Predictive factors for recurrence of ovarian endometrioma after laparoscopic excision

PURPOSE: To analyze the factors that might influence the recurrence of ovarian endometriomas after laparoscopic excision.METHODS: A retrospective cohort study. We evaluated 129 patients who underwent laparoscopic excision of ovarian endometriomas from 2003 to 2012 and who were followed up for at least two years after surgery. Vaginal ultrasound was repeated to exclude persistent lesion and to identify recurrence. The Student's t-test was used to compare continuous variables and the χ2 or Fischer exact test (for values of less than five) was used to test homogeneity between proportions. A logistic regression model for multivariate proportional hazards was used to analyze predictors of long-term outcome. The level of significance was set at 5% in all analyses.RESULTS: The overall rate of ovarian endometrioma recurrence was 18.6%. Endometrioma diameter, surgical procedure techniques and demographic data such as age, presenting symptoms, body mass index, smoking and physical exercise habits were not associated with recurrence, whereas interruption of postoperative medical treatment was significantly correlated with a higher recurrence rate (OR 23.7; 95%CI 5.26-107.05; p=0.001).CONCLUSION: Current oral contraceptive use appears to be associated with a dramatic reduction in the risk of recurrence of ovarian endometriotic cysts. Treatment interruption was associated with a higher recurrence rate of ovarian endometrioma after laparoscopic treatment.

【研究目的】本研究旨在分析腹腔镜下卵巢子宫内膜异位囊肿（ovarian endometrioma）剔除术后的复发影响因素。
【研究方法】本研究为回顾性队列研究。纳入2003年至2012年间接受腹腔镜下卵巢子宫内膜异位囊肿剔除术的129例患者，所有患者术后随访时长至少2年。术后重复行经阴道超声检查，以排除病灶残留并确认复发情况。采用成组t检验（Student's t-test）比较连续型变量，采用卡方检验（χ² test）或费希尔精确检验（Fisher exact test，适用于理论频数小于5的场景）分析组间构成比的齐同性；采用多因素比例风险logistic回归模型分析长期预后的预测因素。所有分析均设定显著性水平为5%。
【研究结果】本研究中卵巢子宫内膜异位囊肿的总体复发率为18.6%。囊肿直径、手术操作技术以及年龄、首发症状、体质量指数、吸烟与运动习惯等人口学特征均与复发无显著关联；而术后药物治疗中断与更高的复发风险显著相关（比值比Odds Ratio, OR=23.7，95%置信区间Confidence Interval, CI=5.26~107.05，p=0.001）。
【研究结论】当前口服避孕药的使用与卵巢子宫内膜异位囊肿复发风险的显著降低相关。术后药物治疗中断则与腹腔镜手术后卵巢子宫内膜异位囊肿更高的复发率相关。