Analysis Of Correlative Factors For Recurrence Of Ovarian Endometriosis After Conservative Surgery

Objective: To analyse correlative factors that influence the recurrence of ovarian endometriosis after conservative surgery.Methods: 560 patients of ovarian endometriosis were collected who underwent conservative surgery in the Forth Hospital of Hebei Medical University between January 2010 and June 2014.A retrospective study was performed on patients who had a minimum of 24 months of follow-up after conservative surgery.Recurrence was defined as the presence of endometrioma more than 2 cm in size,detected by ultrasonography within 2 years of surgery.Twenty-one variables(age of onset,infertility,preoperative pregnancy,preoperative delivery,previous intrauterine operation,previous cesarean section,previous treatment of endometriosis,serum level of CA125,pain,painful nodules in Douglas pouch,presence of uterine myoma,presence of adenomyosis,co-existence of deep endometriosis,laparoscopy or laparotomy,revised ASRM stage,multiple cysts,largest cyst diameter,anatomical location of the ovarian endometrioma,post-operative medical treatment,course of post-operative medical treatment and post-operative pregnancy)were evaluated to assess their effects on the recurrence.The data was analyzed using logistic regression analysis.Results:1 528 patients were followed-up among the 560 patients with a followup rate of 94.29%,and 102 patients recurred,the overall rate of recurrence was 19.32%.2 Factors associated with higher recurrence by univariate analysis were as follows: previous treatment of endometriosis(P<0.0001),pain(P=0.035),painful nodules in Douglas pouch(P=0.003),largest cyst diameter(P<0.0001),laparoscopy or laparotomy(P=0.014),bilateral involvement(P=0.031).Factors associated with lower recurrence were post-operative medical treatment(P=0.005)and post-operative pregnancy(P<0.0001).3 Significant factors that were independently associated with higher recurrence by logistic regression analysis were previous treatment of endometriosis(OR=4.148,95%CI=1.939-8.870,P<0.0001),painful nodules in Douglas pouch(OR=3.332,95%CI=1.442-7.702,P=0.005),largest cyst diameter(OR=2.332,95%CI=1.443-3.769,P=0.001)and bilateral involvement(OR=1.780,95%CI=1.092-2.901,P=0.021).Significant factors that were independently associated with lower recurrence were post-operative medical treatment(OR=0.562,95%CI=0.351-0.900,P=0.016)and post-operative pregnancy(OR=0.180,95%CI =0.089-0.361,P<0.0001).Conclusions:1 Recurrence of ovarian endometriosis after conservative surgery is closely related to the clinical characteristics of patients.2 Previous treatment of endometriosis,painful nodules in Douglas pouch,largest cyst diameter and bilateral involvement are significant factors associated with higher recurrence of the disease.3 Post-operative medical treatment and post-operative pregnancy are favourable prognostic factors.4 Gynaecologists should optimize the timing of surgery according to the factors that are independently associated with the recurrence of ovarian endometriosis.Patients with risk factors should be treated with GnRH-a actively and closely followed-up after surgery to guard against the possibility of recurrence.Patients with bearing requirement should be encouraged to pregnant as soon as possible after surgery.