卵巢子宫内膜异位囊肿术后复发患者的临床病理特点和手术疗效分析

目的 分析卵巢子宫内膜异位症(内异症)囊肿术后复发的临床病理特点和手术疗效.方法 回顾性分析2003年1月至2008年12月北京协和医院收治的69例卵巢内异症囊肿术后复发患者的临床资料,分析总结其复发特点及临床结局.前次手术双侧卵巢内异症囊肿29例(42％,29/69);单侧40例(58％,40/69),其中左侧19例(48％,19/40),右侧21例(52％,21/40).术后包块复发57例,单纯疼痛复发12例.结果 69例患者中位复发间隔时间38个月(1～144个月).57例包块复发患者中,双侧卵巢内异症囊肿术后复发24例,中位复发间隔时间31个月;单侧复发33例,中位复发间隔时间39个月;两者比较,差异无统计学意义(P =0.452).左侧复发37例,复发率77％(37/48);右侧复发34例,复发率68％ (34/50);两者比较,差异无统计学意义(P=0.396).12例单纯疼痛复发患者中10例合并子宫腺肌病(AM),4例合并深部浸润型内异症(DIE).29例合并AM和(或)DIE平均手术时间75.1 min,平均术中失血量114.9 ml;40例单纯内异症囊肿则分别为49.9 min和38.4 ml;两者分别比较,差异均具有统计学意义(P均＜0.05).69例患者术后均获随访,平均随访时间32个月(3个月～8年).6例患者内异症囊肿再次复发,中位复发间隔时间为3年(6个月～6年);38例患者有生育要求,仅4例完成生育.结论 临床诊断内异症复发确诊率高,疼痛主要与AM相关,内异症囊肿合并DIE和(或)AM是导致手术难度增大的主要原因;二次术后患者整体预后差.

Clinicopathological characteristics of recurrent endometriosis and the outcomes of secondary surgery

Objective To investigate clinicopathological characteristics of recurrent endometriosis and outcomes of secondary surgery.Methods 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.Results 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 blilateral 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.Conclusions 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.