Busacca Mauro, Vignali Michele
Department of Obstetrics and Gynecology, University of Milano, Macedonio Melloni Hospital, Italy.
J Minim Invasive Gynecol. 2009 Mar-Apr;16(2):142-8. doi: 10.1016/j.jmig.2008.12.013.
Endometrioma is one of the most frequent pathologies in gynecologic surgery. Laparoscopic cyst excision is considered the best treatment in terms of lower recurrence and improved fertility. However, it was recently questioned whether the excision of the endometrioma could decrease the function of the operated ovary and if it could affect the subsequent fertility. Even if a consistent amount of ovarian tissue is unintentionally removed together with the capsule of the cyst, resulting in does not show the follicular pattern observed in working ovaries. Currently, no definitive data clarify whether the damage to the ovarian reserve, observed in patient with endometrioma, is related to the surgical procedure, to the previous presence of the cyst, or both. Electrosurgial coagulation during hemostasis could play an important role in terms of damage to ovarian stroma and vascularization. Particular attention must be paid in presence of bilateral endometriotic cysts. In fact, an increase in premature ovarian failure rate was reported when both the ovaries are involved in surgery. Incase of assisted reproductive techniques, no clear evidence indicates which is the best approach for concomitant endometriotic cyst. On the base of these considerations endometriomas Should be treated only in case of pain, infertility, and in asymptomatic patients if the cyst diameter is greater than 4 cm.
子宫内膜异位囊肿是妇科手术中最常见的病变之一。就降低复发率和提高生育能力而言，腹腔镜囊肿切除术被认为是最佳治疗方法。然而，最近有人质疑子宫内膜异位囊肿切除术是否会降低手术侧卵巢的功能，以及是否会影响后续生育能力。即使在切除囊肿包膜时意外切除了相当数量的卵巢组织，剩余的卵巢组织也不会呈现出正常工作卵巢中观察到的卵泡模式。目前，尚无确凿数据能阐明子宫内膜异位囊肿患者中观察到的卵巢储备功能损害是与手术操作、囊肿先前的存在有关，还是两者都有关系。止血过程中的电外科凝固可能对卵巢基质和血管形成造成损害，这一点至关重要。对于双侧子宫内膜异位囊肿，必须给予特别关注。事实上，当双侧卵巢都参与手术时，报道的卵巢早衰发生率会增加。在辅助生殖技术的情况下，没有明确证据表明哪种方法对于合并子宫内膜异位囊肿是最佳的。基于这些考虑，子宫内膜异位囊肿仅在出现疼痛、不孕的情况下，以及对于无症状患者，当囊肿直径大于4厘米时才应进行治疗。
