卵巢子宮內膜異位瘤手術對停經年齡的影響

2018 年 7 月 19 日陳啟煌

Hum Reprod. 2011年8月24日 (搶鮮版)

出處:第二名的不孕症期刊

雙邊卵巢子宮內膜異位瘤手術對停經年齡的影響

來自意大利的研究

摘要

背景

手術切除的卵巢子宮內膜異位可能導致卵巢功能受損仍然是Questions。為了檢驗這一假設，卵巢子宮內膜異位傷害的卵巢功能的手術加速卵巢衰竭而研究本文。

方法

在三級大學醫院，縱向前瞻性世代研究。患者之間接受1993年3月和2007年11月被評定為子宮內膜異位症腹腔鏡手術在研究納入一項前瞻性追蹤 3，6和12個月，然後每年進行。月經模式，症狀和生育的結果研究。

結果

在超過 14年的時間追蹤，302例患者納入研究。患者平均年齡（± SD）為 32.6 ± 5.6歲;在後續時間中位數為 8.5年（範圍 2-17年）。更年期是記錄在43名婦女（14.3％）在平均年齡為 45.3 ± 4.3歲（範圍 32-52歲）。以前接受雙邊切除術的婦女在絕經年齡比單側卵巢子宮內膜異位手術者早停經（42.1 ± 5.1與47.1年± 3.5歲，P = 0.003）。卵巢早衰（POF）觀察 7/ 43（16.3％）在絕經期的患者; 雙邊子宮內膜異位瘤切除後，大部分（4，57.1％）。雙邊子宮內膜異位瘤切除和術前卵巢子宮內膜異位瘤大小和絕經年齡有顯著關係（R（2）= 0.754，P = 0.002）。

結論

患者動了雙邊子宮內膜異位瘤切除手術有增加卵巢早衰竭的風險。卵巢在手術時實質的損失似乎與囊腫的大小有關。在單側卵巢子宮內膜異位的情況下，完整的對側卵巢可能適當補償卵巢功能。

PS: 過大的卵巢子宮內膜異位瘤，手術仍是必要的，然而要慎選時機及手術醫師，2次卵巢子宮內膜異位瘤手術對復發者特別是不孕或未婚者傾向別再度切除，卵巢體積會大幅遞減，卵子少甚至連人工生殖時卵庫存量也很少，進而早發停經。

Hum Reprod. 2011 Aug 24. [Epub ahead of print]

Ovarian surgery for bilateral endometriomas influences age at menopause.

Coccia ME, Rizzello F, Mariani G, Bulletti C, Palagiano A, Scarselli G.

SourceDepartment of Science for the Health of Woman and Child, University of Florence , Via Ippolito Nievo 2, 50129 Florence , Italy .

Abstract

BACKGROUNDQuestions remain as to whether surgical excision of ovarian endometriomas might cause damage to ovarian function. To test the hypothesis that ovarian surgery for endometrioma compromises ovarian function and accelerates ovarian failure.METHODSIn a tertiary university Clinic, longitudinal prospective cohort study. Patients who underwent laparoscopy for endometriosis between March 1993 and November 2007 were assessed for inclusion in the study. A prospective follow-up at 3, 6 and 12 months then yearly was conducted. Evolution of menstrual pattern, symptoms and reproductive outcomes were investigated.RESULTSFrom over the 14-year period, 302 patients were included in the study. The mean age (±SD) of patients was 32.6 ± 5.6 years; the median duration of follow-up was 8.5 years (range 2-17 years). Menopause was documented in 43 women (14.3%) at a mean age of 45.3 ± 4.3 years (range 32-52 years). Women previously submitted to bilateral cystectomy were younger at menopause than those with monolateral endometrioma (42.1 ± 5.1 years versus 47.1 ± 3.5 years, P = 0.003). Premature ovarian failure (POF) was observed in 7 of 43 (16.3%) menopausal patients; the majority (4, 57.1%) after bilateral cystectomy. The relationship between the preoperative ovarian endometriomas total diameter and menopausal age was significant in case of surgery for bilateral endometriomas (R(2) = 0.754, P = 0.002).CONCLUSIONSPatients who had been operated on for bilateral endometriomas have an increased risk of POF. Ovarian parenchyma loss at the time of surgery seems related to cyst diameter. In the case of unilateral ovarian endometrioma, the contralateral intact ovary might adequately compensate.