| Objective:To investigate the risk factors for pain and cyst recurrence after laparoscopic conservative surgery for ovarian endometriosis cysts,thereby instructing clinical work to reduce the recurrence rate after conservative surgery by enhancing the postoperative management of patients with risk factors for recurrence.Methods:A retrospective analysis of patients who underwent laparoscopic ovarian cyst excision for a mass in the adnexal region at Shenyang Women and Infants Hospital from January 2017 to December 2019,with postoperative pathology suggesting endometriosis cysts,in which 274 patients were selected according to inclusion criteria and exclusion criteria,and divided into 61 cases in the study group and 213 cases in the control group according to whether they recurred within 36 months after surgery.Information was obtained by reviewing the patient’s electronic medical record and follow-up with the patient in person by telephone.The data collected included the patient’s general information: age at menarche,body mass index,age at the time of surgery,preoperative pregnancy,history of previous uterine operations,any combined infertility;clinical manifestations: preoperative dysmenorrhoea level,presence of painful intercourse,presence of chronic pelvic pain;preoperative findings: tumor side,preoperative CA125 level,preoperative CA199 level,preoperative fibrinogen level,cyst septation,whether it was combined with uterine fibroids,whether it was combined with adenomyosis;intraoperative and postoperative conditions: ASRM score,whether anti-adhesion agents were used during surgery,postoperative medication,and whether pregnancy occurred during the postoperative follow-up period.The above data were collated and analyzed by SPSS 26.0,the count data were analyzed by Fisher’s exact probability method or chi-square test for one-way analysis,and the measured data were analyzed by t-test or non-parametric test for one-way analysis,and the one-way analysis suggesting statistically significant differences were imported into binary multi-factor logistic regression analysis,and all differences at P < 0.05 were considered to be statistically significant.Results:The overall postoperative recurrence rate in this study was 22.3%.Univariate analysis of the data in both groups showed that age at the time of surgery(χ~2=6.449,P<0.05),preoperative dysmenorrhea level(χ~2=9.887,P<0.05),tumor side(χ~2=27.766,P<0.05),preoperative CA125 level(χ~2=9.447,P<0.05),cyst separation(χ~2=8.034,P <0.05),ASRM stage(χ~2=25.413,P < 0.05),pregnancy or not during the follow-up period(χ~2=14.229,P<0.05),and postoperative medication(χ~2=8.068,P<0.05),with statistically significant differences(P<0.05)for the above eight factors.It was suggested that age at the time of surgery,preoperative dysmenorrhea level,tumor side,preoperative CA125 level,cyst segregation,ASRM stage,whether pregnancy occurred during the follow-up period,and postoperative medication may be associated with the recurrence of ovarian endometriosis.The above statistically different factors were introduced into binary multivariate logistic regression analysis,and the results showed that two of the above factors,preoperative CA125 level and cyst separation,were not associated with the recurrence of ovarian endometriosis(P>0.05).On the other hand,age at the time of surgery included age <30 years(OR=12.617,95%CI=3.941-40.397,P<0.05)and age between 30-39 years(OR=3.637,95%CI=1.309-10.013,P < 0.05),severe dysmenorrhea(OR=4.074,95%CI=1.007-16.479,P<0.05),bilateral cysts(OR=2.626,95%CI:1.158-5.953,P<0.05),ASRM score ≥40(OR=2.942,95%CI:1.288-6.716,P<0.05),whether pregnancy occurred during the follow-up period(OR=0.098,95%CI:0.033-0.287,P<0.05),postoperative medication including standardized postoperative application of gonadotropin-releasing hormone agonist for 4-6 months(OR=0.225,95%CI:0.097-0.521,P<0.05)and application of combination oral contraceptive or dienogest after the use of gonadotropin-releasing hormone agonist(OR=0.079,95%CI:0.006-0.967,P<0.05),the differences in these six factors were statistically significant,indicating that young age at the time of surgery,bilateral cysts,severe dysmenorrhea(VAS score of 8-10),ASRM score ≥40 were independent risk factors for EMS recurrence,postoperative pregnancy,postoperative application of gonadotropin-releasing hormone agonist for 4-6 months and combined application of combination oral contraceptive or dienogest after use of gonadotropin-releasing hormone agonist were protective factors for EMS recurrence.Conclusions:This study showed that young at the time of surgery,especially <30 years,severe dysmenorrhea,bilateral cysts,and ASRM score ≥40 were independent risk factors for the recurrence of ovarian endometriosis.Postoperative pregnancy,postoperative gonadotropin-releasing hormone agonist application and combined application of a combination of oral contraceptive pills or dienogest after gonadotropin-releasing hormone agonist application were protective factors for EMS recurrence.Therefore,in young patients with bilateral cysts and severe dysmenorrhea and high intraoperative ASRM scores,conservative surgical treatment must be followed by intensive management to reduce the recurrence rate in such patients. |
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