were statistically significant ( t=2.23、 P=0.031, t=6.83、 P<0.001, χ 2=5.74、 P=0.017, χ 2=7.87、 P=0.005, χ 2=5.02、 P=0.025). The operation time in the observation group was longer than that in the control group [(75.1±20.1) min vs (56.0±18.9) min], the intraoperative bleeding was more than that in the control group [(79.2±23.0) mL vs (57.8±16.3) mL], and the proportion of bilateral cysts, severe pelvic adhesion, combined adenomyosis and r-AFS stage Ⅳ and rAFS score in the observation group were higher than those in the control group [54.7%(52/95) vs 34.9%(29/83),90.5% (86/95) vs 53.0% (44/83), 41.1% (39/95) vs 22.9% (19/83), 71.6% (68/95) vs 43.4 (36/83), (61.8±22.1) points vs (39.4±19.1) points], the differences between the two groups were statistically significant ( t=6.50、 P<0.001, t=7.06、 P<0.001, χ 2=8.27、 P=0.016, χ 2=31.65、 P<0.001, χ 2=6.65、 P=0.010, χ 2=14.69、 P=0.002, t=7.18、 P<0.001). The proportion of postoperative medication in the observation group was higher than that in the control group [98.9% (94/95) vs 92.8% (77/83)], the difference between the two groups was statistically significant (χ 2=4.47、 P=0.034). In the observation group 35 cases of postoperative pregnancy were all alive (100.0%), and in the control group 38 cases of postoperative pregnancy 35 cases were alive (92.1%), there were 3 cases of spontaneous abortion.There was no statistically significant difference in pregnancy outcomes between the two groups (χ 2=2.88, P=0.090). Conclusions:The OMA with DIE patients have more severe pain symptoms than those without DIE, severe pelvic adhesion is more during operation, r-AFS score is higher and more in stage Ⅳ, but there are no significant differences in the total recurrence rate and fertility outcome after operation