Analysis of the Predictive Factors for the Recurrence of Deep Infiltrating Endometriosis:A 2-Year Prospective Study

Objective:To investigate factors that may be associated with the recurrence of deep infiltrating endometriosis(DIE)and DIE-related symptoms.Methods:Starting in September 2014,women with a confirmed diagnosis of DIE based on surgical and histological findings were included in the prospective study with a 2-year follow-up in our hospital.A total of 84 consecutive patients were included,all of whom underwent laparoscopic surgery.The data were obtained from the medical records of the patients.Follow-up data,including presence of pain as assessed using the visual analog scale(VAS)score and ultrasonography/magnetic resonance imaging findings,were obtained at 3,6,9,12,and 24 months postoperatively.Variables,such as age,body mass index,severity and duration of symptoms,size and location of the lesion,and pre-and postoperative medical treatment,were evaluated using univariate and multivariate analyses to identify factors correlated to recurrence.Results:A total of 11(13.1%)patients presented with recurrence,with a mean time to recurrence of 14.2 months.The univariate analysis showed that the longer duration of menstruation(7.4 vs.6.0,P=0.010),the more advanced revised American Fertility Society(rAFS)stage(Stages I and II vs.III and IV,χ^(2)=9.964,P=0.001),the higher VAS score for dysmenorrhea(9.4 vs.5.2,P=0.001),and the more severe pain during defecation(7.8 vs.4.8,P=0.016)were positively correlated to DIE recurrence.However,the multivariate analysis also revealed that a more severe dysmenorrhea and advanced rAFS stage were the independent factors associated with the recurrence of DIE,with an odds ratio of 1.895(confidence interval[CI]:1.061-3.385,P=0.031)and 4.310(CI:1.091-17.028,P=0.037),respectively.Conclusions:More than 10%of patients presented with recurrence of DIE 2 years after surgery.Recurrence of DIE was more common in patients who complained of more severe dysmenorrhea and had an advanced rAFS stage.

Efficacy and Safety of SanJieZhenTong Capsules,a Traditional Chinese Patent Medicine,on Long-term Management of Endometriosis:A Randomized Controlled Trial

Objective:To compare the efficacy of the traditional Chinese medicine SanJieZhenTong(SJZT)capsules versus gonadotropin-releasing hormone analogs(GnRHa)or oral contraceptives(OCs)in the postoperative treatment of moderate-to-severe endometriosis.Methods:In this prospective clinical trial,women with stage III-IV endometriosis according to the revised American Fertility Society scoring system received three doses of GnRHa immediately after laparoscopic conservative surgery,followed by random assignment to receive treatment with SJZT,GnRHa,or OCs for another 6 months.The primary endpoint was 2-year recurrence,and the secondary endpoints were adverse events,changes in physical function,and quality of life(QoL).Recurrence was assessed using Kaplan-Meier curves and log-rank tests.Generalized estimating equations were used to determine the parameters of the secondary endpoints.Results:A total of 66 women were randomly assigned to the SJZT(n=21),GnRHa(n=21),and OCs(n=24)groups.At a median follow-up of 22 months,no difference in recurrence was found(P=0.72),with one(4.8%),two(9.5%),and one(4.2%)incidence in the SJZT,GnRHa,and OCs groups,respectively.Expectedly,the incidence of side effects such as hot flush,insomnia,and arthralgia in the SJZT and OCs groups was significantly lower than that in the GnRHa group(P=0.00).In addition,the female sexual function index was significantly improved in the SJZT group,with a higher value than that in the GnRHa(odds ratio[OR]=5.25,95%confidence interval[CI]:2.09-13.14,P=0.00)and OCs(OR=3.94,95%CI:1.58-9.83,P=0.00)groups.Conclusions:SJZT showed more effective pain relief and QoL improvement in patients with moderate-to-severe endometriosis than GnRHa or OCs did.Fewer adverse events than those observed with other agents indicate that this alternative medicine,SJZT,could be a novel option for the long-term management of endometriosis.