[Study on incidence and associated factors of different degree endometrioma adhesions]

To investigate the relationship between degree of endometrioma adhesions and clinical feature, surgical treatment and postoperative recurrence.

From Jan 2003 to Mar 2008, 662 patients with endometrioma undergoing laparoscopic ovarian endometrioma excision in Peking Union Medical College Hospital were studied retrospectively. All patients were classified into four groups according to the extent of adhesions: 31 cases in none adhesions group, 123 cases in mild adhesions group (filmy thickness, avascular, easily separated adhesions), 310 cases in moderate adhesions group (less than a half of ovary was adjacent to dense thickness adhesions which was difficult to separate, or above a half of ovary were adjacent to filmy thickness adhesions) and 198 cases in severe adhesions group (above a half of ovary was adjacent to dense thickness, well vascularized adhesions which was difficult to separate, and always involved the other pelvic organs, observed angiogenesis). The comparison of degree, characteristics, period of pain, lab test, surgical management and postoperative recurrence was performed among those above groups. In the mean time, risk factors and multinomial logistic regression were analyzed.

(1) Clinical characteristics: The incidence of patients with dysmenorrhea, dyspareunia, straining feeling in anus, chronic pelvic pain and the level of CA(125) (> 35 kU/L) was remarkably higher in moderate-to-severe adhesion groups than in none-to-mild adhesions groups (P = 0.000, 0.000, 0.001, 0.006 and 0.000, respectively). Infertility rate were significantly higher in severe adhesions group (15.7%, 31/198) than none adhesions group (3.2%, 1/31), mild adhesions group (11.4%, 14/123) and moderate adhesions group (9.7%, 30/310, OR = 1.728, P < 0.05). (2) Operating time and blood loss: Operating time of each groups was as followed: (37 +/- 15) min in none adhesions group, (42 +/- 19) min in mild adhesions group, (50 +/- 20) min in moderate adhesions group and (63 +/- 22) min in severe adhesion group. Blood loss was (23 +/- 12) ml in none adhesion group, (31 +/- 27) ml in mild adhesion group, (40 +/- 32) ml in moderate adhesion group and (70 +/- 67) ml in severe adhesions group. Thicker adhesions result in longer operation time and more blood loss. (3) Combined with other disease: The ratio of patients who combined with adenomyosis or deeply infiltrating endometriosis in moderate-to-severer adhesion groups was higher than patients in none-to-mild adhesions groups (OR = 3.466, P = 0.000). (4) Postoperative recurrence: It was categorized into recurrence of pain and cyst. Moderate-to-severe adhesions was related to higher recurrence rate of pain (OR = 1.685, P = 0.046), but was irrelevant to recurrence of cyst.

The more extent of endometrioma adhesions was related to severer pelvic pain symptoms, longer operating time and more blood loss. Postoperative pain recurrence rate was observed in moderate-to-severe adhesion group. Extent of adhesions was irrelevant to cyst recurrence.