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| 子宫内膜异位症保守性手术治疗后生育表现、疼痛再发及疾病复燃：现有分级系统的预测价值 |
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| Reproductive performance, pain recurrence and disease relapse after conservative surgical treatment for endometriosis: the predictive value of the current classification system |
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| Vercellini P, Fedele L, Aimi G 2009/5/27 10:50:40 |
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| Hum Reprot, 2006, |
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| View at Publisher |
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Abstract
Background:
To assess the predictive value of the current classification of endometriosis in terms of response to surgical treatment, we studied to what extent disease stage, lesion type and lesion site were associated with post-operative pregnancy rate, symptom recurrence and disease relapse.
Methods:
A total of 729 women with endometriosis undergoing first-line conservative laparoscopic surgery were included. Data on age at surgery, disease stage according to the revised American Fertility Society (AFS) classification, anatomical characteristics of endometriotic lesions, fertility status and types and severity of pain symptoms were collected.
Results:
Minimal endometriosis was present in 222 patients, mild in 106, moderate in 197 and severe in 204. The cumulative probability of pregnancy at 3 years from surgery in 537 infertile women was 47% (51% at stage I,45% at stage II, 46% at stage III and 44% at stage IV; log-rank test, χ23 = 1.50, P = 0.68) (Fig 1). The cumulative probability of moderate or severe dysmenorrhoea recurrence in 425 symptomatic subjects was 24% (32% at stage I, 24% at stage II, 21% at stage III and 19% at stage IV; log-rank test, χ23 = 6.39, P = 0.094) (Fig 2). The cumulative probability of disease relapse was 12% (3% at stage I,11% at stage II, 11% at stage III and 23% at stage IV; log-rank test, χ23 = 24.95, P = 0.0001). Using Cox's multivarite proportional hazards regression analysis, no association was observed between endometriosis stage or lesion type and lesion site and any of the considered study outcomes.
Conclusions:
The current classification of endometriosis has an inadequate predictive value with regard to the major clinical outcomes. |
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 疾病资源中心
病例分析 [栏目介绍]
王燕燕 王曙
上海交通大学附属瑞金医院内分泌科
患者，女，69岁。2009年1月无明显诱因下出现乏力，当时程度较轻，未予以重视。2009年3月患者乏力症状加重，尿色逐渐加深，大便习惯改变，颜色变淡。4月18日入我院感染科治疗，诉轻度头晕、心慌，体重减轻10kg。无肝区疼痛，无发热，无腹痛、腹泻、腹胀、里急后重，无恶性、呕吐等。入院半月前于外院就诊，查肝功能：ALT 601IU/L，AST 785IU/L，TBIL 97.7umol/L，白蛋白 41g/L，甲状腺功能：游离T3 30.6pmol/L，游离T4 51.9pmol/L，心电图示快速房颤。
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