Kostrzewa Marta, Stachowiak Grzegorz, Zyła Monika, Kolasa-Zwierzchowska Dorota, Szpakowski Artur, Nowak Marek, Wilczynski Jacek R
Department of Gynecology and Oncological Gynecology, Polish Mother's Memorial Hospital Research Institute in Lodz, Poland.
Medical University of Lodz, Lodz, Poland.
Neuro Endocrinol Lett. 2016 Sep;37(4):295-300.
The golden standard in treatment benign ovarian cysts is laparoscopic cystectomy, but it may also influence women's fertility. The aim of the study was to compare women's fertility after laparoscopic cystectomy of endometrioma versus other benign ovarian tumors.
Out of the 123 patients operated because of benign ovarian tumor (OT), 66 underwent laparoscopic cystectomy of endometrioma (endometrioma group) and 57 underwent laparoscopic cystectomy of other benign ovarian tumor like: functional cyst, hemorrhagic cyst, yellow body cyst or mature teratoma (reference group). OT-related data were obtained from medical documentation (diagnostic tests, medical reproductive and surgical history, clinical status during OT surgery). Follow-up data were collected by means of a telephone interview. The survey included questions focused on women's fertility during a 24-month period following the surgical treatment of OT (conception, subsequent pregnancies, recurrence of OT).
A 24-month follow-up period revealed that the cumulative pregnancy rate was significantly higher in reference group (RG) as compared to endometrioma group (EG), i.e. 52.6% vs. 32.3%. Lower pregnancy risk was demonstrated in a EG group vs. other benign ovarian tumors, HR=0.57 (CI 0.33-0.99; p=0.049), log-rank test p=0.045. Benign OT returned in 19.3% vs. EG 36.3%, HR= 2.5 (CI 1.16-5.55 ; p=0.019) log-rank test: p=0.0136. The EG was divided on two subgroups: women with solitary endometrioma and women with endometrioma and coexistent peritoneal endometriosis. The study showed insignificantly lower risk of pregnancy in a group of advanced endometriosis vs. solitary endometrioma group (HR= 0.79 (CI 0.34-1.83; log-rank test p=0.57; pregnancy rate 29.3% vs. 40.0%). Statistically nonsignificant higher pregnancy rate occurred in a group of women with tumor ≤50mm in size among patients with benign ovarian tumor and solitary endometrioma vs. group of women with tumor >50mm (30% vs. 61%; p=0.09).
There is a low pregnancy rate after laparoscopic cystectomy of benign OT. Moreover, pregnancy rate after cystectomy of endometrioma is significantly lower and the percentage of reccurence of endometrioma is significantly higher. That is why, the decision about surgical treatment among childbearing women must be well-considered because of the risk of subsequent surgery in the future.
治疗良性卵巢囊肿的金标准是腹腔镜囊肿切除术，但它也可能影响女性的生育能力。本研究的目的是比较子宫内膜异位囊肿与其他良性卵巢肿瘤患者在接受腹腔镜囊肿切除术后的生育能力。
在因良性卵巢肿瘤（OT）接受手术的123例患者中，66例接受了子宫内膜异位囊肿的腹腔镜囊肿切除术（子宫内膜异位囊肿组），57例接受了其他良性卵巢肿瘤的腹腔镜囊肿切除术，如功能性囊肿、出血性囊肿、黄体囊肿或成熟畸胎瘤（参照组）。OT相关数据来自医疗记录（诊断检查、生殖和手术病史、OT手术期间的临床状况）。随访数据通过电话访谈收集。该调查包括了聚焦于OT手术治疗后24个月内女性生育情况的问题（受孕、后续妊娠、OT复发）。
24个月的随访期显示，参照组（RG）的累积妊娠率显著高于子宫内膜异位囊肿组（EG），分别为52.6%和32.3%。与其他良性卵巢肿瘤相比，EG组的妊娠风险较低（HR=0.57，95%CI 0.33-0.99；p=0.049），对数秩检验p=0.045。良性OT的复发率在参照组为19.3%，在EG组为36.3%，HR=2.5（95%CI 1.16-5.55；p=0.019），对数秩检验：p=0.0136。EG组又分为两个亚组：孤立性子宫内膜异位囊肿患者和合并腹膜子宫内膜异位症的子宫内膜异位囊肿患者。研究表明，与孤立性子宫内膜异位囊肿组相比，晚期子宫内膜异位症组的妊娠风险略低（HR=0.79，95%CI 0.34-1.83；对数秩检验p=0.57；妊娠率分别为29.3%和40.0%）。在良性卵巢肿瘤和孤立性子宫内膜异位囊肿患者中，肿瘤≤50mm的女性组的妊娠率在统计学上虽无显著差异，但高于肿瘤>50mm的女性组（30%对61%；p=0.09）。
良性OT腹腔镜囊肿切除术后的妊娠率较低。此外，子宫内膜异位囊肿切除术后的妊娠率显著更低，且子宫内膜异位囊肿的复发率显著更高。因此，由于未来有再次手术的风险，育龄期女性在决定手术治疗时必须慎重考虑。
