青春期卵巢型子宫内膜异位症保守手术后复发9例临床分析

目的: 探讨青春期卵巢型子宫内膜异位症（endometriosis,EMs）患者术后复发的可能原因。方法: 回顾性分析经保守性手术治疗后复发的9例青春期卵巢型EMs患者的临床病例资料。 结果: 9例患者中,Ⅰ期1例,Ⅲ期1例,Ⅳ期7例;7例患者于停止药物治疗后3~4个月痛经复发;7例患者初次手术后1年内病灶复发,另外2例分别为手术后3年及4年后复发。病灶复发可见于对侧卵巢3例,初次手术病灶较小一侧卵巢3例,同侧卵巢2例,双侧卵巢复发1例。5例患者初次手术后复发1次,3例患者复发2次,1例患者复发3次。2例患者术后妊娠并足月分娩。9例患者术后药物治疗2~6个周期。结论: 青春期卵巢型EMs患者保守手术后复发患者初次手术时临床分期高,病灶及痛经复发多在手术后1年内。临床分期高、痛经史、术后药物长期管理依从性差及妊娠意愿低等可能是手术后复发原因。

Clinical Analysis of 9 Adolescent Ovarian Endometriosis Recurrence Cases after Conservative Surgery

Objective: To explore the possible causes of postoperative recurrence in adolescent patients with ovarian endometriosis (EMs). Methods: Retrospectively analyzed the clinical data of 9 adolescent ovarian endometriosis recurrent cases who underwent conservative operation. Results: The clinical stage of 9 patients was stage Ⅰ in 1 case, stage Ⅲ in 1 case and stage Ⅳ in 7 cases. 7 patients had dysmenorrhea recurred 3 to 4 months after drug treatment completed. The ovarian EMs recurred in 7 patients within 1 year, 1 patient after 3 years, 1 patient after 4 years followed the first operation. 3 patients had lesion recurred in the contralateral ovary, 3 patients had lesion recurred in the ovary with tiny focus during the primary operation, 2 patients had lesion recurred at the same ovary and 1 patient had bilateral ovarian recurred. 5 patients had experienced recurrence once, 3 patients had recurred twice, and one patient had recurred three times after the primary surgery. 2 patients had delivered at full term after operation. 9 patients had long term drug management 2 to 6 medication cycles after primary surgery. Conclusions: The clinical stage of the primary surgery is usually severe in adolescent recurrence patients after conservative operation, dysmenorrhea and EMs lesion recurrence usually occur within 1 year after surgery. Severe clinical stage, dysmenorrhea, unsatisfied long term drug management and low willing to pregnancy may relate with recurrence after surgery.