目的:分析初次腹腔镜保守性手术治疗卵巢型子宫内膜异位症术后复发的相关因素。方法:回顾性分析2013年1月至2018年12月264例在本院妇科行初次腹腔镜保守性手术且病理确诊的育龄期(20~45岁)卵巢型子宫内膜异位症患者的临床资料,根据术后两年复发情况分为复发组和未复发组,对比分析两组患者月经史、生育史、病灶特点以及术后处理等关键变量,采用Logistic回归模型分析腹腔镜保守性手术治疗卵巢型子宫内膜异位症术后复发的相关因素。结果:随访至2020年12月31日,264例患者术后1年累积复发率为12.5%(33/264),术后两年累积复发率达18.9%(50/264),复发组与非复发组的平均术时年龄分别为(32.90±6.23)岁和(32.36±5.70)岁。单因素分析显示术前CA125水平、急诊手术、初潮年龄、月经周期、行经天数、月经量、痛经程度、术前孕次、术前流产次数、合并深度子宫内膜异位症、合并子宫腺肌症、子宫方位、术后辅助用药等因素无统计学意义(P>0.05),诊治间隔、术前剖宫产史、囊肿直径、囊肿多房、囊肿双侧分布、r-AFS分期、术后妊娠有统计学意义(P<0.05)。进一步由二分类Logistic回归得出3个复发危险因素,为囊肿双侧分布、囊肿直径>10 cm、诊治间隔>1年(P<0.05),1个保护因素为术后妊娠(P<0.05)。结论:初次腹腔镜保守性手术治疗卵巢型子宫内膜异位症的术后两年为复发高风险时段。

[1] PEIRIS A N,CHALJUB E,MEDLOCK D.Endometriosis[J].JAMA,2018,320(24):2608.
[2] 中国医师协会妇产科医师分会子宫内膜异位症专业委员会,中华医学会妇产科学分会子宫内膜异位症协作组.子宫内膜异位症长期管理中国专家共识[J].中华妇产科杂志,2018,53(12):836-841.
[3] 周应芳,彭超,冷金花.要重视子宫内膜异位症的一级和二级预防[J].中华妇产科杂志,2020,55(9):624-626.
[4] 冷金花,史精华.子宫内膜异位症复发的高危因素及其防治策略[J].中华妇产科杂志,2018,53(9):640-643.
[5] TSONIS O,BARMPALIA Z,GKROZOU F,et al.Endometriosis in adolescence:Early manifestation of the traditional disease or a unique variant?[J].Eur J Obstet Gyn R B,2000,247:238-243.
[6] KIKUCHI I,TAKEUCHI H,KITADE M,et al.Recurrence rate of endometriomas following a laparoscopic cystectomy[J].Acta Obstet Gyn Scan,2006,85(9):1120-1124.
[7] LIU X,GUO S W.A pilot study on the off-label use of valproic acid to treat adenomyosis[J].Fertil Steril,2008,89(1):246-250.
[8] SALMINEN L,NADEEM N,ROLFSEN A L,et al.Exploratory analysis of CA125-MGL and-STn glycoforms in the differential diagnostics of pelvic masses[J].J Appl Lab Med,2020,5(2):263-272.
[9] BULLETTI C,DEZIEGLER D,STEFANETTI M,et al.Endometriosis:absence of recurrence in patients after endometrial ablation[J].Hum Reprod,2001,16(12):2676-2679.
[10] CHATTERJEE K,JANA S,DASMAHAPATRA P,et al.EGFR-mediated matrix metalloproteinase-7 up-regulation promotes epithelial-mesenchymal transition via ERK1-AP1 axis during ovarian endometriosis progression[J].Faseb J,2018,32(8):4560-4572.
[11] BARBE A M,BERBETS A M,DAVYDENKO I S,et al.Expression and significance of matrix metalloproteinase-2 and matrix metalloproteinas-9 in endometriosis[J].J Med Life,2020,13(3):314-320.
[12] HAYASHI S,NAKAMURA T,MOTOOKA Y,et al.Novel ovarian endometriosis model causes infertility via iron-mediated oxidative stress in mice[J].Redox Biol,2020,37:101726.
[13] KURITA T,LEE K J,COOKE P S,et al.Paracrine regulation of epithelial progesterone receptor and lactoferrin by progesterone in the mouse uterus[J].Biol Reprod,2000,62(4):831-838.
[14] ZOU Y,ZHOU J Y,GUO J B,et al,The presence of KRAS,PPP2R1A and ARID1A mutations in 101 Chinese samples with ovarian endometriosis[J].Mutat Res,2018,809:1-5.
[15] 李华军,冷金花,郎景和,等.子宫内膜异位症保守性手术后复发的相关因素分析[J].中华妇产科杂志,2005,40(1):13-16.
[16] TARUMI Y,MORI T,OKIMURA H,et al.Interleukin-9 produced by helper T cells stimulates interleukin-8 expression in endometriosis[J].Am J Reprod Immunol,2021,86(3):e13380.
[17] VIGANÒ P,OTTOLINA J,SARAIS V,et al.Coagulation status in women with endometriosis[J].Reprod Sci,2018,25(4):559-565.
[18] SUN T T,CHEN S K,LI X Y,et al,Fertility outcomes after laparoscopic cystectomy in infertile patients with stage III-IV endometriosis:a cohort with 6-10 years of follow-up[J].Adv Ther,2020,37(5):2159-2168.
[19] 刘忠慧.氧化应激标记物及其在女性生殖中的应用[J].国际妇产科学杂志,2015,42(3):311-314.