Liu Xishi, Long Qiqi, Guo Sun-Wei
Shanghai Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Shanghai, China.
Shanghai Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China.
Reprod Sci. 2016 Sep;23(9):1217-24. doi: 10.1177/1933719116632921. Epub 2016 Feb 25.
Women tend to receive more surgical procedures than men. Our mouse study shows that surgical stress promotes the development of endometriosis. This study was undertaken to test the hypothesis that surgery increases the risk of endometriosis. We recruited 208 patients with ovarian endometrioma and 212 age-matched patients with ovarian teratoma and retrieved information on the history of any surgical procedures after menarche, grouped by laparotomy, laparoscopy, gynecologically related procedures, cesarean section, and surgeries performed on torso and extremities was recorded. We then evaluated the association, if any, between endometriosis and history of surgical procedures. Cases and controls were comparable with respect to age, marital status, education level, and occupation. Eleven (5.3%) cases had laparotomy before the index surgery while 4 (1.9%) controls did. Sixty-six (31.7%) cases had Cesarean section while 53 (25.0%) controls did. Multivariate analysis identified age, at the index surgery laparotomy, and cesarean section as 3 factors positively associated with the risk of endometriosis while parity was found to be negatively associated with the risk. Laparotomy was associated with increased risk of endometriosis (odds ratio [OR] = 3.64, 95% confidence interval [CI] = 1.08-12.31), while cesarean section was associated with 2-fold increase in risk (OR = 2.16, 95% CI = 1.31-3.55). Both laparotomy and cesarean section may increase the risk of endometriosis probably by activation of adrenergic signaling, thus facilitating angiogenesis and accelerating the growth of endometriotic lesions that are already in existence. This finding may have important ramifications for the perioperative management of patients with increased risk or recurrence risk of endometriosis.
女性接受的外科手术往往比男性更多。我们的小鼠研究表明，手术应激会促进子宫内膜异位症的发展。本研究旨在验证手术会增加子宫内膜异位症风险这一假设。我们招募了208例卵巢子宫内膜异位囊肿患者和212例年龄匹配的卵巢畸胎瘤患者，并收集了初潮后任何外科手术史的信息，按剖腹手术、腹腔镜检查、妇科相关手术、剖宫产以及躯干和四肢手术进行分组记录。然后，我们评估了子宫内膜异位症与外科手术史之间是否存在关联。病例组和对照组在年龄、婚姻状况、教育水平和职业方面具有可比性。11例（5.3%）病例在索引手术前接受过剖腹手术，而对照组有4例（1.9%）。66例（31.7%）病例接受过剖宫产，而对照组有53例（25.0%）。多因素分析确定，在索引手术时的年龄、剖腹手术和剖宫产是与子宫内膜异位症风险呈正相关的3个因素，而产次与风险呈负相关。剖腹手术与子宫内膜异位症风险增加相关（优势比[OR]=3.64，95%置信区间[CI]=1.08 - 12.31），而剖宫产与风险增加2倍相关（OR = 2.16，95% CI = 1.31 - 3.55）。剖腹手术和剖宫产都可能通过激活肾上腺素能信号通路增加子宫内膜异位症的风险，从而促进血管生成并加速已存在的子宫内膜异位病灶的生长。这一发现可能对子宫内膜异位症风险增加或复发风险增加的患者的围手术期管理具有重要意义。
