| Background and ObjectiveEndometriosis(EMT)is one of the most common benign diseases in the department of gynecology and can occur anywhere in the body,but ovarian endometriosis(OEM)is the most common.Although EMT is a benign disease,it has some characteristics of malignant diseases such as planting,invasion and distant metastasis.Surgical treatment is the main treatment of OEM.However,related studies have shown that the recurrence rate of OEM can be as high as 40%-50%after 5 years of surgery.Repeated operation can lead to irreversible decline of ovarian function,which seriously affects the quality of life and health of patients.Although many studies have been conducted on the mechanism of recurrence after EMT at home and abroad,the mechanism of postoperative recurrence remains unclear.Long-term management of EMT Chinese experts agree that endometriosis should be considered a“chronic disease”,requiring long-term management plans,using drugs to control the condition,and avoiding repeated surgical procedures.However,there is still no exact drug treatment plan to prevent postoperative recurrence.And the main drugs include non-steroidal anti-inflammatory drugs,oral contraceptives,progesterone,androgen derivatives,and Gonadotropin releasing hormone analogue(GnRH-a).This study was designed to analyze the effect of different kinds of combined use of GnRH-a and oral contraceptives on postoperative recurrence and related factors affecting postoperative recurrence after laparoscopic conservative treatment of ovarian endometriosis.And to provide some relevant evidence for the long-term management 0f the ovarian endometriosis after laparoscopic conservative treatment and reduce the postoperative recurrence rate.Materials and methods1.Source of Materials:Retrospective analysis of 90 patients with ovarian endometriosis who met the inclusion criteria and exclusion criteria in the department of gynecology of the Second Affiliated Hospital of Zhengzhou University from September 2015 to January 2017,including 33 patients in the postoperative untreated group and 57 cases in thepostoperative medication group.And then we divided the postoperative medication group into 42 patients in the GnRH-a group and 15 patients in the oral contraceptive group according to the drug type,To analyse the recurrence rate in the first year and the second year after surgery and the cumulative recurrence rateof 2 years after surgery among the each groups.At the same time,according to the recurrence after surgery,they were divided into recurrent group and non-recurred group,and the intraoperative age,disease stage,postoperative medication,cyst side,preoperative pregnancy,preoperative prenatal,postoperative pregnancy,the preoperative CA125 level,the largest cyst size and preoperative painwere were compared and analyzed between the two groups.2.Statistical methods:Statistical analysis was performed using SPSS25.0statistical software;measurement data were analyzed by one-way ANOVA or rank sum test,count data were analyzed byχ~2 test;logistic regression analysis was used for multivariate analysis.The test level was a=0.05,and the difference was statistically significant at P<0.05.Results1.The recurrence rate of the postoperative untreated group(21.2%)in the first year was significantly higher than the recurrence rate of in the postoperative medication group(3.5%),and there was a statistically significant difference between the two groups(P=0.020);The recurrence rate of postoperative untreated group(19.2%)was higher than that in the postoperative medication group(12.7%)in the second year,but the difference was not statistically significant(P=0.664);The cumulative recurrence rate of 2 years after surgery in the postoperative untreated group(36.4%)was significantly higher than the postoperative medication group(15.8%),and the difference was statistically significant(P=0.026).2.There was no recurrence in the first year after operation in the GnRH-a group,and the recurrence rate in the first year after operation was significantly lower than that in the oral contraceptive group(13.3%),but the difference was not statistically significant(P=0.066);The recurrence rate of the GnRH-a group(14.3%)was higher than in the oral contraceptive group(7.7%),but there was no significant difference between the two groups(P=0.883).The cumulative recurrence rateof 2years after surgery of the GnRH-a group(14.3%)was lower than that in the oral contraceptive group(20.0%),but the difference was not statistically significant(P=0.914).3.The total incidence of postoperative adverse reactions in the GnRH-a group was 88.1%,which was significantly higher than that in the oral contraceptive group(40.0%),and the difference was statistically significant(P=0.001).4.Univariate analysis was performed between the postoperative recurrence group and the non-recurrent group.The intraoperative age,disease stage,cyst side,postoperative pregnancy,postoperative medication,and preoperative pain were statistically significant between the two groups(P<0.05).There was no significant difference in preoperative pregnancy,preoperative preoperative,preoperative serum CA125 level and maximum cyst size between the two groups(P>0.05).5.Multivariate logistic regression analysis was performed between the recurrence group and the non-recurrent group.The difference of the intraoperative age,bilateral cyst,postoperative medication and postoperative pregnancy between the two groups was statistically significant(P<0.05).There was no significant difference in staging and preoperative pain(P>0.05).Conclusions1.Ovarian endometriosis laparoscopic conservative surgery combined drug therapy can reduce the short-term recurrence rate after surgery;2.The effect of GnRH-a preparation and oral contraceptives in ovarian endometriosis after laparoscopic conservative surgery are similar in preventing postoperative recurrence.However the incidence of adverse reactions combined with GnRH-a after laparoscopic conservative surgery for ovarian endometriosis is higher than that of oral contraceptives;3.Intraoperative age and bilateral ovarian cysts are independent risk factors for postoperative recurrence after laparoscopic conservative treatment of ovarian endometriosis.Postoperative medication and postoperative pregnancy can reduce the risk of postoperative recurrence;disease staging and preoperative Pain is not related to postoperative recurrence. |
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