Analysis of clinical characteristics, diagnosis, treatment, and postoperative outcomes in deep infiltrating endometriosis: a retrospective study.

Objectives: To investigate the clinical characteristics of deep infiltrating endometriosis (DIE), summarize the experiences in its diagnosis and management, and identify potential peripheral blood indicators associated with the severity of pelvic adhesions.

Methods: Clinical data were collected from 185 patients with pathologically confirmed DIE admitted to Wuxi Maternal and Child Health Hospital between January 2015 and December 2024. A retrospective analysis was conducted on the general information, perioperative conditions, postoperative pregnancy outcomes, and recurrence status in patients with DIE. Endometriosis lesions were described using the revised American Society for Reproductive Medicine (rASRM) and #Enzian classifications. At the same time, the severity of pelvic adhesions in DIE patients was graded. The differences in relevant peripheral blood indicators among patients with different degrees of adhesions were compared, and Spearman correlation analysis was used to evaluate the correlation between these indicators and the severity of pelvic adhesions.

Results: The initial detection rates of DIE lesions using gynecological examination, ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI) were 7.1  %, 1.1 %, 15.7 %, and 19.6 %, respectively. 40.0 % of patients had multiple DIE lesions (≥2), 77.3 % (143/185) of lesions were localized in the #Enzian B chamber. Patients with severe pelvic adhesions had a significantly higher platelet-to-lymphocyte ratio (PLR) than those with mild adhesions (p  = 0.019) and a significantly shorter thrombin time (TT) compared to both no-adhesion and mild-adhesion groups (p = 0.025 and p = 0.016, respectively). The degrees of pelvic adhesions was significantly positively correlated with PLR (r  = 0.241, p = 0.001), and negatively correlated with TT (r  = -0.206, p = 0.005). Postoperatively, 4.9 % of patients experienced adverse reactions. The post-surgery pregnancy rate was 68.8 %, and the recurrence rate was 15.97 %.

Conclusion: The diagnosis and treatment of DIE remain challenging. Among patients with DIE, the #Enzian classification system is more suitable for describing the size and severity of endometriotic lesions. Furthermore, we found that the PLR and thrombin time can reflect the pelvic adhesion status in in these patients.