Study On Influencing Factors Of Delayed Diagnosis Of Endometriosis And Its Influence On Pregnancy

Objective To analyze the delayed diagnosis of endometriosis and related factors affecting the delayed diagnosis of endometriosis on pregnancy by collecting and analyzing the data of patients with pathological diagnosis of endometriosis from December 2017 to December 2019.Methods The clinical data of 262 patients admitted to our Hospital from December 2017 to December 2019 who were diagnosed as endometriosis with dysmenorrhea by pathological examination after laparoscopic surgery were collected,including:Age at the time of surgery,menarche time,menstruation,marital and reproductive status,CA12 5 level,BMI,surgical procedure,maximum cyst diameter,single/ bilateral lesions,whether there was complicated DIE and endometriosis stage,and the patients were followed up by outpatient service and telephone,and the delayed endometriosis diagnosis return visit questionnaire was filled in.Understand whether the patient has primary dysmenorrhea,age at the onset of dysmenorrhea,severity of dysmenorrhea,changes in dysmenorrhea rhythm,accompanying symptoms,infertility,initial visit to the doctor,pre-operation intervention,endometriosis related operation history,postoperative fertility intention and fertility status.Follow-up time is up to September 2022.Statistical analysis was conducted afterwards.Results 1.The median delay in diagnosis was 15.0 years(0.1 to 33 years)for the262 patients with endometriosis with pain symptoms included in the study.2.Univariate analysis shows that:The diagnostic delay time of endodysmenorrhea patients with menarche or primary dysmenorrhea was 19 years(7-33years),which was significantly longer than that of patients with secondary dysmenorrhea for 1 year(0.17,14)(Z = 11.576,P<0.01).The diagnostic delay time of patients with different dysmenorrhea changes was different.The delay in diagnosis of dysmenorrhea was 14 years(0.17-30 years)for patients with aggravated dysmenorrhea and 16 years(0.17-33 years)for patients with no change or remission(Z=6.079,P<0.01).The delay time of diagnosis of endometriosis was 22 years(0.17-33 years)for those who had given birth and 14 years(0.17-30 years)for those who had not given birth(Z=5.813,P<0.01).The delay in diagnosis was significantly shorter in patients with concomitant symptoms than in patients without concomitant symptoms(5 years vs1 5years),and in patients with chronic pelvic pain than in patients without concomitant symptoms(15 years vs20 years).The delay time of diagnosis in patients with coital pain was shorter than that in patients without coital pain(15 vs20 years),but the differences were not statistically significant(P>0.05).There was a strong negative correlation between the age at which pain symptoms first appeared and the delay in diagnosis(correlation coefficient-0.624,P<0.01).The earlier the onset of pain symptoms,the longer the delay in diagnosis of endometriosis.3.Multivariate analysis showed that the occurrence of dysmenorrhea immediately after menarche,previous fertility and changes in pain rhythm were independent factors affecting the delay in the diagnosis of endometriosis(P<0.01).4.After clinical diagnosis of endometriosis,28.6%(75/262)of patients chose surgical treatment,40.5%(106/262)of patients chose temporary follow-up observation,and 30.9%(81/262)chose conservative treatment.There were statistically significant differences in ovarian cyst diameter and dysmenorrhea degree(VAS score)among patients who underwent immediate surgery,observation and non-surgical treatment(P<0.01),but there was no statistically significant difference in age among the three groups(P=0.399).5.There were a total of 114 patients with fertility requirements after surgery,among which 46.5%(53/ 114)had completed fertility by the end of follow-up.The fertility rate in the group with diagnosis delay time ≤ 15 years was 54.9% higher than that in the group with diagnosis delay time > 15 years(39.5%),and the difference was statistically significant(P=0.02).There was no significant difference in the postoperative natural conception rate between the group with the diagnosis delay time≤14 years and the group with the diagnosis delay time > 14 years(P=0.325).Conclusion There is a delay in diagnosis of endometriosis,and the delay time is1 5.0 years.The occurrence of dysmenorrhea immediately after menarche,the change of dysmenorrhea rhythm,and previous fertility are all factors affecting the delay time of diagnosis of endometriosis.The earlier the onset of pain symptoms in patients,the longer the delay in diagnosing endometriosis.Delayed diagnosis of endometriosis will have adverse effects on postoperative pregnancy and reduce postoperative fertility.