Clinical Analysis Of 31 Cases Of Adolescent Endometriosis

Background:Endometriosis is a gynecological disorder that endometrial stroma and glands implant outside the uterus.Patients with endometriosis may have relevant symptoms occurring during adolescence,but diagnosis is often delayed.In 2004,World Health Organization(WHO)established that endometriosis occurring in adolescent women aged 10-19 is called adolescent endometriosis.The main clinical manifestations of adolescent endometriosis are dysmenorrhea and chronic pelvic pain which is unrelated to menstrual cycle.The pathological manifestations of adolescent endometriosis are varied,such as ovarian endometriosis,peritoneal endometriosis,and even deep infiltrating endometriosis.Endometriosis is a progressive diseases,besides diagnosis in adolescent patients is often delayed,so that the pelvic structure of adolescent female can be badly destroyed,which has a serious physical and mental impact on the population.Endometriosis can also cause damage to long-term reproductive function.So,early diagnosis and timely treatment are particularly important for adolescent patients with endometriosis.The main treatments of endometriosis are surgical therapy and drug treatment.But there are some limitations in the treatment of adolescent patients with endometriosis.At the same time,due to the particularity of the adolescent population,psychological counseling and treatment should not be neglected.Therefore,further research on adolescent endometriosis is urgently needed.Objective:Through a retrospective analysis of the data of 31 cases of adolescent endometriosis in the Second Hospital of Jilin University,the pathogenesis,clinical manifestations,diagnosis and treatment of the disease were analyzed to provide theoretical basis for the clinical diagnosis and treatment of adolescent endometriosis.Methods:A total of 33 patients aged 10-19 with endometriosis who were diagnosed by pathology after operation in the Second Hospital of Jilin University from January 2013 to September 2018 were collected.We understand the pathogenesis,high risk factors,clinical manifestations,diagnosis and treatment of adolescent endometriosis through statistical analysis of clinical data of these patients.Results:Altogether 33 patients were included in this study,of which 31 cases were followed up successfully.The average age of 31 patients diagnosed was(16.97±0.67)years,and the average age of menarche was(13.03±0.52)years.Among them,the clinical manifestations were dysmenorrhea(90.32%),chronic pelvic pain(29.03%),abnormal menstruation(menorrhagia,irregular menstrual cycle,etc.)(35.48%),dyspareunia(3.23%),other manifestations(such as gastrointestinal symptoms,genitourinary symptoms,nervous system symptoms,etc.)(16.13%),and BMI index < 18 of 5 cases(16.13%).31 cases were examined by ultrasound before operation,in which 3 patients were indicated endometriosis and 28 patients were indicated pelvic mass.Preoperative CA125 examination was performed in 23 patients and 17 of them were abnormal.Intraoperative staging was performed by r-ASF staging method:6 cases stage I,9 cases stage II,8cases stage III,8cases stage IV.7 cases with genital tract malformation,including uterine deformity 4 cases,vaginal deformity 1 cases,infantile uterus with hymen atresia 1 cases,complete mediastinal uterus with vaginal mediastinum 1 cases.The mean age of diagnosis was(14.71±2.21)years in the malformation group and(17.62±1.06)years in the non-malformation group,and the difference of these two groups was statistically significant.The time between menarche and diagnosis was(2.14±0.90)years in the malformation group and(4.46±1.59)years in the non-malformation group,and the difference of these two groups was statistically significant.Compared with the non-malformed group,the lesion involved in the genital tract malformation group was smaller and earlier.All the 31 patients received surgical treatment,including laparoscopic surgery 22 cases(70.97%),hysteroscopy combined with laparoscopic surgery 2 cases(6.45%)and open surgery 7 cases(22.58%).Ovarian endometriosis cyst exfoliation was performed in 27 cases,pelvic endometriosis ablation in 6 cases,hysterectomy and cut open the atresia of hymen in 1 cases,stump hysterectomy 1 cases,hysterectomy of the mediastinum and remove the vaginal mediastinum 1 cases.Postoperative adjuvant drug therapy included 22 patients(70.97%),among which recurrence rate was 18.18%(4/22),and recurrence rate in the simple surgery group was 66.67%(6/9),and the difference of these two groups was statistically significant.Conclusion:Genital tract malformation,especially obstructive genital tract malformation,is easy to lead to the occurrence of endometriosis in adolescence.The main clinical manifestations are dysmenorrhea and chronic pelvic pain during adolescence.Auxiliary examination,such as gynecological color doppler ultrasound,CA125 are helpful to the diagnosis of adolescent endometriosis.Surgical treatment is the main method for adolescent endometriosis,and postoperative adjuvant drug treatment is of great significance for reducing recurrence.