Borghese B, Marzouk P, Santulli P, de Ziegler D, Chapron C
Service de gynécologie obstétrique 2 et médecine de la reproduction, université Paris Descartes, Sorbonne Paris Cité, groupe hospitalier Cochin-Broca-Hôtel-Dieu, AP-HP, 75014 Paris, France; Institut Cochin, université Paris Descartes, Sorbonne Paris Cité, CNRS (UMR 8104), 75014 Paris, France; Inserm, U1016, 75014 Paris, France.
J Gynecol Obstet Biol Reprod (Paris). 2013 Dec;42(8):786-93. doi: 10.1016/j.jgyn.2013.09.033. Epub 2013 Nov 7.
The surgical management of presumed benign ovarian tumors (PBOT) must ensure complete removal of the cyst, reduce the risk of recurrence (especially in case of endometrioma), prevent any risk of tumor dissemination, and must preserve healthy ovarian tissue. Asymptomatic PBOT should not be punctured. Expectation is preferable to puncture. Laparoscopy is the gold standard for surgical treatment. Single-port laparoscopy is feasible and being evaluated. Peritoneal exploration and peritoneal cytology are conventionally performed. Ovarian cystectomy, oophorectomy and salpingo-oophorectomy are the standard techniques. Suture after cystectomy is not recommended. The extraction of the cyst using an endoscopic bag is recommended. Peritoneal washing after surgery is recommended. The use of anti-adhesions barriers is not recommended routinely. In case of dermoid cyst, cystectomy by mesial incision may decrease the risk of intraoperative rupture. In case of endometrioma, the intraperitoneal cystectomy is recommended as first-line surgery. Exclusive bipolar coagulation should be avoided because of increased risk of recurrence and lower pregnancy rates. There is no argument to support the use of plasma energy and CO2 laser in the treatment of endometriomas. Ethanol sclerotherapy may be proposed in patients with recurrent endometriomas after surgery and referred to medically assisted procreation, although there is no comparative trial with cystectomy.
疑似良性卵巢肿瘤（PBOT）的手术管理必须确保囊肿完全切除，降低复发风险（尤其是子宫内膜异位囊肿），防止肿瘤播散的任何风险，并且必须保留健康的卵巢组织。无症状的PBOT不应穿刺。观察优于穿刺。腹腔镜检查是手术治疗的金标准。单孔腹腔镜检查可行且正在评估中。传统上进行腹膜探查和腹膜细胞学检查。卵巢囊肿切除术、卵巢切除术和输卵管卵巢切除术是标准技术。不建议囊肿切除术后缝合。建议使用内镜袋取出囊肿。建议术后进行腹膜冲洗。不常规推荐使用抗粘连屏障。对于皮样囊肿，经中线切口进行囊肿切除术可降低术中破裂风险。对于子宫内膜异位囊肿，建议将腹腔内囊肿切除术作为一线手术。应避免单纯使用双极电凝，因为复发风险增加且妊娠率较低。没有证据支持在子宫内膜异位囊肿治疗中使用等离子体能量和二氧化碳激光。对于术后复发的子宫内膜异位囊肿且转诊至辅助生殖的患者，可考虑乙醇硬化治疗，尽管尚无与囊肿切除术的对比试验。
