Department of Obstetrics and Gynecology, Chang Gung University, Taoyuan, Taiwan.
J Minim Invasive Gynecol. 2013 Sep-Oct;20(5):595-603. doi: 10.1016/j.jmig.2013.03.004.
To evaluate the efficiency of transvaginal aspiration accompanied by ethanol sclerotherapy for treating cyst recurrence in patients who have previously undergone surgery to treat endometriosis and to analyze various factors that influence success rates using a data mining system.
Retrospective cohort study (Canadian Task Force classification II-3).
Teaching hospital affiliated with Chang Gung University, Taoyuan, Taiwan.
One hundred ninety-six patients with endometrioma recurrence.
A total of 274 transvaginal aspirations followed by sclerotherapy with 95% ethanol. Treatment times varied from immediate removal (0-10 minutes) to in situ retention. Patients were followed up at 3, 6, and 12 months to detect complications, determine the size and persistence of cysts, obtain the pelvic pain score, and assess for pregnancy or the need for repeat surgical intervention. A decision tree was used to determine factors from the collected data that most influenced the success of treatment.
Cyst size was consistently reduced until 6 months after ethanol sclerotherapy. The mean (SD) cyst reduction rate was 37.2% (42.2%), and the pain score reduction rate was 20.5% (71.5%). The antral follicle count was simultaneously increased by 36.4%. Sixty-three patients (23%) required repeated surgery during the observation period and were treated with either repeat aspiration (13.5%) or major laparoscopic or open laparotomic interventions (8.4%). Eighteen of 101 infertile patients (17.8%) achieved pregnancy. The total recovery rate (pregnancy or no persistence of symptoms or cyst) was significantly higher in patients in the groups that received longer treatment (7-10 minutes and retention) than in the groups with shorter treatment (0-6 minute) (47.0% vs 28.7%; p < .005). The highest recovery rate was observed in patients with longer treatment time, smaller cysts (≤5.05 cm), lower CA 125 level (≤62.03 IU/mL), and fewer cysts (≤3 cm) (35 of 49 [71.4%]). In patients with larger cysts and cysts with clear contents, better success can be achieved with longer treatment. The use of postoperative ovarian suppression, traditional Chinese medicine, or no therapy for 6 months before the study was not significant among groups.
Ultrasound-guided sclerotherapy with 95% ethanol retention is an effective alternative therapy for recurrent ovarian endometrioma, in particular in selected patient groups.
评估经阴道抽吸联合乙醇硬化疗法治疗子宫内膜异位症术后复发囊肿的疗效，并通过数据挖掘系统分析影响成功率的各种因素。
回顾性队列研究（加拿大任务组分类 II-3）。
中国台湾长庚大学附属医院教学医院。
196 例内异症囊肿复发患者。
共行 274 次经阴道抽吸术，继以 95%乙醇硬化治疗。治疗时间从即刻切除（0-10 分钟）至原位保留不等。患者在 3、6 和 12 个月时接受随访，以检测并发症、确定囊肿大小和持续存在情况、获得盆腔疼痛评分，并评估妊娠或再次手术干预的需要。采用决策树确定从收集的数据中确定对治疗成功影响最大的因素。
乙醇硬化治疗后，囊肿大小持续缩小，直至 6 个月。平均（SD）囊肿缩小率为 37.2%（42.2%），疼痛评分缩小率为 20.5%（71.5%）。同时窦卵泡计数增加了 36.4%。在观察期间，63 例患者（23%）需要重复手术，分别采用重复抽吸（13.5%）或主要腹腔镜或开腹剖腹手术干预（8.4%）进行治疗。101 例不孕患者中有 18 例（17.8%）妊娠。在接受较长治疗（7-10 分钟和保留）的患者中，总恢复率（妊娠或无持续症状或囊肿）显著高于接受较短治疗（0-6 分钟）的患者（47.0%比 28.7%；p<.005）。在治疗时间较长、囊肿较小（≤5.05cm）、CA125 水平较低（≤62.03IU/mL）和囊肿较少（≤3cm）的患者中，观察到最高的恢复率（35 例中有 35 例[71.4%]）。对于较大的囊肿和囊内有清晰内容物的患者，较长的治疗时间可以获得更好的效果。术后卵巢抑制、中药、或研究前 6 个月不治疗在各组之间没有显著差异。
经阴道超声引导下 95%乙醇保留硬化疗法是治疗复发性卵巢子宫内膜异位症的有效替代疗法，尤其是在某些患者群体中。
