Abstract：
Ovarian endometriomas (OEs) are commonly detected by ultrasound in individuals affected by endometriosis. Although surgery was widely regarded in the past as the gold standard for treating OEs, especially in the case of large cysts, the surgical management of OEs remains debated. Firstly, OEs often represent the \"tip of the iceberg\" of underlying deep endometriosis, and this should be considered when treating OEs to ameliorate patients\' pain for focusing on the surgical objectives and providing better patient counseling. In the context of fertility care, OEs may have a detrimental effect on ovarian reserve through structural alterations, inflammatory responses, and oocyte reserve depletion. Conversely, the surgical approach may exacerbate the decline within the same ovarian reserve. While evidence suggests no improvement in in-vitro fertilization (IVF) outcomes following OE surgery, further studies are needed to understand the impact of OE surgery on spontaneous fertility. Therefore, optimal management of OEs is based on individual patient and fertility characteristics such as the woman\'s age, length of infertility, results of ovarian reserve tests, and surgical background. Among the available surgical approaches, cystectomy appears advantageous in terms of reduced recurrence rates, and traditionally, bipolar coagulation has been used to achieve hemostasis following this approach. Driven by concerns about the negative impact on ovarian reserve, alternative methods to obtain hemostasis include suturing the cyst bed, and novel methodologies such as CO2 laser and plasma energy have emerged as viable surgical options for OEs. In instances where sonographic OE features are non-reassuring, surgery should be contemplated to obtain tissue for histological diagnosis and rule out eventual ovarian malignancy.
摘要：
卵巢子宫内膜瘤（OEs）通常通过超声在受子宫内膜异位症影响的个体中检测到。尽管手术在过去被广泛认为是治疗OEs的黄金标准，尤其是在大囊肿的情况下，OEs的外科治疗仍存在争议。首先,OEs通常代表深层子宫内膜异位症的“冰山一角”，在治疗OEs时，应考虑这一点，以减轻患者的疼痛，专注于手术目标并提供更好的患者咨询。在生育保健方面，OEs可能通过结构改变对卵巢储备产生不利影响，炎症反应，和卵母细胞储备耗竭。相反，手术方法可能会加剧相同卵巢储备功能的下降.虽然有证据表明OE手术后的体外受精（IVF）结局没有改善，需要进一步的研究来了解OE手术对自然生育的影响.因此,OEs的最佳管理是基于个体患者和生育特征，如女性的年龄，不孕症的长度，卵巢储备试验结果,和外科背景。在可用的手术方法中，膀胱切除术在降低复发率方面似乎是有利的，传统上，在这种方法之后，双极凝血已用于实现止血。由于担心对卵巢储备的负面影响，获得止血的替代方法包括缝合囊肿床，和新的方法，如CO2激光和等离子体能量已经成为可行的手术选择。在超声检查OE特征不能令人放心的情况下，应考虑手术以获得组织进行组织学诊断，并排除最终的卵巢恶性肿瘤。
