年轻未生育女性卵巢型子宫内膜异位症保守性手术后复发的围手术期危险因素分析

Perioperative Risk Factors Analysis of Recurrence after Conservative Surgery for Ovarian Endometriosis in Young Nulliparous Women

摘要: 目的：探讨年轻未生育女性卵巢型子宫内膜异位症(OMA)腹腔镜保守术后复发的危险因素，为个体化管理与生育力保护提供依据。方法：回顾性分析2015年12月~2023年1月扬州大学附属医院156例首次腹腔镜保守手术的年轻未生育OMA患者，按复发情况分为复发组(31例)与未复发组(125例)，采用单因素及多因素Logistic回归分析以识别危险因素。结果：术后3年内复发率19.9%。单因素分析显示，两组间BMI、痛经程度、囊肿最大径、囊肿侧别、CA125、dNLR、球蛋白、纤维蛋白原、D-二聚体、血红蛋白差异显著。多因素分析显示，较高的BMI和血红蛋白水平与复发风险降低独立相关；双侧囊肿、较大的囊肿最大径和较高的球蛋白水平与复发风险增加独立相关。结论：围手术期综合评估患者的营养状况、病灶特征及炎症–免疫状态，有望为识别复发高危人群提供参考，但其临床效用尚需前瞻性研究进一步验证。

Abstract: Objective: To explore the risk factors for recurrence after laparoscopic conservative surgery in young nulliparous women with ovarian endometrioma (OMA), providing a basis for individualized management and fertility preservation. Methods: A retrospective analysis was conducted on 156 young nulliparous OMA patients who underwent their first laparoscopic conservative surgery at the Affiliated Hospital of Yangzhou University from December 2015 to January 2023. Patients were divided into the recurrence group (31 cases) and the non-recurrence group (125 cases) based on recurrence status. Univariate and multivariate Logistic regression analyses were performed to identify risk factors. Results: The recurrence rate within 3 years after surgery was 19.9%. Univariate analysis showed significant differences between the two groups in BMI, severity of dysmenorrhea, maximum cyst diameter, cyst laterality, CA125, dNLR, globulin, fibrinogen, D-dimer, and hemoglobin. Multivariate analysis showed that higher BMI and hemoglobin levels were independently associated with reduced risk of recurrence, while bilateral cysts, larger maximum cyst diameter, and higher globulin levels were independently associated with increased risk of recurrence. Conclusion: Comprehensive perioperative assessment of patients’ nutritional status, lesion characteristics, and inflammatory-immune status may provide a reference for identifying high-risk populations for recurrence, but its clinical utility requires further validation through prospective studies.