Chandra Anjali, Rho A Mi, Jeong Kyungah, Yu Taeri, Jeon Ji Hyun, Park So Yun, Lee Sa Ra, Moon Hye-Sung, Chung Hye Won
Department of Obstetrics and Gynecology, Ewha Womans University Mokdong Hospital, Ewha Womans University School of Medicine, Seoul, Korea.
Department of Obstetrics and Gynecology, Deen Dayal Upadhyay Hospital, Delhi, India.
Obstet Gynecol Sci. 2018 Jan;61(1):111-117. doi: 10.5468/ogs.2018.61.1.111. Epub 2017 Dec 18.
Endometriosis is a common and recurring gynecologic disease which have afflicting females of reproductive age. We investigated the efficacy of long-term, post-operative use of dienogest for ovarian endometrioma.
We studied 203 patients who had undergone laparoscopic or robotic surgery for ovarian endometrioma, and were administrated dienogest 2 mg/day beginning in July of 2013, and continuing. We evaluated side effects of dienogest and ultrasonography was performed every 6 months to detect potential recurrence of endometrioma (2 cm) in these post-surgical patients.
The follow-up observation periods were 30.2±20.9 months from surgery. The mean age was 34.1±7.2 years old. The mean diameter of pre-operative endometrioma was 5.6±3.0 cm. One hundred eighty-two (89.7%) women received dienogest continuously for 12.0±7.1 months. Of the subjects, 21 (10.3%) patients discontinued dienogest at 2.4±1.0 months. The most common side effect when dienogest was discontinued was abnormal uterine bleeding. The occurrence rate of vaginal bleeding was 15.8%, a number which did not differ significantly in patients with/without post-operative gonadotropin releasing hormone agonist administration. The other side effects were gastrointestinal trouble including constipation, acne, headache, depression, hot flush, weight gain, and edema. However, no serious adverse events or side effects were documented and recurrent endometriomas were diagnosed in 3 patients (1.5%).
The data indicates that dienogest was both tolerable and safe for long-term use as prophylaxis in an effort to obviate the recurrence of ovarian endometrioma post-operatively, as well as potential need for surgical re-intervention.
子宫内膜异位症是一种常见的复发性妇科疾病，困扰着育龄女性。我们研究了长期术后使用地诺孕素治疗卵巢子宫内膜异位囊肿的疗效。
我们研究了203例接受腹腔镜或机器人手术治疗卵巢子宫内膜异位囊肿的患者，自2013年7月起开始每天服用2mg地诺孕素，并持续服用。我们评估了地诺孕素的副作用，并每6个月进行一次超声检查，以检测这些术后患者子宫内膜异位囊肿（≥2cm）的潜在复发情况。
从手术开始的随访观察期为30.2±20.9个月。平均年龄为34.1±7.2岁。术前子宫内膜异位囊肿的平均直径为5.6±3.0cm。182名（89.7%）女性连续服用地诺孕素12.0±7.1个月。在这些受试者中，21名（10.3%）患者在2.4±1.0个月时停用了地诺孕素。停用 地诺孕素时最常见的副作用是子宫异常出血。阴道出血的发生率为15.8%，在术后使用/未使用促性腺激素释放激素激动剂的患者中这一数字无显著差异。其他副作用包括胃肠道问题，如便秘、痤疮、头痛、抑郁、潮热、体重增加和水肿。然而，未记录到严重不良事件或副作用，3例患者（1.5%）被诊断为复发性子宫内膜异位囊肿。
数据表明，地诺孕素长期用于预防卵巢子宫内膜异位囊肿术后复发以及潜在的再次手术干预需求是可耐受且安全的。
