Jee Byung Chul
Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
Clin Exp Reprod Med. 2022 Jun;49(2):76-86. doi: 10.5653/cerm.2021.05183. Epub 2022 May 4.
Ovarian cystectomy is the preferred technique for the surgical management of ovarian endometrioma. However, other techniques such as ablation or sclerotherapy are also commonly used. The aim of this review is to summarize information regarding the efficacy of ablation and sclerotherapy compared to cystectomy in terms of ovarian reserve, the recurrence rate, and the pregnancy rate. Several studies comparing ablation versus cystectomy or sclerotherapy versus cystectomy in terms of the serum anti-Müllerian hormone (AMH) decrement, endometrioma recurrence, or the pregnancy rate were identified and summarized. Both ablation and cystectomy have a negative impact on ovarian reserve, but ablation results in a smaller serum AMH decrement than cystectomy. Nonetheless, the recurrence rate is higher after ablation than after cystectomy. More studies are needed to demonstrate whether the pregnancy rate is different according to whether patients undergo ablation or cystectomy. The evidence remains inconclusive regarding whether sclerotherapy is better than cystectomy in terms of ovarian reserve. The recurrence rates appear to be similar between sclerotherapy and cystectomy. There is not yet concrete evidence that sclerotherapy helps to improve the pregnancy rate via in vitro fertilization in comparison to cystectomy or no sclerotherapy.
卵巢囊肿剔除术是手术治疗卵巢子宫内膜异位囊肿的首选技术。然而，其他技术如消融或硬化治疗也常用。本综述的目的是总结与囊肿剔除术相比，消融和硬化治疗在卵巢储备、复发率和妊娠率方面疗效的相关信息。确定并总结了几项在血清抗苗勒管激素（AMH）下降、子宫内膜异位囊肿复发或妊娠率方面比较消融与囊肿剔除术或硬化治疗与囊肿剔除术的研究。消融和囊肿剔除术均对卵巢储备有负面影响，但消融导致的血清AMH下降幅度小于囊肿剔除术。尽管如此，消融后的复发率高于囊肿剔除术后。需要更多研究来证明患者接受消融或囊肿剔除术后妊娠率是否不同。关于硬化治疗在卵巢储备方面是否优于囊肿剔除术，证据仍不确凿。硬化治疗和囊肿剔除术的复发率似乎相似。尚无确凿证据表明与囊肿剔除术或不进行硬化治疗相比，硬化治疗有助于通过体外受精提高妊娠率。
