Exploration Of The Related Factors Of Recurrence After Laparoscopic Ovarian Cystectomy

Objective:Laparoscopic cystectomy is a common and effective method for the treatment of ovarian endometriosis cysts,but the recurrence rate is high.The mechanism of recurrence is still unclear.In this project,the patients with ovarian endometriosis cysts underwent laparoscopic cystectomy were recruited to study the recurrence and pregnancy of the patients after the surgery.The differences in clinical data,gene expression profiles and biological function of the lesions were compared.The risk factors of recurrence were investigated.Materials and Methods:Biological experiments using clinical samples was combined with retrospective analysis and follow-up.From January 2012 to December 2015,80 cases with complete clinical data and lesion samples were selected from patients undergoing laparoscopic ovarian cystectomy at the First Affiliated Hospital of Xiamen University were selected as the study subjects.The follow-up period was 30-66 months.Recurrence and pregnancy rate were recorded within the period.qRT-PCR was used to detect the mRNA expression levels of related genes in ectopic endometrium obtained by surgery.Their protein localization and expression were detected by immunohistochemistry.The endometrial cells were isolated and primarily cultured.The migration and invasion ability were then detected by transwell assay.Results:The follow-up results showed that 23 of 80 patients had recurrence after operation and the recurrence rate was 28.75%.The recurrence rate in the second year after operation was 13.8%,which was significantly higher than the recurrence rate after the first,third and fourth year.There were no significant differences in blood group,dysmenorrhea,previous abortion,previous pregnancy,number of delivery,r-AFS stage,cyst size,involvement of the ovaries,and postoperative GnRH treatment duration between the relapsed and non-relapsed groups.(P>0.05).Postoperative contraceptive measures were not taken in 53 patients.The number of pregnancy was 20,the cumulative pregnancy rate was 37.7%,live births were 17 cases,and the cumulative live birth rate was 32.1%.The postoperative total pregnancy rate was 26.4%within 1 year after surgery,which was higher than 2-5 years.The cumulative pregnancy rate was 11.3%(P>0.05).Preoperative pregnancy rates in patients with a history of miscarriage were lower than those without abortion(P<0.05).The average age of postoperative pregnancy was significantly lower than that of non-pregnant patients,and the difference was statistically significant(P<0.001).Factors such as blood type,number of previous deliveries,r-AFS stage,cyst size,and affected ovary did not have a significant effect on postoperative pregnancy rates.The expressions of E-cadherin,Keratin 18,N-cadherin,Vimentin,and estrogen and progesterone receptors in the ectopic endometrium of the recurrent and non-recurrent groups were compared.Results showed that E-cadherin and Keratin 18 were highly expressed in the non-relapsed group,while N-cadherin and Vimentin were highly expressed in the relapsed group.The expression of estrogen receptor(ERa)in the recurrent group was higher than that in the non-recurrent group;on the contrary,the expression of progesterone receptor(PR)in the non-recurrent group was higher than that in the recurrent group,however,both data were not statistically different.The expression level of ER? in the recurrent group was significantly lower than that in the non-recurrent group.The ability of migration and invasion in the primary endometrial cells in the recurrent group were stronger than that in the non-recurrent group.Conclusion:(1)The peak period of postoperative recurrence probability of patients with endometriosis is within 1-2 years after surgery.(2)The risk of postoperative pregnancy in younger patients with endometriosis is higher than that in older patients.The pregnancy rate is higher in patients without history of abortion than that with abortion.(3)There is a positive correlation between the degree of EMT and the recurrence rate.(4)The biological behavior of ER? is a protective factor for recurrence.