Leicester Fertility Centre, University Hospitals of Leicester, Leicester, UK.
Reprod Biomed Online. 2011 Jul;23(1):15-24. doi: 10.1016/j.rbmo.2010.11.013. Epub 2010 Dec 1.
Endometrioma is commonly seen in women of reproductive age who may wish to preserve their ovarian function. Surgical treatment is associated with a high recurrence rate and its employment for women undergoing assisted conception has recently been challenged. Medical treatment has not been shown to be effective in controlling symptoms or improving fertility potential. The results of retrospective and non-randomized studies have been inconsistent and created an ongoing debate between gynaecologists and fertility specialists. This manuscript reviews and critically appraises the evidence for management of endometrioma in women of reproductive age. In asymptomatic women, surgical treatment is usually recommended for women above the age of 40 and for large endometriomas. Except for pelvic clearance, there is insufficient evidence to suggest that surgical treatment of endometrioma is better than medical treatment with respect to the long-term relief of symptoms and quality of life. Laparoscopic excision of ovarian endometrioma prior to IVF does not offer any additional benefit over expectant management. A large, well-designed, adequately powered randomized controlled study that compares the effects of surgical removal versus expectant management of endometrioma on ovarian performance and pregnancy outcomes in women undergoing IVF is warranted.
卵巢子宫内膜异位囊肿在育龄妇女中较为常见，这些患者可能希望保留卵巢功能。手术治疗与较高的复发率相关，并且最近对接受辅助受孕的妇女采用手术治疗提出了质疑。药物治疗在控制症状或提高生育潜能方面尚未显示出有效性。回顾性和非随机研究的结果不一致，这在妇科医生和生育专家之间引发了持续的争论。本文综述并批判性地评估了育龄妇女卵巢子宫内膜异位囊肿的治疗证据。对于无症状的妇女，通常建议年龄大于 40 岁和囊肿较大的妇女进行手术治疗。除了盆腔清除术外，没有足够的证据表明手术治疗在长期缓解症状和生活质量方面优于药物治疗。在 IVF 之前进行腹腔镜切除卵巢子宫内膜异位囊肿并不能比期待治疗带来任何额外的益处。需要进行一项大型、精心设计、充分有力的随机对照研究，比较手术切除与期待治疗对接受 IVF 的妇女的卵巢功能和妊娠结局的影响。
