Clinical Analysis Of Endometriosis Associated With Genital Tract Malformation In Adolescence

Background Endometriosis is a common disease in fertile women,its clinical characteristics mainly include pelvic mass,pelvic pain,dysmenorrhea and infertility.It is a disease that has serious impact on female ovarian reserve function and fertility.According to WHO,the age of adolescent is 10 to 19 years old.The incidence of adolescent endometriosis increased year by year,and related reports reported that the incidence rate is not even lower than adult's.The pathogenesis of endometriosis is not yet completely clear,but Sampson's "blood reflux theory" is well accepted by scholars domestic and overseas.According to this theory,genital tract obstruction should be the main factor of all the endometriosis risk factors.Different types of reproductive tract deformities associated with different kinds of clinical manifestations,as for such a complex situation,it is difficult to perform diagnosis and treatment.Due to the young age and psychological immaturity of adolescents,there is generally a long time delay in diagnosis for most adolescent patients.Objective To investigate the clinical characteristics,diagnosis and treatment of endometriosis associated with genital tract malformation.in order to find out proper methods for the early diagnosis and treatment of the disease.Methods We retrospectively analyzed the data of 15 patients associated with genital tract malformation of 71 adolescent patients of endometriosis who admitted to our hospital from July 2012 to December 2015.Taking the age of onset,menarche age,menstrual status,clinical characteristics,ultrasonography of pelvic and urinary system,MRI,CA125,surgical methods and intraoperative conditions as the main observation indicators.Postoperative follow-up was performed and follow-up results were recorded.Female genital tract malformations are classified according to Chinese Obstetrics and Gynecology(3rd Edition).Analysis was undertaken by SPSS21.0.The measurement data were analyzed with the use of independent-sample t test.Data was expressed in the form of (?)±s.Results 1.There were 15 cases associated with genital tract malformation in a total number of 71 cases of adolescent endometriosis,of which the genital tract malformation incidence rate was 21.1% and the average age was 15.0 ± 0.7 years.The average onset age of the non-malformations was 17.9 ± 0.5 years,and the difference of these two groups was statistically significant(P <0.05).2.For adolescent endometriosis associated with genital malformations,the main reasons for treatment were dysmenorrhea progressively severe and cyclical pelvic pain with primary amenorrhea,rate was 80%.3.The coincidence rate of Pelvic color Doppler ultras diagnosis compare to surgery result was 80%,and that of MRI was 90%.4.In genitourinary malformations,the incidence of urinary tract malformation was 66.7%,which happened in all the patients diagnosed to be rudimentary uterine horn and HWWS associated with ipsilateral renal agenesis.5.Ovarian has a high risk about 73.3% to be endometriosis lesions,most of which about 60%.were moderate severe.6.All patients underwent laparoscopic surgery to remove pelvic lesions.Combined hysteroscopy or vaginal surgery was performed to remove the obstruction,Postoperative follow-up for 13 cases,abdominal pain relief rate was 92.3%,and the recurrence rate was low about 7.7%.Conclusions 1.The chief symptoms of adolescent endometriosis patients associated with genital tract malformation were progressive dysmenorrhea or cyclic abdominal pain complicated with primary amenorrhea.Pelvic color Doppler ultras and MRI both contributed to diagnosis.Surgery should be operated in time to remove the obstruction 2.Genital tract abnormalities often associated with urinary malformations,so patients with urinary malformation should perform a pelvic color Doppler ultrasound examination in order to get an early age diagnosis of genital malformations.