| BackgroundEndometriosis(EMs) is a disease that abnormal growths of tissue,histologically resembling the endometrium,are present out of the utering lining.According to the WHO to the age of puberty,the age of 10-19 is adolescent endometriosis. At present the pathogenesis of endometriosis is unclear,Sampson’s "blood reflux theory" was recognized by scholars all over the world.In the domestic, academician Lang Jinghe proposed a "eutopic decision theory".In recent years, the incidence of adolescent endometriosis increased year by year,Domestic and foreign literature shows that the adolescent endometriosis incidence rate is not lower than the childbearing age women. Foreign research reports laparoscopy adolescents with chronic pelvic pain, EMs incidence rate of 45%, and the incidence increases with age. Due to the particularity of endometriosis in adolescence such as age,psychology,there is generally a long delay in diagnosis for most women.How to improve the diagnosis and treatment of adolescence endometriosis is an urgent issue that need to be addressed and discussed. The clinical manifestations of endometriosis between the youth and adults is not exactly the same.Abroad study shows endometriosis in adolescence can present with cyclic or noncyclic pain.In addition,it can be associated with gastrointestinal and bladder symptoms,but ovarian endometriosis cysts are relatively rare.Domestic study confirmed the ratio ofendometriosis in adolescence with pelvic mass is higher than foreign’s. The diagnosis and treatment of endometriosis in adolescence mainly based on the adults. Detailed history taking and pelvic ultrasonography combined with serum CA125 are used to check initial diagnosis, but the final diagnosis is laparoscopy.Operative laparoscopy can be undertaken to make a definitive diagnosis of endometriosis.But we should pay attention to patients who merge genital tract obstruction and correct deformity.It’s better to use auxiliary drug therapy after operation.Combining with the characteristics of adolescent psychology, it is approriate to give psychological care and help.Therefore,the diagnosis and treatment of adolescent patients with endometriosis need to be individualized.ObjectiveTo investigate the possible pathogenesis, clinical presentations, diagnosis and treatment modalities of endometriosis in adolescence and improve the level of diagnosis and treatment of the disease by a retrospective analysis of 35 cases of endometriosis in adolescence in the Third Affiliated Hospital of Zhengzhou University.MethodsThe records of adolescent endometriosis who were admitted to the Third Affiliated Hospital,Zhengzhou University between June 2009 and January 2015 were retrospectively reviewed.All of the cases were underwent surgery and had a pathologically confirmed diagnosis of endometriosis.The general situation and clinical data were recorded and the regular follow-up was performed. The median postoperative follow-up time was 20 months(12 months-24 months). The follow-up deadline was January 2016. According to whether combination of genital tract deformity, the merger of genital tract malformation in adolescent endometriosis patients were defined as abnormal group,non malformation patients were defined as normal group. According to whether the use of auxiliary drug therapy after surgery is divided into Gn RH-a group, other drug group and the untreated group.Analysis wasundertaken using SPSS16.0.Measurement data was analyzed with the use of independent-sample t test or rank sum test. Enumeration data was analyzed using the Fisher exact test. The test level was α=0.05.ResultsA total of 41 cases of adolescent endometriosis patients met the inclusion criteria.And 35 cases were followed up successfully.The follow up rate was 85.4%. Among the 35 cases of adolescent endometriosis patients, the main symptoms of periodic abdominal pain and chronic pelvic pain patients accounted for 57.1%(20/35), pelvic mass in patients accounted for 37.1%( 13/35).Preoperative pelvic ultrasound examination revealed a positive rate of endometriosis 94.3%(33/35), preoperative serum CA125 examination was positive in 60%(18/30).All patients underwent laparoscopic surgery, if combined with genital malformations, deformities according to the site, combined with hysteroscopy or vaginal surgery28.6%( 10/35) were complicated with genital tract malformation,two cases of oblique vaginal septum syndrome patients with oblique septum side renal agenesis.The average age of diagnosis in patients with abnormal group was(16.3±1.3),while the average age of normal group was(17.9±1.0),the difference of these two groups was of statistical significance(P<0.05).The average age of menarche in abnormal group was(11.4±1.0),while the average age of menarche in normal group was(12.8±1.4),the difference of these two groups was of statistical significance(P<0.05).The recurrence rate of Gn RH-a group was 13.6%,the recurrence rate of other drugs group was42.9%,,while the recurrence rate of untreated group was 66.7%. Gn RH-a group and the other drugs group differences were statistically significant The recurrence rate diffrence betweenother drugs group was of statistical significance(P<0.167). Gn RH-a group and untreated group was of statistical significance(P<0.167). while the other drugs group and the untreated group recurrence rate was no significant difference(P>0.05).ConclusionThe clinical symptoms of adolescent patients with endometriosis mainly for periodic abdominal pain and chronic pelvic pain. It often associated with genital malformations.Gynecological Endoscopy and Pelvic ultrasonography is a main diagnosis and treatment of adolescent endometriosis. Using Gn RH-a after surgery can reduce the recurrence rate recently. |
PDF Full Text Request