1.Diagnosis and management of 57 cases with rectovaginal endometriosis.
Journal of Zhejiang University. Medical sciences 2009;38(5):531-534
OBJECTIVETo study the diagnosis and therapy of the rectovaginal endometriosis.
METHODSClinical data of 57 women with rectovaginal endometriosis admitted to the West China Second University Hospital of Sichuan University in last two years,were retrospectively reviewed.
RESULTThe average age of patients was 40.1 years. The main clinical manifestations were dysmenorrheal, changes of menorrhea and digestive stimulation. The diameter of deep endometriosis nodules was between 1-6 cm, and 77% were found to have more than one nodules. Seven of these patients had positive results in transvaginal ultrasonography; 61%(11/18) patients had elevated CA125 levels. Thirteen patients were given preoperational medical treatment, but had no effect. All patients, except one accepted laparotomic therapy of complete excision of endometriosis nodules; 23 cases underwent drug therapy after operation. No patients had recurrence in recto-vaginal septum after complete excision; only one recurred in right ovary. Patients who failed to remove the total lesion showed improvement in pain.
CONCLUSIONDiagnosis of the rectovaginal endometriosis is based on symptoms, vaginal and rectal examination, and auxiliary examination. Complete excision of endometriosis nodules is the main therapeutic method.
Adult ; Dysmenorrhea ; etiology ; Endometriosis ; classification ; diagnosis ; surgery ; Endosonography ; methods ; Female ; Humans ; Laparoscopy ; methods ; Middle Aged ; Rectal Diseases ; diagnosis ; surgery ; Retrospective Studies ; Vaginal Diseases ; diagnosis ; surgery
2.The Prognostic Value of Individual Adhesion Scores from the Revised American Fertility Society Classification System for Recurrent Endometriosis.
Bo Hyon YUN ; Young Eun JEON ; Seung Joo CHON ; Joo Hyun PARK ; Seok Kyo SEO ; Sihyun CHO ; Young Sik CHOI ; Ji Sung LEE ; Byung Seok LEE
Yonsei Medical Journal 2015;56(4):1079-1086
PURPOSE: This study aimed to evaluate the prognostic value of each component of the revised American Fertility Society (rAFS) classification system for the first recurrence of endometriosis after conservative laparoscopy. MATERIALS AND METHODS: As this was a retrospective cohort study, data were collected by reviewing medical records. A total of 379 women ages 18 to 49 years were included. Women who underwent conservative laparoscopy with histologic confirmation of endometriosis at Gangnam Severance Hospital between March 2003 and May 2010 were included. Individual components of the rAFS classification system as well as preoperative serum CA-125 levels were retrospectively analyzed to assess their prognostic values for recurrence of endometriosis. RESULTS: Of 379 patients, 80 (21.2%) were found to have recurrence of endometriosis. The median duration of follow-up was 19.0 months, and the mean age at the time of surgery was 31.8+/-6.7 years. In endometriosis of advanced stage, younger age at the time of surgery, bilateral ovarian cysts at the time of diagnosis, a rAFS ovarian adhesion score >24, and complete cul-de-sac obliteration were independent risk factors of poor outcomes, and a rAFS ovarian adhesion score >24 had the highest risk of recurrence [hazard ratio=2.948 (95% CI: 1.116-7.789), p=0.029]. CONCLUSION: Our results suggest that of the rAFS adnexal adhesion scores, the ovarian adhesion score rather than the tubal adhesion score was associated with a significantly increased risk of recurrent endometriosis. The preoperative serum CA-125 level may be also a significant prognostic factor for recurrence, as known. However, it seemed to only have borderline significance in affecting recurrence in the current study.
Adolescent
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Adult
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Cohort Studies
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Endometriosis/*classification/*surgery
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Female
;
Fertility
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Follow-Up Studies
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Humans
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Kaplan-Meier Estimate
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Laparoscopy/*methods
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Middle Aged
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Prognosis
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Recurrence
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Retrospective Studies
;
Risk Factors
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*Tissue Adhesions
;
Treatment Outcome
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United States