青春期卵巢型子宫内膜异位症保守手术后复发9例临床分析

Clinical Analysis of 9 Adolescent Ovarian Endometriosis Recurrence Cases after Conservative Surgery

目的:探讨青春期卵巢型子宫内膜异位症(endometriosis,EMs)患者术后复发的可能原因。方法:回顾性分析经保守性手术治疗后复发的9例青春期卵巢型EMs患者的临床病例资料。结果:9例患者中,Ⅰ期1例,Ⅲ期1例,Ⅳ期7例;7例患者于停止药物治疗后3~4个月痛经复发;7例患者初次手术后1年内病灶复发,另外2例分别为手术后3年及4年后复发。病灶复发可见于对侧卵巢3例,初次手术病灶较小一侧卵巢3例,同侧卵巢2例,双侧卵巢复发1例。5例患者初次手术后复发1次,3例患者复发2次,1例患者复发3次。2例患者术后妊娠并足月分娩。9例患者术后药物治疗2~6个周期。结论:青春期卵巢型EMs患者保守手术后复发患者初次手术时临床分期高,病灶及痛经复发多在手术后1年内。临床分期高、痛经史、术后药物长期管理依从性差及妊娠意愿低等可能是手术后复发原因。

Objective:To explore the possible causes of postoperative recurrence in adolescent patients with ovarian endometriosis(EMs).Methods:Retrospectively analyzed the clinical data of 9 adolescent ovarian endometriosis recurrent cases who underwent conservative operation.Results:The clinical stage of 9 patients was stageⅠin 1 case,stageⅢin 1 case and stageⅣin 7 cases.7 patients had dysmenorrhea recurred 3 to 4 months after drug treatment completed.The ovarian EMs recurred in 7 patients within 1 year,1 patient after 3 years,1 patient after 4 years followed the first operation.3 patients had lesion recurred in the contralateral ovary,3 patients had lesion recurred in the ovary with tiny focus during the primary operation,2 patients had lesion recurred at the same ovary and 1 patient had bilateral ovarian recurred.5 patients had experienced recurrence once,3 patients had recurred twice,and one patient had recurred three times after the primary surgery.2 patients had delivered at full term after operation.9 patients had long term drug management 2 to 6 medication cycles after primary surgery.Conclusions:The clinical stage of the primary surgery is usually severe in adolescent recurrence patients after conservative operation,dysmenorrhea and EMs lesion recurrence usually occur within 1 year after surgery.Severe clinical stage,dysmenorrhea,unsatisfied long term drug management and low willing to pregnancy may relate with recurrence after surgery.