卵巢子宫内膜异位症患者腹腔镜保守性手术后复发相关因素分析
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摘要
目的:探讨卵巢子宫内膜异位症患者腹腔镜保守性手术后复发的影响因素。方法:回顾分析2012年6月-2016年6月在郑州大学第三附属医院妇科行腹腔镜保守性手术且术后按纳入条件随访资料完整的卵巢子宫内膜异位症304例的临床资料,以术后2年内复发的70例为观察组,以未复发的234例为对照组,采用单因素及多因素Logistic回归分析法分析复发的相关影响因素。结果:单因素回归分析在年龄、术前痛经、术前产次、既往治疗史、既往就诊医院级别、卵巢囊肿侧别、手术分期、术后药物(促性腺激素释放激素激动剂,Gn RH-a)治疗、术后妊娠均与卵巢子宫内膜异位症复发相关(P<0.05)。多因素回归分析显示,术前痛经、既往药物治疗、双侧卵巢囊肿是卵巢子宫内膜异位症复发的危险因素。而年龄大、既往就诊三级甲等医院、术后药物(Gn RH-a)治疗、术后妊娠4个因素是卵巢子宫内膜异位症复发的保护因素。结论:对有高危因素的卵巢子宫内膜异位症患者,应选择级别高的医院就诊,早期发现、早期手术,采取创伤小、能彻底清除病灶的个体化治疗方案,术后相关药物治疗及术后受孕可以有效预防子宫内膜异位症的发生。
Objective:To investigate the influencing factors of recurrence after laparoscopic conservative surgery in patients with ovarian endometriosis.Method:From June 2012 to June 2016 in the Third Affiliated Hospital of Zhengzhou University gynecological laparoscopic conservative surgery and postoperative follow-up data included 304 patients according to the condition of complete ovarian endometriosis,with postoperative recurrence within 2 years of the 70 cases of the observation group,with no recurrence in 234 cases as the control group,using logistic single factor and multiple regression analysis of recurrence related factors.Result:Single factor regression analysis of age,preoperative dysmenorrhea,preoperative production,previous treatment history,previous hospital level,ovarian cyst side,surgical stage, postoperative drug(Gn RH-a) treatment,postoperative pregnancy and ovarian endometriosis recurrence were statistically significant(P<0.05).Multivariate regression analysis showed that preoperative dysmenorrhea,previous drug treatment,bilateral ovarian cysts were risk factors for recurrence of ovarian endometriosis.Four factors,including age,previous treatment of three hospitals,postoperative drugs(Gn RH-a) treatment,postoperative pregnancy were protective factors for the recurrence of ovarian endometriosis.Conclusion:For patients with high risk factors of ovarian endometriosis,should choose a high level of hospital treatment,early detection,early surgery,taking trauma,can completely remove the lesion of the individualized treatment plan.Postoperative related drug therapy and postoperative pregnancy can effectively prevent the occurrence of endometriosis.
Objective:To investigate the influencing factors of recurrence after laparoscopic conservative surgery in patients with ovarian endometriosis.Method:From June 2012 to June 2016 in the Third Affiliated Hospital of Zhengzhou University gynecological laparoscopic conservative surgery and postoperative follow-up data included 304 patients according to the condition of complete ovarian endometriosis,with postoperative recurrence within 2 years of the 70 cases of the observation group,with no recurrence in 234 cases as the control group,using logistic single factor and multiple regression analysis of recurrence related factors.Result:Single factor regression analysis of age,preoperative dysmenorrhea,preoperative production,previous treatment history,previous hospital level,ovarian cyst side,surgical stage, postoperative drug(Gn RH-a) treatment,postoperative pregnancy and ovarian endometriosis recurrence were statistically significant(P<0.05).Multivariate regression analysis showed that preoperative dysmenorrhea,previous drug treatment,bilateral ovarian cysts were risk factors for recurrence of ovarian endometriosis.Four factors,including age,previous treatment of three hospitals,postoperative drugs(Gn RH-a) treatment,postoperative pregnancy were protective factors for the recurrence of ovarian endometriosis.Conclusion:For patients with high risk factors of ovarian endometriosis,should choose a high level of hospital treatment,early detection,early surgery,taking trauma,can completely remove the lesion of the individualized treatment plan.Postoperative related drug therapy and postoperative pregnancy can effectively prevent the occurrence of endometriosis.
引文
[1]Dimitrijevic D,Vasiljevic M,Anicic R,et al.Recurrence rate of ovarian endometriosis in patients treated with laparoscopic surgery and postoperative suppressive therapy[J].Clin Exp Obstet Gynecol,2015,42(3):339-343.
[2]Paka C,Miller J,Nezhat C.Predictive factors and treatment of recurrence of endometriosis[J].Minerva Ginecol,2013,65(2):105-111.
[3]谢幸,苟文丽.妇产科学[M].8版.北京:人民卫生出版社,2013:268-274.
[4]Cucinella G,Granese R,Calagna G,et al.Oral contraceptives in the prevention of endometrioma recurrence:does the different progestins used make a difference[J].Arch Gynecol Obstet,2013,288(4):821-827.
[5]中华医学会妇产科学分会子宫内膜异位症协作组.子宫内膜异位症的诊治指南[J].中华妇产科杂志,2015,50(3):161-169.
[6]于玲,田永杰.子宫内膜异位症发病相关因素的临床研究[J].山东大学学报(医学版),2013,63(2):79-83.
[7]崔丹,崔满华.子宫内膜异位症复发的相关因素研究[J].中国妇幼保健,2013,28(15):2369-2371.
[8]廖金兰,陆桂玲.腹腔镜手术联合药物治疗子宫内膜异位症117例临床分析[J].医学临床研究,2014,27(8):1441-1443.
[9]Kim M L,Kim J M,Seong S J,et al.Recurrence of ovarian endometrioma after second-line,conservative,laparoscopic cyst e-nucleation[J].American Journal of Obstetrics and Gynecology,2014,210(3):216.
[10]李雪英,罗军,程卫.多因素分析腹腔镜术后子宫内膜异位症复发[J].中国内镜杂志,2010,16(8):813-816.
[11]Ouchi N,Akira S,Mine K,et al.Recurrence of ovarian endometrioma after laparoscopic excision:Risk factors and prevention[J].Journal of Obstetrics and Gynaecology Research,2014,40(1):230-236.
[12]郭欢欢,申爱荣,徐胜男,等.腹腔镜卵巢子宫内膜异位囊肿保守性手术后复发的相关因素分析[J].中南大学学报(医学版),2016,41(4):405-410.
[13]Granese R,Perino A,Calagna G,et al.Gonadotrophinreleasing hormone analogue or dienogest plus estradiol valerate to prevent pain recurrence after laparoscopic surgery for endometriosis:a multi-center randomized trial[J].Acta Obstet Gynecol Scand,2015,94(6):637-645.
[14]赵蕾.子宫内膜异位症保守手术后复发相关危险因素探讨[J].吉林医学,2016,10(37):2500-2501.
[15]Zheng Q,Mao H,Xu Y,et al.Can postoperative Gn RH agonist treatment prevent endometriosis recurrence A metaanalysis[J].Arch Gynecol,2016,294(1):201-207.
[16]Vercellini P.Introduction:Management of endometriosis:moving toward a problem-oriented and patient-centered approach[J].Fertil Steril,2015,104(4):761-763.
[17]周洋,吴玉仙,金志军.子宫内膜异位症发病机制的研究进展[J].国际妇产科学杂志,2017,44(1):103-107.
[18]宁丽,陈萱,庄如锦,等.子宫内膜异位症发病机制的研究进展[J].现代生物医学进展,2016,16(3):593-596,556.
[19]刘玉敏,汪雯雯,符金花.子宫内膜异位症术后复发相关因素分析[J].中国妇幼保健,2015,30(35):6184-6185.
[20]Zhang L,Xiong W,Xiong Y,et al.17β-Estradiol promotes vascularendothelial growth factor expression via the Wnt/β-catenin pathwayduring the pathogenesis of endometriosis[J].Mol Hum Reprod,2016,22(7):526-535.
[2]Paka C,Miller J,Nezhat C.Predictive factors and treatment of recurrence of endometriosis[J].Minerva Ginecol,2013,65(2):105-111.
[3]谢幸,苟文丽.妇产科学[M].8版.北京:人民卫生出版社,2013:268-274.
[4]Cucinella G,Granese R,Calagna G,et al.Oral contraceptives in the prevention of endometrioma recurrence:does the different progestins used make a difference[J].Arch Gynecol Obstet,2013,288(4):821-827.
[5]中华医学会妇产科学分会子宫内膜异位症协作组.子宫内膜异位症的诊治指南[J].中华妇产科杂志,2015,50(3):161-169.
[6]于玲,田永杰.子宫内膜异位症发病相关因素的临床研究[J].山东大学学报(医学版),2013,63(2):79-83.
[7]崔丹,崔满华.子宫内膜异位症复发的相关因素研究[J].中国妇幼保健,2013,28(15):2369-2371.
[8]廖金兰,陆桂玲.腹腔镜手术联合药物治疗子宫内膜异位症117例临床分析[J].医学临床研究,2014,27(8):1441-1443.
[9]Kim M L,Kim J M,Seong S J,et al.Recurrence of ovarian endometrioma after second-line,conservative,laparoscopic cyst e-nucleation[J].American Journal of Obstetrics and Gynecology,2014,210(3):216.
[10]李雪英,罗军,程卫.多因素分析腹腔镜术后子宫内膜异位症复发[J].中国内镜杂志,2010,16(8):813-816.
[11]Ouchi N,Akira S,Mine K,et al.Recurrence of ovarian endometrioma after laparoscopic excision:Risk factors and prevention[J].Journal of Obstetrics and Gynaecology Research,2014,40(1):230-236.
[12]郭欢欢,申爱荣,徐胜男,等.腹腔镜卵巢子宫内膜异位囊肿保守性手术后复发的相关因素分析[J].中南大学学报(医学版),2016,41(4):405-410.
[13]Granese R,Perino A,Calagna G,et al.Gonadotrophinreleasing hormone analogue or dienogest plus estradiol valerate to prevent pain recurrence after laparoscopic surgery for endometriosis:a multi-center randomized trial[J].Acta Obstet Gynecol Scand,2015,94(6):637-645.
[14]赵蕾.子宫内膜异位症保守手术后复发相关危险因素探讨[J].吉林医学,2016,10(37):2500-2501.
[15]Zheng Q,Mao H,Xu Y,et al.Can postoperative Gn RH agonist treatment prevent endometriosis recurrence A metaanalysis[J].Arch Gynecol,2016,294(1):201-207.
[16]Vercellini P.Introduction:Management of endometriosis:moving toward a problem-oriented and patient-centered approach[J].Fertil Steril,2015,104(4):761-763.
[17]周洋,吴玉仙,金志军.子宫内膜异位症发病机制的研究进展[J].国际妇产科学杂志,2017,44(1):103-107.
[18]宁丽,陈萱,庄如锦,等.子宫内膜异位症发病机制的研究进展[J].现代生物医学进展,2016,16(3):593-596,556.
[19]刘玉敏,汪雯雯,符金花.子宫内膜异位症术后复发相关因素分析[J].中国妇幼保健,2015,30(35):6184-6185.
[20]Zhang L,Xiong W,Xiong Y,et al.17β-Estradiol promotes vascularendothelial growth factor expression via the Wnt/β-catenin pathwayduring the pathogenesis of endometriosis[J].Mol Hum Reprod,2016,22(7):526-535.