Risk Factors Analysis Of Recurrence Of Pelvic Endometriosis After Fertility Function Preserved Surgery

Background and ObjectiveEndometriosis is caused by ectopic endometrial invasion of normal tissues,which is common among women of childbearing age and is a common disease in gynecology.The pelvic cavity is the most frequently invaded part of the ectopic lesion.The lesion may form nodules or masses locally.Pain and infertility are common clinical symptoms.Laparoscopic fertility function preserved surgery is an effective and commonly used method for the treatment of this disease,but the recurrence rate is high.The factors affecting postoperative recurrence are complex and there is no clear determination.In this study,the risk factors of postoperative recurrence were explored by analyzing and comparing the clinical data of pelvic endometriosis patients with recurrent and non-recurrent patients within 2 years after fertility function preserved surgery.Methods213 patients with endometriosis who underwent fertility function preserved surgery and were followed up for at least 2 years at the Second Affiliated Hospital of Zhengzhou University from September 2013 to September 2016 was choosen,and were classified according to whether they relapsed within 2 years.There were 42patients in the recurrence group and 171 patients in the non-recurrent group.The clinical data were retrospectively analyzed.Observe and compare the relationship between 21 variables of age,education level,blood type,course of disease,history of endometriosis,history of allergies,family history of endometriosis,history of uterine surgery,uterine fibroids,adenomyosis,preoperative pregnancy,preoperative delivery,number of abortions,dysmenorrhea,painful nodules in Douglas pouch,uterine activity,intraoperative staging,lesion side,preoperative serum CA 125(Carbohydrate antigen 125,CA125)level,postoperative pregnancy,postoperative medication and postoperative recurrence.The risk factors for recurrence were screened by univariate analysis of the clinical parameters of the two groups,and the independent risk factors for recurrence were identified by two-class Logistic regression analysis.Results1.Univariate analysis showed that there was a statistically significant difference between the recurrent group and the non-recurrent group in the history of treatment of endometriosis(?~2=10.265;P=0.001),dysmenorrhea(?~2=10.696;P=0.001),painful nodules in Douglas pouch(?~2=11.768;P=0.001),intraoperative staging(?~2=7.781;P=0.005),postoperativepregnancy(?~2=9.724;P=0.002)andpostoperative medication(?~2=7.237;P=0.007).There was no significant difference in the comparison of age,education level,blood type,course of disease,history of allergies,family history of endometriosis,history of intrauterine surgery,uterine fibroids,adenomyosis,preoperative pregnancy,preoperative delivery,number of abortions uterine activity,lesion side,and preoperative serum CA 125 level in two groups(P>0.05).2.Multivariate two-class Logistic regression analysis showed that the independent relevant factors of postoperative recurrence included the history of treatmentofendometriosis(OR=4.377,95%CI=1.466-13.066,P=0.008),dysmenorrhea(OR=2.933,95%CI=1.232).-6.983,P=0.015),painful nodules in Douglas pouch(OR=2.852,95%CI=1.063-7.654,P=0.037),intraoperative staging(OR=2.492,95%CI=1.070-5.804,P=0.034),postoperative pregnancy(OR=0.239,95%CI=0.074-0.767,P=0.016)and postoperative medication(OR=0.241,95%CI=0.094-0.615,P=0.003).Conclusions1.History of treatment of endometriosis,dysmenorrhea,painful nodules in Douglas pouch and intraoperative staging(stage III-IV)are independent risk factors for recurrence after fertility function preserved surgery in patients with pelvic endometriosis.2.Postoperative pregnancy and postoperative drug therapy are independent protective factors for for recurrence after fertility function preserved surgery in patients with pelvic endometriosis.