Treatment of endometriomas: Surgical approaches and the impact on ovarian reserve, recurrence, and spontaneous pregnancy

IF 3.9 2区医学 Q1 OBSTETRICS & GYNECOLOGY Best Practice & Research Clinical Obstetrics & Gynaecology Pub Date : 2023-12-05 DOI:10.1016/j.bpobgyn.2023.102449

Dana Baraki, Elliott G. Richards, Tommaso Falcone

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Abstract

Endometriomas may contribute to infertility and are associated with diminished ovarian reserve. Surgical management can damage the ovarian cortex and further diminish ovarian reserve. Surgical therapy of endometriomas can be achieved via cystectomy, ablation (electrosurgical, laser, or plasma energy), sclerotherapy, or oophorectomy. Each approach has varying effects on ovarian reserve, spontaneous pregnancy rates, and recurrence rates: Cystectomy is associated with a low recurrence rate but higher risk of diminished ovarian reserve; Ablation (with laser or plasma energy) appears to have minimal effect on ovarian reserve while also having low recurrence rates; Sclerotherapy is mixed in terms of effect on ovarian reserve as well as recurrence rates. Fertility preservation counseling is recommended for patients considering surgical management. The surgical approach selected should be tailored to each individual patient with respect to their fertility and therapeutic goals.

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子宫内膜异位瘤的治疗:手术入路及其对卵巢储备、复发和自然妊娠的影响

子宫内膜异位瘤可能导致不孕，并与卵巢储备减少有关。手术治疗可损伤卵巢皮质，进一步减少卵巢储备。子宫内膜瘤的手术治疗可以通过膀胱切除术、消融术(电外科、激光或等离子体能量)、硬化疗法或卵巢切除术来实现。每种方法对卵巢储备、自然妊娠率和复发率的影响各不相同:膀胱切除术复发率低，但卵巢储备减少的风险较高;消融(激光或等离子体能量)似乎对卵巢储备的影响最小，同时复发率也很低;就卵巢储备和复发率的影响而言，硬化疗法是混合的。对于考虑手术治疗的患者，建议进行生育保留咨询。手术方法的选择应根据每个患者的生育能力和治疗目标量身定制。

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来源期刊

Best Practice & Research Clinical Obstetrics & Gynaecology 医学-妇产科学

CiteScore

9.40

自引率

1.80%

发文量

113

审稿时长

54 days

期刊介绍： In practical paperback format, each 200 page topic-based issue of Best Practice & Research Clinical Obstetrics & Gynaecology will provide a comprehensive review of current clinical practice and thinking within the specialties of obstetrics and gynaecology. All chapters take the form of practical, evidence-based reviews that seek to address key clinical issues of diagnosis, treatment and patient management. Each issue follows a problem-orientated approach that focuses on the key questions to be addressed, clearly defining what is known and not known. Management will be described in practical terms so that it can be applied to the individual patient.