Koshiba Akemi, Mori Taisuke, Okimura Hiroyuki, Akiyama Kanoko, Kataoka Hisashi, Takaoka Osamu, Ito Fumitake, Matsushima Hiroshi, Kusuki Izumi, Kitawaki Jo
Department of Obstetrics and Gynecology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan.
J Obstet Gynaecol Res. 2018 Oct;44(10):1970-1976. doi: 10.1111/jog.13725. Epub 2018 Jul 10.
We aimed to evaluate whether hormonal therapy immediately after postsurgical recurrence of ovarian endometrioma controls disease progression and can be an alternative therapeutic option to avoid multiple repeat surgeries.
We enrolled 146 patients treated for endometrioma at the University Hospital of Kyoto Prefectural University of Medicine between 2009 and 2015. After laparoscopic cystectomy using the stripping technique, opening of cul-de-sac obliterations and complete resection of the deep infiltrating endometriosis lesions, the patients either received no treatment (n = 83), oral contraceptives (OC; n = 32) or dienogest (DNG; n = 27), depending on their medical history. Four patients were excluded because they changed their regimens during the follow-up period. All patients were followed up every 3 months. Patients who developed recurrence of endometrioma immediately received DNG, OC or gonadotropin-releasing hormone agonist.
Overall, 16 patients developed a recurrence of the endometrioma (12 in the nontreatment group, three in the OC group and one in the DNG group). The 11 patients with recurrence were treated with DNG immediately after the diagnosis of recurrent endometrioma. Among them, seven patients continued treatment with DNG (2 mg) for 24 months. After 24 months of treatment with DNG, complete resolution of recurrent endometrioma was achieved in four (57.1%) of seven patients. There was no improvement in the three patients who received OC and one patient who underwent secondary surgery.
DNG therapy early after recurrence of postsurgical endometrioma appears to be viable for reducing the risk of repeated surgery.
我们旨在评估卵巢子宫内膜异位囊肿术后复发后立即进行激素治疗能否控制疾病进展，以及是否可作为避免多次重复手术的替代治疗选择。
我们纳入了2009年至2015年间在京都府立医科大学附属医院接受子宫内膜异位囊肿治疗的146例患者。在采用剥除技术进行腹腔镜囊肿切除、打开后陷凹粘连并完全切除深部浸润性子宫内膜异位症病灶后，根据患者病史，部分患者未接受治疗（n = 83），部分患者口服避孕药（OC；n = 32）或地诺孕素（DNG；n = 27）。4例患者因在随访期间改变治疗方案而被排除。所有患者每3个月进行一次随访。子宫内膜异位囊肿复发的患者立即接受DNG、OC或促性腺激素释放激素激动剂治疗。
总体而言，16例患者出现子宫内膜异位囊肿复发（未治疗组12例，OC组3例，DNG组1例）。11例复发患者在诊断为复发性子宫内膜异位囊肿后立即接受DNG治疗。其中，7例患者继续使用DNG（2 mg）治疗24个月。经过24个月的DNG治疗，7例患者中有4例（57.1%）复发性子宫内膜异位囊肿完全消退。接受OC治疗的3例患者和接受二次手术的1例患者均无改善。
术后子宫内膜异位囊肿复发后早期进行DNG治疗似乎对于降低重复手术风险是可行的。
