Exacoustos Caterina, Zupi Errico, Amadio Annalisa, Amoroso Concetta, Szabolcs Beata, Romanini Maria Elisabetta, Arduini Domenico
Obstetrics and Gynecology Department, Università degli Studi di Roma Tor Vergata, Rome, Italy.
J Minim Invasive Gynecol. 2006 Jul-Aug;13(4):281-8. doi: 10.1016/j.jmig.2006.03.002.
This study involved patients who, after laparoscopic surgery, had recurrence of endometriomas detected by sonography. The aim of this study was to evaluate the role of transvaginal sonography (TVS) in the management of recurrent endometriomas and to establish ultrasonographic criteria that would direct the therapy toward additional surgery versus medical or expectant management.
Retrospective analysis of 62 reproductive-age women who showed recurrence of endometriomas on TVS after laparoscopic removal of an ovarian endometrioma by the stripping technique (Canadian Task Force classification II-1).
Obstetrics and Gynecology Department, University of Rome Tor Vergata.
Sixty-two patients with recurrent endometriomas after first-line treatment with laparoscopy.
Ultrasonographic follow-up and/or second surgery.
Recurrence of an ovarian endometrioma was defined as the presence of ovarian cysts with the typical sonographic criteria of endometriomas and a diameter of more than 10 mm. The clinical and sonographic postoperative follow-up period lasted from 6 to 97 months (median 24.6) after the first procedure. Of 62 patients with recurrent endometriomas, 50 had recurrence on the treated ovary, 7 on the contralateral untreated ovary, and 5 on both the treated and untreated ovaries. Recurrence of endometriomas was associated with symptoms (pain or infertility) in 47 patients (76%), while the remaining 15 (24%) were asymptomatic. Of the 47 symptomatic patients with recurrence detected by TVS, a second procedure was performed in 15. Second surgery in these patients was indicated by the larger size of the recurrent cysts, a poor response to medical treatment, the presence on TVS of pelvic adhesions and nodules of deep endometriosis, and overall progression of the disease. Symptomatic patients who did not undergo a second procedure (32) had smaller recurrent endometriomas. However of the 31 symptomatic patients with large recurrent endometriomas (>3 cm), only 45% had repeat surgery.
Recurrent endometriomas, as detected by TVS, can remain asymptomatic and do not necessarily progress in size with or without medical treatment. The decision to reoperate depends less on the endometrioma's size than on symptoms, in particular severe pain, and failure of medical treatment. However such patients are also more likely to have signs of deep nodules and adnexal/bowel adhesions and larger endometriomas on TVS scan, thus predisposing them to require a second procedure.
本研究纳入了腹腔镜手术后经超声检查发现子宫内膜异位囊肿复发的患者。本研究的目的是评估经阴道超声（TVS）在复发性子宫内膜异位囊肿管理中的作用，并建立超声标准，以指导针对额外手术与药物或观察性管理的治疗。
对62名育龄妇女进行回顾性分析，这些妇女在通过剥除术腹腔镜切除卵巢子宫内膜异位囊肿后，经TVS显示子宫内膜异位囊肿复发（加拿大工作组分类II-1）。
罗马第二大学妇产科。
62例一线治疗采用腹腔镜手术后出现复发性子宫内膜异位囊肿的患者。
超声随访和/或二次手术。
卵巢子宫内膜异位囊肿复发定义为存在具有子宫内膜异位囊肿典型超声标准且直径大于10mm的卵巢囊肿。首次手术后临床及超声术后随访期为6至97个月（中位数24.6个月）。62例复发性子宫内膜异位囊肿患者中，50例在治疗侧卵巢复发，7例在对侧未治疗卵巢复发，5例在治疗侧和未治疗侧卵巢均复发。47例（76%）子宫内膜异位囊肿复发患者伴有症状（疼痛或不孕），其余15例（24%）无症状。在TVS检测出复发的47例有症状患者中，15例进行了二次手术。这些患者进行二次手术的指征为复发性囊肿较大、药物治疗反应不佳、TVS显示盆腔粘连和深部子宫内膜异位结节以及疾病总体进展。未进行二次手术的有症状患者（32例）复发性子宫内膜异位囊肿较小。然而，在31例复发性子宫内膜异位囊肿较大（>3cm）的有症状患者中，只有45%进行了再次手术。
TVS检测到的复发性子宫内膜异位囊肿可能无症状，无论是否接受药物治疗，其大小不一定会进展。再次手术的决定较少取决于子宫内膜异位囊肿的大小，而更多取决于症状，特别是严重疼痛以及药物治疗失败。然而，这类患者在TVS扫描中也更有可能出现深部结节和附件/肠道粘连的迹象以及较大的子宫内膜异位囊肿，因此更倾向于需要进行二次手术。
