Department of Operative Gynecology and Gynecologic Oncology, Polish Mother's Memorial Hospital Research Institute, Lodz, Poland.
Department of Gynecological Surgery and Oncology, Medical University, Lodz, Poland.
Int J Gynaecol Obstet. 2019 Sep;146(3):350-356. doi: 10.1002/ijgo.12884. Epub 2019 Jun 28.
To determine the long-term impact of laparoscopic cystectomy for endometriomas and benign cysts on ovarian reserve and selection of the most effective method of assessment.
The present study was carried out between November 2013 and December 2016. Participants were assigned to laparoscopic cystectomy for diagnosed unilateral benign ovarian cysts and divided into groups: the endometrioma group (EG) (n=35) and the other benign ovarian tumor group (OG) (n=35). Before and at 3 and 12 months after the procedure, transvaginal ultrasonography was performed to assess antral follicle count (AFC) and ovarian volume (OvVol); laboratory tests were ordered for anti-Műllerian hormone (AMH) serum concentration assays. Pregnancy rates were counted in a 12-month follow-up. Statistica12 software was used for analysis.
The present study included 70 women aged 18-40 years. AMH serum concentration decreased significantly 3 months after laparoscopic cystectomy (4.89 ± 3.66 ng/mL to 3.45 ± 3.37 ng/mL; P<0.001). A greater decrease of AMH concentrations was observed in the EG (45.39% vs 14.87%; P=0.021). Twelve months of observation revealed a suppression in the drop of the AMH concentration, while AFC and OvVol remained unaffected. The likelihood of spontaneous pregnancy was three times higher in the OG (hazard ratio [HR] 3.57, 95% confidence interval [CI] 1.08-12.5).
There was a significant decline in AMH levels in the EG 3 months after cystectomy. No further fall in AMH concentration was observed in the 12-month follow-up. The serum AMH concentration could be considered a valuable marker for ovarian reserve assessment after laparoscopic cystectomy.
确定腹腔镜卵巢囊肿切除术治疗子宫内膜异位症囊肿和良性囊肿对卵巢储备的长期影响，并选择最有效的评估方法。
本研究于 2013 年 11 月至 2016 年 12 月进行。参与者被分配接受诊断为单侧良性卵巢囊肿的腹腔镜卵巢囊肿切除术，并分为两组：子宫内膜异位症囊肿组（EG）（n=35）和其他良性卵巢肿瘤组（OG）（n=35）。在手术前和手术后 3 个月和 12 个月，经阴道超声检查评估窦卵泡计数（AFC）和卵巢体积（OvVol）；实验室检查用于抗苗勒管激素（AMH）血清浓度检测。在 12 个月的随访中计算妊娠率。使用 Statistica12 软件进行分析。
本研究共纳入 70 名 18-40 岁的女性。腹腔镜卵巢囊肿切除术后 3 个月 AMH 血清浓度显著下降（4.89±3.66ng/mL 降至 3.45±3.37ng/mL；P<0.001）。EG 中 AMH 浓度的下降更为明显（45.39%比 14.87%；P=0.021）。12 个月的观察发现 AMH 浓度下降受到抑制，而 AFC 和 OvVol 保持不变。OG 自发性妊娠的可能性高出三倍（风险比[HR]3.57，95%置信区间[CI]1.08-12.5）。
EG 组在手术后 3 个月时 AMH 水平显著下降。在 12 个月的随访中未观察到 AMH 浓度进一步下降。血清 AMH 浓度可作为腹腔镜卵巢囊肿切除术后卵巢储备评估的有价值标志物。
