During the 10-year study period, a total of 168 patients were initially diagnosed with TOA or pelvic abscess. Of these, 113 patients fulfilled the inclusion criteria. The final analysis was performed in 113 patients, which included 20 women with endometriosis as the study group and 93 women without endometriosis as the control group in Supplementary Fig. 1. Demographic data and clinical characteristics of the participants are shown in Table 1. Compared with the control group, women in the endometriosis group were more likely to have lower pregnancy parities (45.0% vs 19.4%, p = 0.021) and to have a higher risk of infertility history (40.0% vs 0.0%, p = 0.000). However, there was no statistically significant differences with regard to age at menarche, menopause, marital status and BMI. We still found that the risk of TOA was significantly higher in patients with endometriosis at the age of 20–39 (P = 0.036).
Table 1
The comparison of demographic factors between women endometriosis and non-endometriosis who were hospitalized for TOA.
characteristics | Endometriosis(n = 20) | No endometriosis n = 93 | P |
Age | | | 0.036* |
20–39 | 11/20 (55.0%) | 27/93 (29.0%) | |
40–55 | 9/20 (45.0%) | 66/93 (71.0%) | |
Menarche age | 13.65 ± 1.67 | 14.23 ± 1.63 | 0.847 |
Menopause | 1/20 (5.0%) | 10/93 (10.8%) | 0.686 |
Married | 19/20 (95.0%) | 91/93 (97.8%) | 0.446 |
BMI | 23.52 ± 3.19 | 23.58 ± 4.92 | 0.243 |
Parity | | | 0.021* |
0 | 9/20(45.0%) | 18/93 (19.4%) | |
≥ 1 | 11(55.0%) | 75/93 (80.6%) | |
Infertility | 8/20 (40.0%) | 0/93 (0.0%) | 0.000* |
Data are presented as mean ± SD, n (%). BMI Body Mass Index, TOA tube ovarian abscess.* P < 0.05. |
As shown in Table 2, risk factors of increasing TOA were analyzed in the endometriosis group and the non-endometriosis group. The incidence for risk factors in the endometriosis group compared to the non-endometriosis group, such as history of gynecological surgery (40% vs 35.4%, p = 0.799), history of previous PID (5.0% vs 21.5%, p = 0.116), history of IVF (5.0% vs 0.0%, p = 0.177), recent insertion or removal of an intrauterine device (IUD) (40.0% vs 47.3%, p = 0.626), and the differences all had no statistical significance.
Table 2
Analysis risk factors of in TOA women with endometriosis and without endometriosis.
characteristics | Endometriosis(n = 20) | No endometriosis n = 93 | P |
History of gynecological surgery | 8/20 (40.0%) | 33/93 (35.4%) | 0.799 |
History of pelvic inflammaton | 1/20 (5.0%) | 20/93 (21.5%) | 0.116 |
IVF | 1/20 (5.0%) | 0/93 (0.0%) | 0.177 |
Intrauterine ring | 8/20 (40.0%) | 44/93 (47.3%) | 0.626 |
Data are presented as n (%). IVF in vitro fertilization, TOA tube ovarian abscess. |
The clinical symptoms and clinical characteristics of patients in the endometriosis group and non-endometriosis group are listed in Table 3. Fever (35% vs 37.6%) and abdominal pain (60.0% vs 76.3%) were common clinical symptoms in the endometriosis group and non-endometriosis group. The results shown the symptoms did not differ between the two groups. We also compared the red blood cell count and hemoglobin concentration between the two groups. We found the red blood cell count and hemoglobin concentration had no significance difference. Moreover, most of the elevated inflammatory markers did not differ between the endometriosis group and the non-endometriosis group, such as WBC count (45.0% vs 41.9%, p = 0.808), fibrinogen concentration (45.0% vs 58.4%, p = 0.324), neutrophils (50.0% vs 51.6%, p = 1.000), CRP (87.5% vs 89.7%, p = 1.000), and PCT (40.0% vs 36.4%, p = 1.000) at admission, other than the BPCs. The incidence of elevated BPCs was notably increased than that in the control group (75% vs 46.23%, p = 0.026). Table 3 shows that 75/113 (66.4%) of women had a CA-125 level drawn on presentation, 11/14 (71.4%) women in the endometriosis group had an elevated CA-125 level, 36/61 (59.0%) women in the non-endometriosis group had been elevated. While, no significance difference was shown on CA-125 level.
Table 3
Analysis of clinical symptoms and biochemical results between TOA women with and without endometriosis.
characteristics | Endometriosis(n = 20) | No endometriosis (n = 93) | P |
Fever | 7/20 (35.0%) | 35/93 (37.6%) | 1 |
Abdominal pain | 12/20 (60.0%) | 71/93 (76.3%) | 0.164 |
Red blood cell count | 3.77 ± 0.52 | 3.93 ± 0.61 | 0.404 |
Hemoglobin concentration | 111.67 ± 16.53 | 110.74 ± 19.01 | 0.373 |
WBC increased | 9/20 (45.0%) | 39/93 (41.9%) | 0.808 |
Blood platelet increased | 5/20 (25.0%) | 43/93 (46.2%) | 0.026* |
Fibrinogen increased | 9/20 (45.0%) | 52/93 (58.4%) | 0.324 |
Neutrophils increased | 10/20 (50.0%) | 48/93 (51.6%) | 1.000 |
CRP increased | 7/8 (87.5%) | 35/39 (89.7%) | 1.000 |
PCT increased | 2/5 (40.0%) | 4/11 (36.4%) | 1.000 |
CA125 increased | 10/14 (71.4%) | 36/61 (59.0%) | 0.546 |
Bacteria culture positive | 3/8 (27.3%) | 23/46 (50.0%) | 0.200 |
Blood culture positive | 2/6 (33.3%) | 2/13 (15.4%) | 0.557 |
Secretion culture positive | 0/3 (0.0%) | 5/11 (45.5%) | 0.258 |
Data are presented as mean ± SD, n (%). WBC white blood cell count, CRP C-reactive protein, PCT procalcitonin, TOA tube ovarian abscess. * P < 0.05 |
In addition, bacteria cultures were sampled in 3/8 (27.3%) of the endometriosis group and 23/46 (50.0%) of the non-endometriosis group. A total of 2/6 (33.3%) of blood cultures taken in the endometriosis group and 2/13 (15.4%) in the non-endometriosis group at admission were culture positive; 0/3 (0.0%) cervicovaginal isolate secretion cultures taken in the endometriosis group and 5/11 (45.5%) in the non-endometriosis group were positive. However, there was no significance difference in the bacteria cultures, blood cultures and secretion cultures.
Table 4 shows a comparison of treatment between the endometriosis group and the non-endometriosis group. The duration of hospital stay, total treatment time, and antibiotic treatment time did not differ between the groups. Moreover, the approach did not differ between the groups, with a similar percentage of women undergoing laparotomy as compared to laparoscopic procedures (p = 0.773). Compared with the non-endometriosis group, the endometriosis group was significantly associated with surgical complications during the perioperative period (15.0% vs 0.0%, p = 0.000). Three patients had perioperative surgical complications in the endometriosis group, of whom 2 patients had septic shock and 1 patient had intestinal obstruction. We also found significant differences between the endometriosis group and the non-endometriosis group with respect to operative blood loss (347 ± 445.77 vs 204.67 ± 289.46, p = 0.014). There were no significant differences between the groups regarding antibiotic replacement times, abscess location, emergency surgery, or relapse.
Table 4
Analysis management factors of TOA in women with endometriosis and without endometriosis.
characteristics | Endometriosis(n = 20) | No endometriosis (n = 93) | P |
Hospital stay | 10.60 ± 8.56 | 11.76 ± 9.05 | 0.825 |
Total treatment time | 14.40 ± 9.36 | 15.95 ± 11.29 | 0.351 |
Antibioti treatment time | 8.10 ± 5.61 | 12.22 ± 8.15 | 0.140 |
Antibiotic replacement times | | | 0.196 |
0 | 10/20 (50.0%) | 30/93 (32.3%) | |
≥ 1 | 10/20 (50.0%) | 63/93 (67.7%) | |
Abscess location | | | 1.000 |
tube ovary abscess | 12/20 (60.0%) | 55/93 (59.1%) | |
tube abscess | 8/20 (40.0%) | 38/93 (40.9%) | |
Emergency surgery | 2/20 (10.0%) | 12/93 (13.3%) | 0.773 |
Blood loss | 347 ± 445.77 | 204.67 ± 289.46 | 0.014* |
Laparotomy | 5/20 (25.0%) | 20/93 (22.2%) | 0.773 |
Complication | 3/20 (15.0%) | 0/93 (0.0%) | 0.005* |
Relapse | 1/20 (5.0%) | 3/93 (3.1%) | 0.547 |
Data are presented as mean ± SD, n (%). TOA tube ovarian abscess. * P < 0.05 |