子宫内膜异位症保守性手术后复发的相关因素分析

Correlative factors analysis of recurrence of endometriosis after conservative surgery

目的 确定与子宫内膜异位症 (内异症 )保守性手术后病变复发的相关因素。方法对 2 85例保守性手术治疗并经病理证实的内异症患者观察并随访 36个月 ,观察患者年龄、发病年龄、术前孕次、术前产次、后穹窿痛性结节、子宫活动度、血清CA12 5、既往内异症手术史、腹腔镜手术史、内异症病变侧别、术中和术后美国生育学会修订的内异症分期标准 (r AFS ,1985 )评分、术后孕激素治疗 6个月、术后枸橼酸氯米芬 (其他名称 :克罗米酚 )促排卵治疗、术后孕次、术后产次等 31项指标 ,随访中记录病变复发情况及复发时间。应用SPSS软件行COX回归风险分析筛查复发的相关因素。结果共有 83例 (2 9 1% ,83/2 85 )患者复发 ,每年复发例数、复发率和累积复发率为 ,第 1年 4 1例 ,14 4 % (41/2 85 )和 14 4 % (41/2 85 ) ;第 2年 30例 ,10 5 % (30 /2 85 )和 2 4 9% (71/2 85 ) ;第 3年 12例 ,4 2 % (12 /2 85 )和 2 9 1% (83/2 85 )。经单变量分析 ,危险性相关因素为既往有内异症手术史 (OR值为 13 6 30 ,P <0 0 1)、后穹窿有痛性结节 (OR值 6 133,P <0 0 1)、术后应用枸橼酸氯米芬促排卵治疗 (OR值 5 173,P <0 0 1)、左侧盆腔病变 (OR值 4 5 0 3,P <0 0 1)、双侧盆腔病变 (OR值 3 70 9,P <0 0 5 )和术后r

Objective To determine the correlative factors with recurrence of endometriosis after conservative surgery Methods A cohort study was performed on 285 patients who had a minimum of 36 months of follow up after conservative surgery for endometriosis All patients underwent clinical interview, physical examination and ultrasonography The factors measured included: age at surgery, age at onset of disease, gravidity, parity, tenderness nodule at cul de sac (yes/no), uterus mobility (movable/fixed), serum CA 125 level, type of operation (laparoscopy/laparotomy), history of operation for endometriosis (yes/no), side of endometrioma (left/right/bilateral), intraoperative revised classification American Fertility Society (r AFS) scores, post operative r AFS scores, highest post operative temperature, post operative adjuvant therapy, post operative gravidity and parity The recurrent rate and its predictive factors were evaluated and the univariate, multivariate COX regression and Kaplan Meier analyses were performed to determine the predictive factors for recurrence of endometriosis Results The related factors and their odds ratio( OR ) by univariate analysis were as follows: history of endometriosis surgery, 13 630( P <0 01); nodules with tenderness at cul de sac, 6 133( P <0 01); post operative administration of clomiphene, 5 173( P <0 01); left endometrioma, 4 503 ( P < 0 01); bilateral endometrioma, 3 709( P <0 01); post operative r AFS scores, 1 831( P <0 01); post operative gravidity, 0 392( P <0 05); post operative administration of progesterone for 6 months, 0 472( P <0 01);laparoscopic surgery, 0 567( P <0 05); pre operative parity, 0 640( P <0 05); pre operative gravidity, 0 759( P <0 05); age at onset of disease, 0 912( P <0 01) and age at surgery, 0 932( P <0 05) Meanwhile, the related factors and their odds ratio ( OR ) by multivariate COX analysis were as follows: history of endometriosis surgery, 8 219( P <0 01); bilateral endometrioma, 6 369( P <0 01); left endometrioma, 2 682( P <0 05); tenderness nodules at cul de sac, 2 154( P <0 05); post operative administration of clomiphene, 1 860( P <0 05); post operative r AFS scores, 1 188( P <0 01); post operative gravidity, 0 253( P <0 01); post operative administration of progesterone for 6 months, 0 518( P <0 05); age at surgery, 0 937( P <0 01) Conclusions The risk factors for recurrence of endometriosis include a history of endometriosis surgery, bilateral endometrioma, left endometrioma, tenderness nodules at cul de sac, post operative administration of clomiphene, post operative r AFS scores,whereas the protective factors include the post operative gravidity, post operative adjuvant therapy and age at surgery