Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, 128 Shenyang Road, Shanghai, 200090, China.
Shanghai Key Laboratory of Female Reproductive Endocrine Related Disease, 413 Zhaozhou Road, Shanghai, China.
BMC Womens Health. 2022 Mar 21;22(1):83. doi: 10.1186/s12905-022-01666-5.
This study aimed to summarize and analyze clinical characteristics and reproductive outcomes in postoperative deep infiltrating endometriosis (DIE).
This retrospective cohort study included 55 reproductive-aged patients who were diagnosed with DIE, wished to conceive and underwent resection surgery at the Obstetrics and Gynecology Hospital, Fudan University, from January 2009-June 2017. Those with any plausible infertility factor or abnormalities in the partner's semen analysis were excluded. Patient characteristics, preoperative symptoms, infertility history, intraoperative findings and reproductive outcomes were followed up and recorded. Risk factors for reproductive outcomes were identified for women who became pregnant versus those who did not by univariate logistic regression. Additionally, pre- and postoperative endometriosis health profile questionnaire-30 (EHP-30), Knowles-Eccersley-Scott Symptom questionnaire (KESS), Cox Menstrual Symptom Scale (CMSS) and Female Sexual Function Index (FSFI) scores were used to evaluate the effect of DIE surgery on quality of life.
The average age was 30.22 ± 3.62 years, with no difference between the pregnancy and nonpregnancy groups. The average follow-up time was 26.57 ± 14.51 months. There were 34 pregnancies (61.82%): 24 (70.59%) conceived spontaneously and 10 (29.41%) by in vitro fertilization (IVF). Twenty-eight patients (82.35%) had term deliveries. The interval between operation and pregnancy was 10.33 ± 5.6 (1-26) months. Univariate analysis showed that a lower endometriosis fertility index (EFI) score (EFI < 8) was a risk factor for infertility (OR: 3.17 (1.15-10.14), p = .044). For patients with incomplete surgery, postoperative gonadotropin-releasing hormone agonist (GnRHa) administration improved the pregnancy rate (p < 0.05). Regarding quality of life, there was significant improvement (p < 0.05) in the postoperative EHP-30, KESS and CMSS scores compared with preoperative scores in both groups. Although there was no obvious difference in FSFI scores, significant improvement in dyspareunia was observed (p < 0.05).
Overall, the postoperative pregnancy rate of DIE patients was 61.82%. Surgical management of DIE for patients with complaints of pain and with pregnancy intentions was feasible and effective. Long-term expectant treatment should not be advised for patients with lower EFI scores (EFI < 8), and postoperative IVF-ET may be a good choice. More cases should be enrolled for further study, and randomized studies are required.
本研究旨在总结和分析术后深部浸润型子宫内膜异位症（DIE）的临床特征和生殖结局。
这是一项回顾性队列研究，纳入了 2009 年 1 月至 2017 年 6 月在复旦大学妇产科医院就诊并诊断为 DIE、有生育愿望且接受了手术切除的 55 例育龄期妇女。排除存在任何合理不孕因素或其伴侣精液分析异常的患者。随访并记录患者特征、术前症状、不孕史、术中发现和生殖结局。采用单因素 logistic 回归分析妊娠组和未妊娠组患者的生殖结局的影响因素。此外，采用子宫内膜异位症健康状况问卷-30 量表（EHP-30）、Knowles-Eccersley-Scott 症状问卷（KESS）、Cox 月经症状量表（CMSS）和女性性功能指数（FSFI）评分评估 DIE 手术对生活质量的影响。
患者平均年龄为 30.22±3.62 岁，妊娠组和未妊娠组间无差异。平均随访时间为 26.57±14.51 个月。34 例（61.82%）妊娠：24 例（70.59%）自然受孕，10 例（29.41%）行体外受精（IVF）。28 例（82.35%）足月分娩。手术至妊娠的时间间隔为 10.33±5.6（1-26）个月。单因素分析显示，较低的子宫内膜异位症生育指数（EFI）评分（EFI＜8）是不孕的危险因素（OR：3.17（1.15-10.14），p=0.044）。对于手术不彻底的患者，术后给予促性腺激素释放激素激动剂（GnRHa）治疗可提高妊娠率（p＜0.05）。在两组患者中，与术前相比，术后 EHP-30、KESS 和 CMSS 评分均显著改善（p＜0.05）。尽管 FSFI 评分无明显差异，但性交困难明显改善（p＜0.05）。
总体而言，DIE 患者的术后妊娠率为 61.82%。对于有疼痛症状且有生育愿望的 DIE 患者，手术治疗是可行且有效的。对于 EFI 评分较低（EFI＜8）的患者，不建议长期进行期待性治疗，术后 IVF-ET 可能是一个不错的选择。需要纳入更多病例进行进一步研究，并开展随机对照研究。
