| Objective: To investigate the correlation between serum CA125and AFSstaging, selections of surgical approaches and comparison of related indicationsbetween LS (laparoscopic surgery) and AS (laparotomy) through analyzingclinical features and surgical approaches of patients with endometriosis.Methods:580patients underwent ovarian endometriosis cystectomy andappendectomy in the department of Gynecology which were pathologicallyconfirmed as ovarian endometriosis after operation were included in the study.Retrospective analysis of ages, cyst diameter and location of side, serumCA125, AFS staging, surgical approaches and related factors (operationduration, blood loss, postoperative temperature recovery time, exhaust time,days of hospitalization) were carried out, comparison of the data acquired wereexamined by u test and X~2test with the statistical analysis software ofSPSS13.0, and P<0.05were identified as statistically significant．Results:①Age: The ages of the580patients ranged from16to53withthe mean age of35. the peak of age is between21-45.②The group weredivided into two main groups by Clinical manifestation:146cases (25.2%)were asymptomatic and434cases were symptomatic with the main clinicalmanifestations of: menstrual abnormalities216cases (42%), dysmenorrheal171cases (33%), irregular abdominal pain111cases (21%) and infertility21cases (4%).③Cyst: The Cyst were divided in to three groups by direction:Left209cases (36%), right180cases (31%), bilateral191cases (32.9%); TheCyst were divided in to four groups by diameter:2-5cm295cases (50.8%),6-10cm266cases (45.8),11-15cm10cases,16-26cm9cases (1.5%). Patientsmainly distributed in the group of less than10cm.④The group were dividedinto two main groups by CA125:365cases’ results were available in which285 cases (78.1%) were normal. Abnormal cases were divided in to three groups:35-100U/ml64cases (17.5%),100-200(including200) U/ml14cases (3.8%)and>200U/ml2cases (0.5%). In the group of AFS Ⅰ49cases (87.5%) hadnormal CA125while35-100U/ml6cases (10.9%),100-200(including200)U/ml1case (1.8%); in the group of AFSⅡ64cases (83.1%) had normalCA125while35-100U/ml11cases (14.3%),100-200(including200) U/ml2cases (2.6%); in the group of AFS Ⅲ115cases (79.3%) had normal CA125while35-100U/ml22cases (15.2%),100-200(including200) U/ml7case(4.8%),200-320U/ml1case (1.1%); and in the group of AFS Ⅳ57cases(65.5%) had normal CA125while35-100U/ml25cases (28.7%),100-200(including200) U/ml4case (4.6%),200-320U/ml1case (1.1%).⑤Surgicalapproaches: Four surgical approaches including LS cystectomy, LS annexresection, AS cystectomy and AS adnexectomy were mainly included in thisclinical analysis and were selected according to the ages: LS cystectomy,accounting for51.86%, was mainly selected for the patients of20years old andbelow, LS cystectomy accounted for58.9%in the group of21-35while AScystectomy accounted for40.7%, in the group of36-45LS cystectomyaccounted for36.2%and AS cystectomy accounted for57.4%, the group of46years old and above consisted of14.81%of AS cystectomy and68.5%of AScystectomy. Grouped by the cyst diameter, patients with cyst diameter2-5cmwho underwent the operation of LS cystectomy accounted for51.8%of it’sgroup and58.2%of all the cases underwent LS cystectomy, which was a largeproportion. In the group of6-10cm LS cystectomy accounted for40.6%of it’sgroup and41.1%of all the cases underwent laparoscopic cystectomy, in thegroup of11-15cm AS cystectomy accounted for70%of it’s group and2.4%ofall the cases underwent AS cystectomy while AS accounted for10%. In thegroup of which diameter16-26cm, AS cystectomy accounted for66.7%of it’sgroup and2.1%of all the cases underwent this approach while AS adnexectomy accounted for33.3%of this group. In the grouped of patients hadnormal CA125, the number of cases underwent LS cystectomy, AS cystectomy,LS adnexectomy and AS adnexectomy were142(49.8%),130(45.6%),0and13(4.6%), respectively; In the group of patients whose serum CA125is35-100U/ml, the numbers of patients who underwent the four above mentionedapproaches were23(35.9%),36(56.2%),1(1.56%) and13(4.6%),respectively; In the group of CA125100-200(including200) U/ml the numberswere7(50%),6(42.8%),0and1(7.1%), and in the group ofCA125200-320U/ml the numbers were1(50%),0,0and1(50%).⑥Intraoperative and postoperative comparison of the relevant indicators betweenLS and AS: LS had shorter operation duration, less blood loss, quicker recovery,shorter hospital stay but longer duration of fever when compared to the AS,especially in those AFS Ⅳ, LS have longer period of thermoregulationrecovery.Conclusion: Ovarian endometriosis was of age-related, which mainlyinvolve childbearing women within21-45years old;1/4patients wereasymptomatic, the clinical manifestation were abnormal menstruation,dysmenorrhea, irregular abdominal pain and infertility; No significantdifference was found among the location of left, right and bilateral side; Mostcyst had the diameter of less than10cm; CA125should be best tested in thepatients with follicular phase and had relevance to the AFS staging, it’s leveland positive ratio increased correspond to the AFS staging; Cystectomy wasmore commonly used regardless of age, AS and semiconservative surgery weremore commonly used as the age increased. Selection between LS and ASaffected by the diameter of the cyst and the level of CA125, but it is not withthe selection between cystectomy and adnexectomy. |
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