Department of Clinical Sciences, Rosalind Franklin University of Medicine and Science, North Chicago; Department of Minimally Invasive Gynecologic Surgery, Advocate Lutheran General Hospital, Park Ridge, Illinois..
J Minim Invasive Gynecol. 2021 Mar;28(3):575-586. doi: 10.1016/j.jmig.2020.11.020. Epub 2020 Nov 26.
To establish an endometrioma treatment paradigm (decision tree) in the treatment of an ovarian endometrioma through the review of current literature.
A thorough literature search, including PubMed, Google Scholar, and the Cochrane Library, was performed from April 2020 to July 2020. The review was completed by using the following keywords: METHODS OF STUDY SELECTION: Articles published in English that addressed the endometrioma in regard to the following were included: (1) diagnosis, (2) treatment of pain on the basis of size and/or surgical intervention, (3) treatment of fertility on the basis of size and/or surgical intervention, (4) surgical technique, (5) in vitro fertilization success on the basis of size and/or surgical intervention, (6) risk of rupture at the time of egg retrieval, (7) impact on the antimüllerian hormone and antral follicle count postsurgery, and (8) impact on implantation.
TABULATION, INTEGRATION, AND RESULTS: Fifty-six articles were included in this systematic review. While conducting this literature review, several themes were noted. In general, the literature on the ovarian endometrioma seems to be homogeneous in regard to imaging the endometrioma, excision rather than desiccation for an endometrioma ≥3-cm causing pain and/or infertility, minimal use of bipolar energy at the time of ovarian surgery, and risk of severe infection secondary to inadvertent rupture of cysts during egg retrieval. Conversely, studies on the ovarian endometrioma are much more heterogeneous in terms of surgery and assisted reproductive technology, that is, whether surgery should be performed. Certainly, an endometrioma ≥5-cm should be excised before assisted reproductive technology. Moreover, it seems that the antral follicle count and implantation may be enhanced with surgery.
By completing an extensive literature review, an easy-to-use algorithm for the diagnosis, evaluation, and treatment of endometriomas was developed to help clinicians in their treatment of patients with endometriosis in the short and long terms.
通过回顾现有文献，为卵巢子宫内膜异位症的治疗建立一个子宫内膜异位症治疗范例（决策树）。
从 2020 年 4 月至 2020 年 7 月，我们进行了全面的文献检索，包括 PubMed、Google Scholar 和 Cochrane 图书馆。使用以下关键字进行了检索：研究选择方法：纳入了发表在英语期刊上的、针对以下方面的子宫内膜异位症相关文章：（1）诊断；（2）基于大小和/或手术干预的疼痛治疗；（3）基于大小和/或手术干预的生育能力治疗；（4）手术技术；（5）基于大小和/或手术干预的体外受精成功率；（6）取卵时破裂的风险；（7）手术后对抗苗勒管激素和窦卵泡计数的影响；（8）对植入的影响。
表格制作、综合和结果：本系统评价共纳入 56 篇文章。在进行文献回顾的过程中，我们注意到了几个主题。总的来说，关于卵巢子宫内膜异位症的文献在子宫内膜异位症的影像学检查、切除而非干燥法治疗引起疼痛和/或不孕的≥3cm 的子宫内膜异位症、卵巢手术时尽量少使用双极电凝、以及取卵时囊肿意外破裂导致严重感染的风险方面似乎是一致的。相反，关于卵巢子宫内膜异位症的研究在手术和辅助生殖技术方面则更加多样化，即是否应进行手术。当然，大于 5cm 的子宫内膜异位症应在辅助生殖技术之前切除。此外，手术似乎可以提高窦卵泡计数和植入率。
通过完成广泛的文献回顾，我们为子宫内膜异位症的诊断、评估和治疗制定了一个易于使用的算法，以帮助临床医生在短期和长期内治疗子宫内膜异位症患者。
