Determinants Of Correlative Factors With Recurrence Of Endometrial Cyst Of The Ovary After Conservative Surgery

Objective:To determine the correlative factors with recurrence of endometrialcyst of the ovary after conservative surgery.Methods:412patients operated on for ovarian endometriosis in DalianGynecology and Obstetrics Hospital from2008to2009were evaluated whose medicalhistory,physical and ultra-sound examination and Serum CA125assay were collectedbefore operation, recording of the location,size of the cyst, adhesions with other organsand cul de sac obliteration during operation.Besides,all visible implants ofendometriosis were removed in all cases who were also assigned according to therevised-American Fertility Society classification system.Specimen underwent throughhistological analysis after surgery.All patients were asked to be followed up at1,6,12months and then yearly after surgery.During follow-up visits,patients were askedwhether any sign or symptom had appeared.Physical examination,ultra-soundexamination and Serum CA125assay were also documented.All data were analysed bySPSS11.5.Student’s t-test was used to compare continuous variables and chi-square testwas used to compare categorical variables.Results:412patients were followed up in2years,78patients recurred.Therecurrent rate was9.2%(38/412) in the1styear and9.7%(40/412) in the2ndyear.Thepatients were also devided into5groups,that was GnRH-a for3months, GnRH-a for6months,gestrinone for3months,gestrinone for6months and no post-operativemedication group,whose2-year total recurrent rate was24.59%、9.67%、30.77%、11.36%、36.96%,respectively. There were statistically significant differences of2-yeartotal recurrent rate in Group GnRH-a for6months or gestrinone for6months with thatin Group GnRH-a for3months or gestrinone for3months(P＜0.05). There were alsostatistically significant differences of2-year total recurrent rate in Group GnRH-a for6months or gestrinone for6months with that in no post-operative medication group(P＜ 0.05),while there was no statistically significant difference of2-year total recurrent ratein Group GnRH-a for3months or gestrinone for3months with that in nopost-operative medication group(P＞0.05).The symptoms or signs of patients whorecurred included dysmenorrhea(62.8%),chronic pelvic pain(19.3%),dyspareunia(17.9)and pelvic mass(70.5%),pelvic painful nodule(65.4%),pelvic adhesions andthickening(29.5%).For recurrence of endometrioma,there were statistically significantdifferences in age at surgery,age at menarche,previous use of endometriosis-relatedmedication,previous endometriosis-related surgery, painful nodule in the Doglaspouch,left sided lesions,bilateral lesions,rAFS score,pregnancy after surgery,use ofclomifene after surgery,use of GnRH-a for6months and gestrinone for6months.Therewere statistically significant differences in all the other group with no post-operativemedication group except the group of gestrinone for3months. There was nostatistically significant difference between the group using different medicine for thesame time,but,there was statistically significant difference between the group using thesame medicine for different time.Conclusion:Endometriosis has a high recurrent rate.The2-year recurrent rate canbe reduced by using GnRH-a or gestrinone for6months,while it can’t be reduced byusing GnRH-a or gestrinone for3months.Consideration should be taken into if anysymptom such as dysmenorrheal,chronic pelvic pain,dyspareunia or any sign such aspelvic mass,pelvic painful nodule,pelvic adhesions appeared.Age at menarche,previoususe of endometriosis-related medication,previous endometriosis-related surgery,painfulnodule in the Doglas pouch,left sided lesions,bilateral lesions,rAFS score,use ofclomifene after surgery were identified to be risk factors and age at surgery,pregnancyafter surgery,use of GnRH-a or gestrinone for6months were identified to be protectivefactors.