Clinical Features And Recurrence Relative Factors After Conservative Surgery Of Ovarian Endometriosis

Objective: To retrospectively analyze the clinical characteristics,surgical features,postoperative adjuvant therapies and recurrence of patients with ovarian endometriosis who underwent conservative surgery.And to investigate the prognosis-related factors of ovarian endometriosis after conservative operation,aiming to provide a clinical basis for the establishment of treatment plans.Methods: Clinical,surgical and follow-up data was collected of patients who underwent conservative surgeries for ovarian cysts and were diagnosed to be ovarian endometrioma pathologically from 2012.08.01 to 2015.06.01 at Jiangsu Subei People’s hospital.Chief complaints,current medical history,past history,menstrual history,marital and reproductive history,gynecological examination(pelvic tenderness,posterior vaginal fornix nodules,uterine tenderness,etc.),related auxiliary examinations(serum CA125 level,B-ultrasound),intraoperative conditions,postoperative follow-ups,such as pain relief,postoperative adjuvant therapies,postoperative pregnancy,postoperative recurrence(gynecological ultrasound or transvaginal ultrasound,serum CA125 level)were all included.SPSS 22.0 was used for statistical analysis to compare the clinical features,treatments and prognosis of patients between recurrent group and non-recurrent group,as well as to explore the recurrence relative factors of ovarian endometriosis after conservative operations.Results:1.219 patients were included in this study,among which the married,unmarried and divorce number were 178(81.28%),40(18.26%)and 1(0.46).The age ranged from 16 to 48 years and the mean age was 32.53±7.28 years.The maximum cyst diameter varied between 2 to 16 centimeters,with an average value of 6.13±1.78 centimeters.And the average time from the last menstrual period to operation was 17.06±0.74 days.There were 84 cases(38.36%),35 cases(15.98%),25 cases(11.41%)and 75cases(34.25%)who clinically had mild,moderate,severe dysmenorrhea and non-dysmenorrhea separately.5 cases(5.02%)were diagnosed with female infertility while 208 cases(94.98%)were not.79 cases(36.07%)had preoperative treatment and 140(63.93%)without.157 patients(71.69%)had elevated preoperative CA125 levels and 62 cases(28.31%)were normal.The previous pregnancy history was positive in 150 patients(68.49%)and negative in 69 cases(31.51%).There were 119 cases(68.49%)with gynecological benign disease and 100 cases(45.66%)without.2.The number of intraoperative cysts on the left,right and bilateral sides were 86(39.27%),61(27.85%)and 72(32.88%),respectively.The number of r-AFS stage I-II and III-IV were 79(36.07%)and 140(63.03%).90 cases(41.10%)were found with intraoperative adhesions and 129 cases(58.90%)were not.A total of 169 patients(77.17%)had received adjuvant therapies,including 74 patients(51.98%)with Gn RHa,67 patients(48.02%)with progesterone and 28 patients with other therapies separately.What’s more,50 patients(22.83%)hadn’t received any adjuvant therapies.45 cases(20.55%)were pregnant after surgery and 174 cases(79.45%)were not.3.The cumulative recurrence rates of ovarian chocolate cysts in the first,second,and third years after conservative surgery were 7.31%(16/219),18.26%(24/219)and 30.59%(40/219),respectively.4.Univariate analysis showed age,combined with other parts of endometriosis / adenomyosis / adenomyosis,elevated serum CA125 level,posterior vaginal fornix nodules,maximum cyst diameter ≥ 5cm,bilateral cysts,severe dysmenorrhea,middle adhesions,r-AFS staging III to IV,preoperative treatment and previous abortion history were relative risk factors for recurrence of ovarian chocolate cysts after conservative surgery(p<0.05).The relative protective factors were postoperative pregnancy and postoperative adjuvant therapy.(p<0.05).5.COX multivariate analysis showed the maximum cyst diameter ≥ 5cm(HR=5.14,95% CI=[2.37,11.14],p<0.05),r-AFS staging III to IV(HR=2.53,95% CI=[1.09,5.85],p<0.05)and posterior vaginal fornix nodules(HR = 3.26,95% CI = [1.75,6.07],p <0.05)were independent risk factors for postoperative recurrence.Postoperative pregnancy(HR=0.32,95% CI= [0.12,0.88],p<0.05)was an independent protective factor for postoperative recurrence.6.The ROC curve showed that the posterior vaginal fornix nodules,the maximum cyst diameter ≥ 5cm and the r-AFS staging III to IV were statistically significant,with relatively high value for predicting recurrence.The AUC and 95% CI were 0.74(95% CI [0.66,0.82],p< 0.05),0.78(95% CI [0.71,0.84],p < 0.05)and 0.72(95% CI [0.65,0.79],p < 0.05)respectively.Conclusions: 1.Clinical features of patients with ovarian endometriosis have predictive value for recurrence after conservative surgery.2.The maximum cyst diameter≥ 5cm,r-AFS staging III to IV and posterior vaginal fornix nodules were recurrence-related risk factors of ovarian endometriosis after conservative surgery,with multivariate analysis suggested to be independent.3.Postoperative pregnancy and postoperative adjuvant therapy can reduce the recurrence rate of conservative ovarian endometriosis after surgery.Multivariate analysis showed that postoperative pregnancy was an independent protective factor.4.Clinical treatment of patients with ovarian endometriosis should comprehensively consider recurrence related factors,patient fertility requirements,socioeconomic conditions and patient wishes,in order to develop individualized comprehensive treatment programs to improve treatment outcomes and prognosis.