Clinico-pathologic characteristics of posterior deeply infiltrating endometriosis lesions, pain symptoms and its treatment using laparoscopic surgery / 中华妇产科杂志

ABSTRACT

Objective To investigate the characteristics of the anatomical distribution of posterior deeply infiltrating endometriosis (PDIE) lesions, pain symptoms and effects of laparoscopic surgery.Methods Clinical data of 176 PDIE patients with laparescopically diagnosed and histologically confirmed were analyzed and compared with data of 179 cases with non-PDIE. According to the invasion of rectum or vaginal fomix, 176 PDIE cases were divided into three groups simple (144 cases), fornix (18 cases) or rectum group (14 cases). Results Compared with the non-PDIE patients, the risk of pain symptoms in PDIE patients were significantly increased, OR for dysmenorrhea, chronic pelvic pain, deep dyspareunia,dyschezia were 6.73 (95% CI, 3.66-12.40), 1.90 (95% CI, 1.17-3.05), 3.09 (95% CI, 1.94-4. 92) and 4.90 (95% CI, 2.07-8.11), respectively (all P < 0.05). The highest incidence of dyschezia was observed in rectum group (50. 0%, P <0.05), while deep dyspareunia in fornix group (72.2%, P < 0.05). The longest operative duration (82±31) minutes and the postoperative hospitalization (7.7±2.1) days were observed in rectum group (P <0.01). The median pain relief time was 56 months in the patients with complete excision of PDIE lesions, which was significantly longer than that in patients with incomplete excision (25 months, P <0.01). Multivariate analysis demonstrated that only incomplete excision of PDIE lesions was the risk factor for shorter pain relief time (P<0.05). Conclusion Conservative laparoscopic surgery may effectively relieve pelvic pain symptoms in patients with PDIE, while incomplete excision of PDIE lesions was the only significant predictor of shorter pain relief time.