Ovarian Endometrial Factors Of Recurrence Of Endometriosis After Conservative Surgery

Objective:To determine the correlative factors with recurrence of endometrial cyst of the ovary after conservative surgery.Methods:A cohort study was performed on 227 patients who were in Hospital for conservative surgery of ovarian endometrial cyst from 2002.01.01 to 2002.12.31. and all were underwent clinical interview,physical examination and ultrasonography. The factors measured included:age at surgery,Age at menarche,Reproductive age, age at onset of disease,Infertility(primary and secondary),history of operation for endometriosis,Type of dysmenorrhea,Severity of dysmenorrhea,Duration of dysmenorrhea,gravidity,parity,BMI(Body mass index),Adhesion,Previous use of endometriosis-related medication,Size of cyst,side of endometrioma(left/right/ bilateral),intraoperative revised classification American Fertility Society(r-AFS) scores,Postoperative medication and type of operation(laparoscopy/ laparotomy).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:183 patients were followed-up in 5 years,and 64 patients recurred,the recurrent rate was 35.0%,(64/183).The number of recurrence.recurrent rate and the total recurrent rate each year were as follows:Twelve patients,7.3%(12/183)and 7.3%(12/183)in the the first year;Fourteen patients,7.7%(14/183)and 14.2%(28/183) in the second year Sixteen patients,8.7%(14/183)and 23.0%(42/183)in the third year;Twelve patients,7.3%(12/183)and 29.5%(54/183)in the forth year;Ten patients,5.5%(10/183)and 35.0%(64/183)in the fifth year.Among them,Sixty-eight patients were complaint of dysmenorrheal and 11 of which recurred.The recurrent rate was 36.4%(4/11).The number of recurrence,recurrent rate and the acumulated recurrent rate each year were as follows:One patient,9.1%(1/11)and 9.1%(1/11)in the first year;One patients,9.1%(1/11)and 18.2%(2/11)in the second year;One patient,9.1%(1/11)and 27.3%(3/11)in the third year;One patient,9.1%(1/11)and 36.4%(4/11)in the forth year;No patient,.0%(0/11)and 36.4%(4/11)in the fifth year.There was no statistically significant difference in these characteristics between the recruited patients and patients who were lost to follow-up.For recurrence of endometrioma,the revised American Fertility Society(rAFS)score,history of operation for endometriosis.younger age at surgery,and previous medical treatment of endometriosis were identified to be risk factors.For recurrence of dysmenorrhea, rAFS score was the only risk factor.Postoperative medication had significant difference in the recurrence of both endometrioma and dysmenorrhea.Postoperative gravidity had significant difference in the recurrence of endometrioma For both recurrences,there was a constant hazard rate in the first 4 years after surgery, indicating that the recurrence in that period is completely random.Conclusions:The risk factors for recurrence of endometrioma include:total rAFS score,history of operation for endometriosis.younger age at surgery,and previous medical treatment of endometriosis,whereas the protective factors include postoperative medication and postoperative gravidity.The total rAFS score is also a risk factor for recurrence of dysmenorrhea.