Mokdad C, Auber M, Vassilieff M, Diguet A, Bourdel N, Marpeau L, Roman H
Clinique gynécologique et obstétricale, CHU « Charles-Nicolle », 1, rue de Germont, 76031 Rouen, France.
Gynecol Obstet Fertil. 2012 Jan;40(1):4-9. doi: 10.1016/j.gyobfe.2011.07.038. Epub 2011 Oct 20.
The aim of our study was to assess ovarian tissue loss related to endometrioma cystectomy by 3D-ultrasonography.
We have retrospectively included 15 women with no previous ovarian surgery who benefited from cystectomy of an unilateral endometrioma the diameter of which was superior to 30mm. Cystectomy has been performed using an ovarian tissue-sparing procedure with no incision of the ovarian cortex. Patients underwent ultrasonography at least 9 months after the surgery. Several ovarian parameters, such as the area on longitudinal cross-section, the volume and the antral follicles count (AFC), were measured on both operated and contra lateral ovary, and then were compared using Mann and Whitney test. The relationship between the reduction of operated ovary volume and preoperative endometrioma diameter was evaluated by multiple regression.
Operated ovary presented a significant reduction in area (mean reduction 229.8mm(2)±47.6; P<0.0001), volume (mean reduction 5.8cm(3)±1.16; P<0.0001) and AFC (mean reduction 5.1±3.8, P=0.002). No statistically significant correlation was found between operated ovary volume reduction and preoperative endometrioma diameter.
Endometrioma cystectomy leads to significant reduction in ovarian parenchyma volume and AFC, when compared to contra lateral ovary. This event must be taken into account in the choice of treatment strategy, especially in the case of enlarged, bilateral and recurrent endometriomas, recurrence, as well as in women presenting with other risk factor for ovarian failure.
本研究旨在通过三维超声评估与子宫内膜异位囊肿切除术相关的卵巢组织损失。
我们回顾性纳入了15例未曾接受过卵巢手术的女性，她们因单侧直径大于30mm的子宫内膜异位囊肿接受了囊肿切除术。囊肿切除术采用保留卵巢组织的方法，未切开卵巢皮质。患者在术后至少9个月接受超声检查。在手术侧和对侧卵巢测量了几个卵巢参数，如纵切面面积、体积和窦卵泡计数（AFC），然后使用曼恩和惠特尼检验进行比较。通过多元回归评估手术侧卵巢体积减少与术前子宫内膜异位囊肿直径之间的关系。
手术侧卵巢在面积（平均减少229.8mm²±47.6；P<0.0001）、体积（平均减少5.8cm³±1.16；P<0.0001）和AFC（平均减少5.1±3.8，P=0.002）方面均有显著减少。手术侧卵巢体积减少与术前子宫内膜异位囊肿直径之间未发现统计学上的显著相关性。
与对侧卵巢相比，子宫内膜异位囊肿切除术导致卵巢实质体积和AFC显著减少。在选择治疗策略时必须考虑到这一情况，特别是在囊肿较大、双侧和复发性子宫内膜异位症、复发以及存在其他卵巢功能衰竭风险因素的女性中。
