Department of Obstetrics and Gynecology, University of Milan and Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy.
Acta Obstet Gynecol Scand. 2013 Jan;92(1):8-16. doi: 10.1111/j.1600-0412.2012.01470.x. Epub 2012 Nov 1.
Ovulation seems crucial in the pathogenesis of ovarian endometriomas. Therefore, suppression of ovulation should be protective against cyst relapse after excision. The objective of this systematic review was to assess the effect of long-term postoperative medical treatment on the risk of endometrioma recurrence. A MEDLINE search was conducted to identify all the comparative studies published in the last 12 years in the English language literature on the relation between long-term postoperative adjuvant therapy and risk of endometrioma recurrence. Of the 12 articles assessed in detail, four were finally selected based on surgery for endometriotic cysts, postoperative medical treatment use for ≥ 12 months vs. expectant management, and ultrasonographic and/or histological diagnosis of endometrioma recurrence. A total of 965 women were enrolled, 726 of whom were in three cohort studies and 239 in one randomized controlled trial. Oral contraceptives (OCs) were always used as postoperative adjuvant treatment. The absolute effect of postoperative OC use was assessed by comparing "always" and "never" users. A recurrent endometrioma was identified in 33 of 423 (8%) "always" OC users and in 117 of 341 (34%) women who underwent expectant management (pooled odds ratio 0.12; 95% confidence interval 0.05-0.29). To define the effect of duration of use, "always" users were compared with "ever" users, and "ever" with "never" users, with a pooled odds ratio of, respectively, 0.21 (95% confidence interval 0.11-0.40) and 0.39 (95% confidence interval 0.23-0.66). Postoperative OC use dramatically decreased the risk of ovarian endometrioma recurrence, especially in women who used OCs regularly and for prolonged periods.
排卵似乎对卵巢子宫内膜异位症的发病机制至关重要。因此，排卵抑制应该可以防止切除后囊肿复发。本系统评价的目的是评估长期术后药物治疗对子宫内膜异位症复发风险的影响。对过去 12 年发表的英文文献中关于长期术后辅助治疗与子宫内膜异位症复发风险之间关系的所有对照研究进行了 MEDLINE 检索。在详细评估的 12 篇文章中，最终选择了 4 篇基于子宫内膜异位症囊肿手术、术后使用辅助治疗≥12 个月与期待治疗、超声和/或组织学诊断子宫内膜异位症复发的文章。共纳入 965 名女性，其中 726 名来自 3 项队列研究，239 名来自 1 项随机对照试验。口服避孕药（OC）一直被用作术后辅助治疗。通过比较“总是”和“从不”使用者，评估术后 OC 使用的绝对效果。在 423 名“总是”OC 使用者中，有 33 名（8%）和 341 名接受期待治疗的女性中（117 名，34%）发现复发性子宫内膜异位症（合并优势比 0.12；95%置信区间 0.05-0.29）。为了确定使用持续时间的效果，将“总是”使用者与“曾经”使用者，以及“曾经”使用者与“从不”使用者进行了比较，合并优势比分别为 0.21（95%置信区间 0.11-0.40）和 0.39（95%置信区间 0.23-0.66）。术后 OC 使用显著降低了卵巢子宫内膜异位症的复发风险，尤其是在经常且长期使用 OC 的女性中。
