| ObjectiveTo investigate recurrent rate of endometriosis and to analysis correlative factors of the patients of PUMCH who have had endometriosis and who have been underwent hysterectomy and bilateral adnexectomy.MethodsA case control study. The clinical records of the patients who had endometriosis and who were underwent hysterectomy and bilateral adnexectomy from January 2000 to April 2006 were collected and sorted and then the patients were followed up. The data were analyzed by statistical software SPSS 13.0.Results1. After statistical analysis the variables of the HRT group and the no HRT group, we confirmed that excluding the postmenopausal case could degrade the disequilibrium between the two groups. After that, the data of the two groups were well equilibrated.2. Our study included 78 patients who had no pains, 18.1% of all study cases. The other patients had different levels of pain.3. 14 patients who had been performed TH or STH previously were also included in our study. All of them were performed trans-abdominal ovariotomy in PUMCH. We suggested that TH should be performed in EM or AM patients who had a plan to remove the uterus.4. The follow-up period of the 433 patients in our study was 1 to 6 years. 392 patients were followed up more than 36 months. There were 2 cases of recurrence in our study. The total recurrent rate was 0.46%, of which 0.80% in EM group and 1.8% in women who received HRT in the same group. The AM group had no recurrence.5. The recurrent rate of the cases of stage I～II was 0, versus a 2.4% rate in the cases of stage III～IV. There was no recurrence case in women who had no AM or myoma, but the recurrent rate of the women with AM was 3.45% and that of the women with myoma was 3.67%. There was no recurrence among women whose pelvic mass of EM was less than 5cm in diameter, versus a rate of 3.64% in women whose pelvic mass of EM was more than 5cm in diameter. There was no recurrence among women whose chocolate cysts of the ovary were less than 3cm in diameter on both sides, versus a rate of 8.33% in women whose chocolate cysts of the ovary were more than 3cm in diameter on both sides. The recurrent rate of cases who had no kiss sign was 0.95%, versus a rate of 20% in who had it. Among women receiving HRT, the chocolate cysts of the ovary more than 3 cm in diameter on both sides were a risk factor. There was a high recurrence rate in patients who were found chocolate cysts more than 3cm in diameter on both sides during operation, 3.9 times more than the other patients.ConclusionsThe recurrent rate of EM after hysterectomy and bilateral adnexectomy was 0.80%. There was no recurrence among women who did not receive HRT, versus a 1.8% rate in women who received HRT. There was also no recurrence in pure AM patients regardless HRT. The HRT should be consisted of estrogen and progesterone or estrogen and progesterone plus androgen if it is used, which is considered safe by EM patients who have been underwent radical operations. Total hysterectomy should be performed in EM or AM patients who have been underwent half radical operations and there should be a follow-up after the operation. Having chocolate cysts of ovary more than 3cm in diameter on both sides is a risk factor for recurrence in patients who receives HRT after the radical operation. There is a high recurrent rate in patients who have been found chocolate cysts more than 3cm in diameter on both sides during operation, 3.9 times more than the other patients. The estrogens should be stopped or reduced the dose according to the conditions in the patient who have a recurrence of EM during HRT after radical operation. Medical therapy or operation should be performed if there are indications.
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