Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, British Columbia Women's Hospital and Health Care Centre, Vancouver, British Columbia, Canada.
Fertil Steril. 2010 Jan;93(1):57-61. doi: 10.1016/j.fertnstert.2008.09.085. Epub 2008 Nov 11.
To assess the behavior of revised American Fertility Society stages I and II endometriosis after surgical treatment, by observation of location of pelvic involvement at reoperation.
Prospective study.
Tertiary referral center at a university-based hospital.
PATIENT(S): Thirty-nine women with persistent or recurrent chronic pelvic pain after laparoscopic excision or ablation of histologically confirmed endometriosis who underwent a second laparoscopy.
INTERVENTION(S): Laparoscopic pelvic mapping and surgical treatment of endometriosis, followed by repeat laparoscopic pelvic mapping of endometriosis at a second laparoscopy.
RESULT(S): Superficial peritoneal endometriosis (revised American Fertility Society stage I-II) endometriosis recurred in 37% of pelvic regions after surgical treatment. Endometriosis was more likely to recur in a treated pelvic region than an adjacent or distant pelvic region (relative risk 2.54; 95% confidence interval 1.63-3.97). A region adjacent to a previously affected pelvic region that was unaffected by endometriosis at the initial laparoscopy was more likely to have endometriosis at the second laparoscopy than a pelvic region distant from the treated pelvic region (relative risk 1.29; 95% confidence interval 0.84-2.0). Unaffected regions at initial laparoscopy had a low probability of having new endometriosis (11%) in the second laparoscopy.
CONCLUSION(S): Recurrence of histologically proven endometriosis after surgical excision is more likely to cluster close to the original area of involvement, reflecting either incomplete excision at the initial surgery or a nonrandom favored implantation of new endometrial implants in adjacent peritoneum. Further studies are needed to elucidate the pathophysiology and mechanisms of recurrence of endometriosis.
通过观察再次手术时盆腔受累部位，评估手术治疗后改良美国生殖医学学会分期 I 和 II 期子宫内膜异位症的行为。
前瞻性研究。
大学附属医院的三级转诊中心。
39 例腹腔镜切除或消融组织学证实的子宫内膜异位症后持续性或复发性慢性盆腔痛的妇女，再次行腹腔镜检查。
腹腔镜盆腔绘图和子宫内膜异位症手术治疗，然后在第二次腹腔镜检查时再次重复腹腔镜盆腔子宫内膜异位症绘图。
手术后，有 37%的盆腔区域出现浅表腹膜子宫内膜异位症（改良美国生殖医学学会分期 I-II 期）子宫内膜异位症复发。与邻近或远处盆腔区域相比，治疗后的盆腔区域更有可能复发（相对风险 2.54；95%置信区间 1.63-3.97）。与治疗后的盆腔区域相比，最初腹腔镜检查时未受累及的邻近盆腔区域更有可能在第二次腹腔镜检查时出现子宫内膜异位症（相对风险 1.29；95%置信区间 0.84-2.0）。最初腹腔镜检查时未受累及的区域在第二次腹腔镜检查中出现新的子宫内膜异位症的可能性较低（11%）。
手术切除后组织学证实的子宫内膜异位症的复发更有可能聚集在最初受累区域附近，这反映了初始手术时的不完全切除或新子宫内膜植入物在邻近腹膜中的非随机有利植入。需要进一步研究阐明子宫内膜异位症复发的病理生理学和机制。
