Objective To explore the relationship between the prognosis and vascular endothelial growth factor (VEGF), matrix metalloproteinase-9 (MMP-9), tissue plasminogen activator (tPA) in patients with endometriosis (EM). Methods Eighty-four EM patients, who were treated with conservative surgery, were selected as the study objects. According to the follow-up of 1 year after surgery, they were divided into recurrence group (11 cases) and non recurrence group (73 cases). The levels of VEGF, MMP-9 and tPA were measured before and after operation, and ROC curve was used to analyze the prognostic value of VEGF, MMP-9 and tPA in EM patients. Results Before surgery, there was no significant difference in the levels of VEGF, MMP-9, and tPA between the two groups of patients (P>0.05). On the 7th day after operation, the levels of VEGF and MMP-9 of the two groups were lower than that of preoperatively, while the levels of tPA were higher than that of preoperative, the differences were statistically significant (P<0.05). The levels of VEGF and MMP-9 were lower than that of patients in the recurrence group, and the tPA level was higher than that of patients in the recurrence group, the difference were statistically significant (P<0.05). ROC curve analysis showed that the AUC of serum VEGF, MMP-9, and tPA levels in evaluating the prognosis of EM patients were 0.783, 0.766, and 0.788, respectively, which had certain accuracy, and the evaluation value of the three-item combination (AUC=0.808, P<0.01) was higher. Conclusion The levels of VEGF, MMP-9, and tPA in patients with endometriosis are closely related to the prognosis, and the three combined tests are more valuable for their prognostic evaluation.