Adolescent Endometriosis: Report of a Series of 55 Cases With a Focus on Clinical Presentation and Long-Term Issues
Adolescent Endometriosis: Report of a Series of 55 Cases With a Focus on Clinical Presentation and Long-Term Issues
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DOI：
10.1016/j.jmig.2015.04.001
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发表时间：
2015-07-01
影响因子：
4.1
通讯作者：
Akladios, Cherif
中科院分区：
文献类型：
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作者：
Audebert, Alain;Lecointre, Lise;Akladios, Cherif
研究目的：报告青少年子宫内膜异位症的临床表现和长期问题。设计：回顾性队列研究。设置：法国波尔多的单一私人临床中心。患者：确诊为子宫内膜异位症的青少年。干预措施：在腹腔镜下进行手术切除或消融或病变。测量和主要结果：研究纳入了1998年3月至2013年4月期间被诊断患有子宫内膜异位症的55名青少年，年龄为12至19岁（平均年龄17.8岁）。除2例外，其余患者均以各种疼痛为主要症状。23例患者术前发现附件肿块，5例在诊断性腹腔镜检查时发现相关不孕问题。4例患者伴有生殖器畸形。51%的患者有阑尾切除术史。19例患者（34.5%）报告了子宫内膜异位症家族史，14例患者（25.45%）有一级亲属受累，47.3%的患者每天至少吸烟5支。浅表种植体31例（56.4%），子宫肌瘤18例（32.72%），深部浸润性子宫内膜异位症（DIE）6例（10.90%）。60%的患者被评为I至II期，40%的患者被评为III至IV期。5例患者失访，37例患者的随访时间为36 - 315个月（平均随访时间为125.5个月）。在未失访的50例患者中，13例（26%）没有疼痛，或通过药物治疗改善并具有可接受的疼痛。未失访的50名青少年中有17名患者（34%）接受了重复腹腔镜检查。35例患者因持续疼痛进行了腹腔镜和/或磁共振成像扫描。其中腺瘤12例（复发7例），DIE 12例（复发3例），复发率分别为36.84%和50%。在这项研究中，有18名患者希望有一个孩子。13例分娩（72.2%），9例妊娠发生在最初表现为I至II期子宫内膜异位症的患者中。11例不孕症患者中，6例成功受孕（54.5%）。结论：青春期子宫内膜异位症并不罕见。在我们的研究中，超过三分之一的患者有家族史。在接受DIE治疗的患者中，有需要重复腹腔镜检查的复发率（症状或病变）较高的趋势。然而，对随后生育率的影响似乎有限。(C)2015年AAGL。All rights reserved.
Study Objective: To report the clinical presentation and long-term issues of adolescent endometriosis.Design: Retrospective cohort study.Setting: Single private clinical center, Bordeaux, France.Patients: Adolescents with a confirmed diagnosis of endometriosis.Interventions: Surgical excision or ablation or lesions performed at laparoscopy.Measurements and Main Results: Fifty-five adolescents, ages from 12 to 19 years (mean age 17.8), who were diagnosed with endometriosis from March 1998 to April 2013 were included in the study. Pain of various types was the leading symptom in all patients, except 2. Twenty-three patients had an adnexal mass identified preoperatively, and 5 had an associated infertility issue at the time of diagnostic laparoscopy. Four patients had an associated genital malformation. Fifty-one percent of the patients had a history of appendectomy. A familial history of endometriosis was reported by 19 patients (34.5%), with a first degree relative affected in 14 cases (25.45%), and 47.3% of patients were smoking at least 5 cigarettes a day. Superficial implants was encountered in 31 cases (56.4%), endometriomas in 18 cases (32.72%), and deep infiltrating endometriosis (DIE) in 6 cases (10.90%). Sixty percent of patients were scored as stages I to II and 40% as stages III to IV. Five patients were lost to follow-up, and 37 had a follow-up ranging from 36 to 315 months (mean follow-up 125.5 months). Among the 50 patients not lost to follow-up, 13 (26%) had either no pain, or improved and had acceptable pain with medical treatment. Seventeen patients of the 50 adolescents not lost to follow-up (34%) underwent a repeat laparoscopy. A subsequent laparoscopic and/or magnetic resonance imaging scan was performed in 35 patients because of persistent pain. Among these, there was 12 endometriomas (7 recurrences) and 12 DIEs (3 recurrences), giving recurrence rates for endometriomas and DIEs of 36.84% and 50%, respectively. During the study, 18 patients wished to have a child. Thirteen had a delivery (72.2%), and 9 pregnancies occurred in patients who initially presented with stage I to II endometriosis. Of the 11 patients who had subfertility, 6 successfully conceived (54.5%).Conclusions: Adolescent endometriosis is not a rare condition. In our study a familial history was reported in more than one-third of patients. Among those patients treated for DIE, there was a trend for higher rates of recurrences (symptoms or lesions) that required repeat laparoscopy. However, the impact on subsequent fertility appeared to have been limited. (C) 2015 AAGL. All rights reserved.