Deng Shan, Leng Jin-hua, Lang Jing-he, Dai Yi, Li Xiao-yan
Department of Obstetrics and Gynecology, Chinese Academy of Medical Sciences, Beijing, China.
Zhonghua Fu Chan Ke Za Zhi. 2011 Nov;46(11):809-12.
To investigate clinicopathological characteristics of recurrent endometriosis and outcomes of secondary surgery.
From Jan. 2003 to Dec. 2008, 69 cases with recurrent endometriosis operated by the same senior gynecologist in Peking Union Medical College Hospital were studied retrospectively in order to summarize clinicopathological characteristics and clinical outcomes. In prior surgery, both ovaries were involved in 29 cases (42%, 29/69), and unilateral ovarian endometriomas were found in 40 cases (58%, 40/69), including 19 cases (48%, 19/40) with left lesions and 21 cases (52%, 21/40) with right lesions. After first surgery, 57 cases presented recurrent pelvic cystic masses and 12 cases presented moderate to severe pain without pelvic mass.
The median recurrence interval was 38 (1 - 144) months. Among 57 cases with recurrent pelvic masses, bilateral ovarian endometiomas recurred in 24 cases at median recurrence interval of 31 months. Unilateral ovarian endometrioma recurred in 33 cases at recurrence interval of 39 months. There was no significant different recurrence period between bilateral and unilateral recurrent ovarian mass (P = 0.452). The recurrent rate of left and right side ovarian lesion was 77% (37/48) and 68% (34/50 cases), respectively, which did not reach statistical difference (P = 0.396). Among 12 recurrent cases with pure pelvic pain, 10 cases were founded combined with adenomyosis (AM), of which 4 cases had deep infiltrated endometriosis (DIE). Compared with the 40 cases of simple ovarian endometriomas, 29 cases complicated by DIE and (or) AM had longer operation time (75.1 min vs. 49.9 min, P = 0.017) and more blood loss (114.9 ml vs. 38.4 ml, P < 0.05). In those 69 recurrent endometriosis patients, the median period of following-up was 32 months (3 months to 8 years). Six cases showed recurrent disease again at median recurrence interval of 3 years (6 months-6 years). Thirty-eight cases had expecting childbearing, however, only 4 women underwent childbirth.
The rate of clinical diagnosis of recurrent endometriosis is quite high. Pain is mostly associated with AM. The major difficulty and challenge of secondary surgery was ovarian endometrioma combined with DIE or AM. Prognosis of recurrent endometriosis is not optimistic after secondary surgery.
探讨复发性子宫内膜异位症的临床病理特征及二次手术的结局。
回顾性研究2003年1月至2008年12月在北京协和医院由同一位资深妇科医生手术治疗的69例复发性子宫内膜异位症患者，以总结其临床病理特征及临床结局。首次手术时，双侧卵巢受累29例（42%，29/69），单侧卵巢子宫内膜异位囊肿40例（58%，40/69），其中左侧病变19例（48%，19/40），右侧病变21例（52%，21/40）。首次手术后，57例出现复发性盆腔囊性包块，12例出现中重度疼痛但无盆腔包块。
复发间隔中位数为38（1 - 144）个月。57例复发性盆腔包块患者中，双侧卵巢子宫内膜异位症复发24例，复发间隔中位数为31个月。单侧卵巢子宫内膜异位囊肿复发33例，复发间隔为39个月。双侧和单侧复发性卵巢包块的复发时间无显著差异（P = 0.452）。左侧和右侧卵巢病变的复发率分别为77%（37/48）和68%（34/50例），差异无统计学意义（P = 0.396）。12例单纯盆腔疼痛复发患者中，10例合并子宫腺肌病（AM），其中4例有深部浸润性子宫内膜异位症（DIE）。与40例单纯卵巢子宫内膜异位囊肿患者相比，29例合并DIE和（或）AM的患者手术时间更长（75.1分钟对49.9分钟，P = 0.017），出血量更多（114.9毫升对38.4毫升，P < 0.05）。69例复发性子宫内膜异位症患者的随访时间中位数为32个月（3个月至8年）。6例在复发间隔中位数为3年（6个月至6年）时再次复发。38例有生育期望，但只有4名女性分娩。
复发性子宫内膜异位症的临床诊断率相当高。疼痛大多与子宫腺肌病有关。二次手术的主要困难和挑战是卵巢子宫内膜异位囊肿合并DIE或AM。复发性子宫内膜异位症二次手术后的预后不容乐观。
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