Muzii L, Marana R, Caruana P, Catalano G F, Margutti F, Panici P B
Department of Obstetrics and Gynecology, Libera Università Campus Biomedico, Rome, Italy.
Am J Obstet Gynecol. 2000 Sep;183(3):588-92. doi: 10.1067/mob.2000.106817.
We sought to evaluate the efficacy of postoperative administration of monophasic, combined, low-dose oral contraceptives on endometrioma recurrence and on persistence-recurrence of associated pain symptoms after laparoscopic treatment of moderate-to-severe endometriosis.
In a prospective, randomized trial 70 patients who were not attempting to conceive, aged 20 to 35 years, underwent laparoscopic excision of ovarian endometriomas, followed by either postoperative administration of low-dose cyclic oral contraceptives for 6 months or no treatment on the basis of a computer-generated sequence. At 3 and 6 months after surgery and then at 6-month intervals, both groups underwent ultrasonographic examination for possible evidence of endometrioma recurrence and for evaluation of the absence, persistence, or recurrence of pain symptoms.
Two patients in the oral contraceptive group did not complete the study. After a mean follow-up of 22 months (range, 12-48 months), there were 2 (6.1%) endometrioma recurrences in the 33 patients who received postoperative oral contraceptives versus 1 (2.9%) recurrence in the 35 patients in the control group (not significant). The moderate-to-severe pain recurrence rate was 9.1% in the oral contraceptive group versus 17.1% in the control group (not significant). The mean time to recurrence of either symptoms or endometriomas was 18.2 months in the oral contraceptive group versus 12.7 months in the control group. The 12-month cumulative recurrence rate at life-table analysis was significantly lower for patients receiving oral contraceptives versus control subjects, whereas no significant difference was evident at 24 and 36 months.
Postoperative administration of low-dose cyclic oral contraceptives does not significantly affect the long-term recurrence rate of endometriosis after surgical treatment. A delay in recurrence is evident at life-table analysis.
我们旨在评估术后给予单相、复方、低剂量口服避孕药对子宫内膜异位囊肿复发以及对中重度子宫内膜异位症腹腔镜治疗后相关疼痛症状的持续-复发情况的疗效。
在一项前瞻性随机试验中，70名年龄在20至35岁、未尝试受孕的患者接受了卵巢子宫内膜异位囊肿的腹腔镜切除术，术后根据计算机生成的序列，35名患者接受低剂量周期性口服避孕药治疗6个月，另35名患者不接受治疗。在术后3个月和6个月，然后每隔6个月，两组均接受超声检查，以寻找子宫内膜异位囊肿复发的可能证据，并评估疼痛症状的消失、持续或复发情况。
口服避孕药组有2名患者未完成研究。在平均随访22个月（范围12 - 48个月）后，接受术后口服避孕药的33名患者中有2例（6.1%）出现子宫内膜异位囊肿复发，而对照组的35名患者中有1例（2.9%）复发（无显著差异）。口服避孕药组中重度疼痛复发率为9.1%，对照组为17.1%（无显著差异）。口服避孕药组症状或子宫内膜异位囊肿复发的平均时间为18.2个月，对照组为12.7个月。生命表分析显示，接受口服避孕药的患者12个月累积复发率显著低于对照组，而在24个月和36个月时无明显差异。
术后给予低剂量周期性口服避孕药对手术治疗后子宫内膜异位症的长期复发率无显著影响。生命表分析显示复发有延迟。
