Clinical Study On The Pathogenic Factors Of Ovarian Endometriosis And Its Prevention Of Recurrence

Objective:To explore the related factors of ovarian endometriosis,so as to provide theoretical basis for primary prevention,early diagnosis and treatment of ovarian endometriosis.At the same time,by studying the recurrence and adverse reactions of patients in each group under different treatment schemes after laparoscopic ovarian endometriosis cyst removal,it provides certain clinical reference for reducing the postoperative recurrence rate and long-term management of ovarian endometriosis cyst.Methods:Patients with ovarian endometriosis who were hospitalized in the First Affiliated Hospital of Jinan University from January 2015 to June 2020 were selected as the case group,and other patients with benign ovarian tumors who were hospitalized in the same hospital during the same period were selected as the control group.The general conditions,menstrual history,reproductive history,lifestyle and complications of the two groups were collected.The patients with the closest tendency score in the two groups were selected by the method of propensity score matching,and the related factors of ovarian endometriosis were screened out by univariate analysis and multivariate logistic regression analysis.At the same time,according to the different choices of patients with ovarian endometriosis after operation,the recurrence rate,median time of recurrence and adverse reactions in non-treatment group,Gn RH-a group,Gn RH-a+ remifemin group,OCP group and gestrinone group were retrospectively analyzed.In the prospective study,we increased the statistics of dienogest,and increased the analysis of the visual analogue score(VAS)of dysmenorrhea and pelvic pain before and after operation and patient satisfaction with medication.Because the VAS score does not follow a normal distribution,the median and interquartile range are used for description.Results:1.After univariate analysis,education,occupation,menarche age,menstrual cycle,menstrual volume,menstrual period,history of dysmenorrhea,number of pregnancy,parity,abortion times,surgical abortion times,delivery mode,adenomyosis and hyperthyroidism were statistically significant.The above variables were analyzed by multivariate logistic regression analysis.The results showed that menstrual period,history of dysmenorrhea and adenomyosis were positively correlated with the occurrence of ovarian endometriosis.The OR values were 1.739,1.755,7.188.The menarche age,menstrual cycle and parity were negatively correlated with the occurrence of ovarian endometriosis cyst.The OR values were0.614,0.383,0.233.2.In the retrospective study,the recurrence rates of the non-treatment group,Gn RH-a group,Gn RH-a+remifemin group,OCP group and gestrinone group were 30.1%,10.9%,10.5%,9.1% and 29.0%,the recurrence rate of Gn RH-a group,Gn RH-a+remifemin group and OCP group is lower than that of non-treatment group,the difference is statistically significant,P<0.001,0.004,0.004.The recurrence rate of Gn RH-a group,Gn RH-a+remifemin group and OCP group were lower than that of the gestrinone group.Only the difference in recurrence rate between the Gn RH-a group and the gestrinone group was statistically significant,P=0.003.The difference between the remaining groups was not statistically significant.3.In the prospective study,the recurrence rates of the non-treatment group,Gn RH-a group,Gn RH-a+remifemin group,OCP group and dienogest group were 34.3%,8.0%,10.0%,3.8%,0 %,the recurrence rates of Gn RH-a group,OCP group and dienogest group were lower than the non-treatment group,and the difference was statistically significant.The P values were 0.002,0.004,and 0.004,respectively.The difference of VAS scores for dysmenorrhea before and after treatment in the 5 groups were 2(0,3),4(4,5),4(3.25,4),4(4,5),4.5(3.25,5),after pairwise comparison,the difference in dysmenorrhea VAS scores of the Gn RH-a group,OCP group and dienogest group was greater than that of the non-treatment group,and the P values were <0.001,0.010,<0.001,and there was no statistical difference between the other groups.The difference in pelvic pain VAS scores before and after treatment in the 5 groups were 2(1,2),3(2,3),3(1.5,4),2.5(1.5,3),2(2,4),respectively.There was no statistically significant difference between the other groups.4.In the retrospective study,the total adverse reaction rates of the Gn RH-a group,Gn RH-a+remifemin group,OCP group,and gestrinone group were 57.4%,24.6%,18.2%,and 42.0%,respectively.In prospective studies,the total adverse reaction rates of Gn RH-a group,Gn RH-a+remifemin group,OCP group and dienogest were 64.0%,45.5%,30.8%,and 72.2%,respectively.Conclusion:1.History of dysmenorrhea,adenomyosis,and long menstrual periods are risk factors for ovarian endometriosis.Late menarche,long menstrual cycles,and multiple deliveries may be protective factors for the onset of ovarian endometriosis.2.Postoperative combined medicine can reduce the recurrence rate of ovarian endometriosis and relieve dysmenorrhea and pelvic pain.3.Dienogest is effective in preventing the recurrence of ovarian endometriosis,and has a high degree of satisfaction.It has good prospects for long-term postoperative management.