| Objective: To review clinical and follow-up information of all cases of endometriosis which is proved during operation in zhujiang hospital in recent 10 years and construct a database of endometriosis; To analyze clinical, operation and pathology characteristic of endometriosis; To follow up and note relapse-concerned data, then analyzing the data with one-factor and multi-factor analysis and constructing Cox regression model of endometriosis relapse; To investigate the function of epithelial neutrophil-activing peptide-78(ENA-78) in endometriosis by menstruating its concentration in ascites and serum of 42 cases of endometriosis.Method:1.All medical records of zhujiang hospital in south university from August 1994 to July 2004 are searched with searching words of pelvic endometriosis, adenomyosis, chocolate cyst, endometriomas and endometriosis of other parts, such as the oviduct, vagina, vulva, etc. A clinical database of endometriosis is set up basing on 495 cases of endometriosis.2. 62 fields are designed according to clinical characteristic of endometriosis, including common situation, pre-operation and post-operation information, operation and follow-up information. Common situation comprises of 12 fields including the number of medical register, name and age of patients, etc; Pre-operation information comprises of 21 fields including complaint, history, menses and marriage history,CA-125 of pre-operation, etc; Operation information comprises of 13 fields including detailed view of operation, r-AFS stages, operation fashion, etc; Post-operation information comprises of 6 fields including diagnosis of pathology, detailed characteristic of pathology, the amount of leukocyte and CA-125 of post-operation, etc. Follow-up information comprises of 10 fields including detailed drug of post-operation therapy, therapy duration, side effect of therapy etc. Access 2000 clinical information data of endometriosis is constructed with handy computer. In order to avoid repeating input and search facility, the sequential number of patients is designed as main field.3.The data of endometriosis database is exported into SPSS 13.0 and Excel 2000 and then clinicah operation and pathology characteristic of endometriosis are summing up. Then relapse-concerned information is analyzed with one-factor and multi-factor analysis methods and Cox regression model of relapse is constructed.4. 42 cases of endometriosis being diagnosed in laparoscopy and 25 cases of non-endometriosis are selected in patients from August 2003 to July 2004. There are 20 cases I , II stages and 22 cases of III, IV stages according to the revised classification of the American Fertility Society. 23 cases of follicular phase and 19 cases of luteal phase are confirmed according menses history. Peripheral venous blood is collected before anesthesia and ascites is obtained in the beginning of operation. After clarification by centrifugation at 2000g for 10 minutes, the supernatant is stored at -70°C until they were assayed. Amounts of ENA-78 in samples were determined with ENA-78-Immunoassay kit according to the manufacturer's protocol. Samples from all patients were measured in parallel and in duplicate to control for interassays variance. The optical density (OD) of each well is measured at dual wavelengths of 450nm.Concentration of ENA-78 is calculated by interpolation from the standard curve.Result:1. It's accurate, fast, complete to input data into the endometriosis database of Access 2000. All information of the disease can be found by inputting the number of medical register or names of patients and all information of some fields can be search by inputting the name of it. The interface of import and output is friendly and all fields can be sorted any time. Statistical analysis is convenient because when exporting the database into Excel 2000 and SPSS 13.0 the data doesn't change the content and type of data. The function of network share can be realized through issuing the database in the network and sharing it with other medical cooperation department.2. 495 cases of endometriosis are searched in our hospital in the past 10 years, There are 307 cases in the latter five years, which is 1.63 times than anterior 5 years.common situation: The average days of one patient in-hospital is 11.3(±3.9)days and the average number is 1.04(±0.11)times. The average marriage age is 24.6(± 3.1)years, menstrual interval 28.8(±5.8) days, duration of menses 5.4(± 1.6)days. There are 45 cases(9.1%) of excessive amounts volume of menstrual flow, 437 cases (88.3%) of middle amounts and 13 cases (2.6%) of little amounts. There are 249 patients (48.3%) who suffer from the symptom of dysmenorrhea for 1-30 years, in which 132 patients (26.8%) suffer for more than 5 years. According to the grade of severity of dysmenorrhea, 45 cases (18.1%) are mild, 149 cases (59.8%) moderate and 55 cases (22.1%) severe separately. As far as marriage and pregnancy history is concerned, 178 cases (35.9%) are unmarried and 318 cases married, 123 cases (24.8%) is never pregnancy and 372 cases (75.2%) opposite. The average times of pregnancy is 2.55(± 1.44), in which the most is 8 times. 189 cases (38.2%) never delivery and 306 cases are opposite. The average times of delivery is 1.65(±0.97).Clinical data: The main complaint associated with endometriosis include the following: pelvic pain, pelvic masses, turbulenced menorrhea, infertility and else. In all cases, 206 cases (41.6%) complain pelvic pain including cycle pain, uncycle painand dyspareunia, 122 cases (24.6%) pelvic masses, 75 cases (15.2%) turbulenced menorrhea including polymenorrhea, hypermenorrhea and abnormal menstrual interval, 56 cases (11.3%) infertility and 36 cases (7.3%) else separately. As far as the position of uterus concerned, 192 cases(38.9%) are front, 88 cases(17.8%) are midst and 215(43.3 %)are back.Operation information: There are 166 cases of adenomyosis, 3 cases of abdomen wall endometriosis, 368 cases of pelvic endometriosis including 233 cases of endometriomas, 11 cases of tube endometriosis and 2 cases of epiploon endometriosis. Certainly one patient can have more than one diagnosis. In 233 cases of endometriomas, 77 patients are bilateral and 156 patients are unilateral. According to r-AFS stages, 96 cases(26.1%) is in stage I , 111 cases(30.1%) in stageII, 99 cases(27.0%) stagelll and 62 cases (16.8%) stagelV. When operation way is concerned, 315 cases (63.6%) are laparoscopy and 180 cases (26.4%) are tradition fashion. According to operation mode, 320 cases (64.6%) are conservative, 141 cases (28.5%) are half-radical fashion and 34 cases (6.9%) are radical fashion. Mean duration time of surgery is 100.1(±70.2)minutes with range from 20 to 270minutes.The volume of mean haemorrhage is 103.2(± 78.6)milliliter with range from 5 to 1200 milliliter. There are 32 patients who bleed in operation more than 400 milliliter and 45 patients (13%) accept blood transfusion of 85.7(±65.5) milliliter average with range from 200 to 1400 milliliter.Pathology information: There are 310 endometriomas in 233 endometriomas patients, in which 242 are diagnosed by pathology and 66 representative clinical endometriomas was diagnosed as the following: ovary simple cyst, ovary luteal cyst or none. The consistent of clinical and pathology is 78.1%. In pathology endometriomas, 4 types of characteristic were found in microscope: ?similarity endometrium having glands and stroma; ?columniation epithelia being found in the surface of cyst; (3) cube epithelia being found in the surface of cyst; ?only iron blood cell and fibre cellbeing found. According to the order of the front class, 110 cases (45.5%), 40 cases (16.5%), 29 cases (11.6%), 63 cases (26.4%) are found separately. Furthermore 4 cases of endometriomas incorporate other ovary tumor, in which one is bilateral borderline serous cytoadenoma, one is bilateral serous cytoadenoma and two are mucous cytoadenoma. Moreover 2leases of endometriomas is infectious.In 166 cases of adenomyosis, 5 are found in the late phase of pregnancy, in which the biggest adenomyoma combining with many red scars in the back wall of uterus is 80mm X 60mm X 60mm in a 38 weeks pregnancy women. One patient of pregnancy adenomyoma rupture is mis-diagnosed as appendicitis because of acute abdomen pain. The correct diagnosis is conformed in operation and pathology characterization of endometriosis combining deciduas reaction in serosa. There are 5 cases of endometriosis of post-menarche in 4~7 years after menopause.3. Single factor analysis of possible factors influencing endometriosis relapse indicates that r-AFS stages, operation mode and patients age influence relapse and operation way, the value of CA-125 is oppositive. According to clinic experience and the outcome of single factor analysis, the variables of patients age, r-AFS stages , chocolate cyst, adenomysis, the operation mode, danazol, thiazole, GNRH- a are introduced into equation and xl~x9 was given according order. A multi-factor regression equation of PI= 1.525 (xl) +0.852 (x2)+0. 0.842 (x3) -0.397 (x4) -0.273 (x5)+ 0.299 (x6)+ 0.100 (x7)-0.022 (x8) -0.326 (x9) was set up. The value of x 2 of the equation is 180.717 and the value of P is 0.000. So the equation was reasonable.4.The concentrations of ENA-78 in serum of endometriosis group 2.97(±1.91) ng/ml are significantly higher than the control group 0.72(±0.24)ng/ml ( P<0.001).The levels of ENA-78 in stages III and IV 4.48(±1.25) ng/ml are significantly higher than those in stages I and II 1.30(±0.74) ng/ml (P<0.001). There is no significant difference between follicular phase and luteal phase in both groups.5. The concentrations of ENA-78 in ascites of endometriosis group 360.3(±331.5) ng/ml are significantly higher than the control group 116.7(±72.9) ng/ml (P<0.001). The levels of ENA-78 in stages III and IV 525.0(±381.3) ng/ml were significantly higherthan those in stages I and II 177.22 (±96.52) ng/ml (P<0.001). ConclusionLit is accurately > fasU complete to input data in the endometriosis database ofAccess2000, which is favor of inputting and transmitting of information and sharing information in network. So it's worth to generalize.2. The complaint of pelvic masses is in the second position, which is more than literature. Post-pregnancy and post-delivery predominate in all patients of endometriosis. occupying 75.2% and 1.8% separately. Conservative and half-radical fashion is still the main operation mode. The percent of Laparoscopy is 63.6%, which indicates that Laparoscopy is the main operation way in our hospital. The consistent of clinical and pathology is only 78.1%. Endometriomas in pregnancy can grow, develop, rupture and arouse pelvic pain. The remain information is according with literature.3. The methods of single factor and multi-factor analysis provide a new way to forecast relapse of endometriosis. The Cox regression equation in this paper is rational. With the data and the variances is more perfective, the forecast of endometriosis relapse will be more reasonable and correct, which will accept and apply by more gynecology physician.4. The concentrations of ENA-78 of endometriosis in ascites and serum is significantly higher than comparison and is positive correlation with severity of disease, which indicates that ENA-78 is possible a factor correlating with endometriosis.
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