Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, China.
Adv Ther. 2020 May;37(5):2159-2168. doi: 10.1007/s12325-020-01299-w. Epub 2020 Mar 21.
Ovarian endometriosis is the most common type of endometriosis (EM), affecting more than 40% of women with EM. Currently, surgical intervention is still controversial in infertile patients with ovarian endometriosis, especially in those with stage III-IV EM. Very few studies have been done to analyze long-term pregnancy results in patients with endometrioma more than 5 years after surgery. Therefore, the aim of this study was to explore the pregnancy outcomes and the related factors in patients with endometrioma and stage III-IV endometriosis during a long-term follow-up postoperatively.
We collected 347 patients with ovarian endometriosis, which included 59 infertile patients with stage III-IV endometriosis who had a minimum of 5 years of postoperative follow-up after undergoing laparoscopic excision of ovarian endometriomas performed by a single doctor at the Peking Union Medical College Hospital from January 2009 to April 2013.
A total of 59 infertile patients were recruited. The mean age was 31.8 ± 3.6 years. The mean size of the endometriomas was 6.8 ± 3.3 cm. Before surgery, dysmenorrhea was present in 88.1% (52/59) of the cases, while chronic pelvic pain was reported in nine cases (15.3%). A total of 20.3% (12/59) of cases were concurrent with leiomyoma, 52.5% (31/59) with deep infiltrating endometriosis (DIE), and 39.0% (23/59) with adenomyosis. During laparoscopy, 21 cases were diagnosed as stage III (35.6%) and 38 as stage IV (64.4%) EM according to the revised American Fertility Society (AFS) classification. After laparoscopic cystectomy, 38 (64.4%) patients became successfully pregnant by the 5th year. All the patients were divided into two groups according to the postoperative pregnancy outcomes. In univariate analysis, the higher mean age and concurrent diagnosis of adenomyosis were seen to be related to poor postoperative pregnancy outcomes (p < 0.05). In multivariate analysis, however, the mean age, chronic pelvic pain (CPP), and adenomyosis were independent risk factors of pregnancy outcomes between the two groups (p < 0.05). With a minimum follow-up of 6 years, 23.7% (14/59) of recurrence was observed in the entire study cohort.
Infertile patients with endometrioma and stage III-IV EM may have lower pregnancy rates after laparoscopic cystectomy if they are older and present with CPP and adenomyosis. Our data showed a lower rate of recurrence but a higher rate of pregnancy after surgery.
卵巢子宫内膜异位症（EM）是最常见的 EM 类型，影响超过 40%的 EM 患者。目前，对于卵巢子宫内膜异位症的不孕患者，尤其是 III-IV 期的患者，手术干预仍存在争议。很少有研究分析手术后 5 年以上患有子宫内膜异位症的患者的长期妊娠结果。因此，本研究旨在探讨长期随访术后患有子宫内膜异位症和 III-IV 期子宫内膜异位症的患者的妊娠结局及其相关因素。
我们收集了 347 例卵巢子宫内膜异位症患者，其中 59 例为不孕且患有 III-IV 期子宫内膜异位症的患者，这些患者均于 2009 年 1 月至 2013 年 4 月期间在我院接受了由同一位医生进行的腹腔镜卵巢子宫内膜异位囊肿切除术，术后随访时间至少 5 年。
共纳入 59 例不孕患者。患者平均年龄为 31.8±3.6 岁。子宫内膜异位症囊肿的平均大小为 6.8±3.3cm。术前，88.1%（52/59）的患者有痛经，9 例（15.3%）有慢性盆腔痛。20.3%（12/59）的患者合并子宫肌瘤，52.5%（31/59）的患者合并深部浸润型子宫内膜异位症（DIE），39.0%（23/59）的患者合并子宫腺肌病。腹腔镜检查时，根据修订后的美国生殖医学协会（AFS）分类，21 例（35.6%）诊断为 III 期，38 例（64.4%）诊断为 IV 期 EM。腹腔镜囊肿切除术后，第 5 年有 38 例（64.4%）患者成功妊娠。根据术后妊娠结局将所有患者分为两组。单因素分析显示，年龄较高和合并子宫腺肌病与术后妊娠结局较差相关（p<0.05）。然而，多因素分析显示，年龄、慢性盆腔痛（CPP）和子宫腺肌病是两组间妊娠结局的独立危险因素（p<0.05）。在整个研究队列中，随访至少 6 年，有 23.7%（14/59）的患者复发。
对于卵巢子宫内膜异位囊肿且患有 III-IV 期子宫内膜异位症的不孕患者，如果年龄较大且伴有 CPP 和子宫腺肌病，腹腔镜囊肿切除术后妊娠率可能较低。我们的数据显示复发率较低，但手术后妊娠率较高。
