背景:子宫内膜异位症是一种慢性炎症性疾病,影响很大比例的育龄妇女。尽管腹腔镜手术通常是首选治疗方法,保留或切除卵巢的决定仍然存在争议。先前的研究在卵巢保存与卵巢切除术对生育结果和疾病复发的影响方面产生了不一致的结果。这项前瞻性研究旨在通过比较这些手术方法对自然妊娠率的影响来解决这一知识差距。怀孕的时间,复发率,子宫内膜异位症患者的术后疼痛。
目的:比较子宫内膜异位症腹腔镜手术中保留卵巢和卵巢切除术的生育结局和复发率。
方法:这项研究于2019年1月至2023年12月在一家三级医院进行。共有312名18至40岁的妇女,诊断为子宫内膜异位症并接受腹腔镜手术,包括在内。将患者分为卵巢保留组(n=204)和卵巢切除术组(n=108)。主要结局指标是在手术后24个月内实现自然妊娠。次要结果包括自然妊娠时间,复发率,和术后疼痛评分。
结果:保留卵巢组的自然妊娠率明显高于卵巢切除组(43.6%vs28.7%,P=0.006)。此外,卵巢保存组的中位自然妊娠时间较短(8.2个月vs11.4个月,P=0.018)。尽管如此,子宫内膜异位症复发在卵巢保存组中更为普遍(22.1%vs11.1%,P=0.014)。两组术后疼痛评分改善相似,没有观察到显著差异。亚组分析表明,在年轻女性(≤35岁)和晚期子宫内膜异位症患者中,保留卵巢对自然妊娠率的益处更为明显。
结论:保留卵巢与高自然妊娠率和短妊娠时间有关。然而,因为复发的风险增加,这个决定应该基于年龄,生育愿望,和疾病的严重程度。
BACKGROUND: Endometriosis is a chronic inflammatory condition affecting a significant proportion of women of reproductive age. Although
laparoscopic surgery is commonly the preferred treatment, the decision to preserve or remove the ovaries remains controversial. Previous studies have yielded inconsistent results regarding the impact of ovarian preservation vs oophorectomy on fertility outcomes and disease recurrence. This prospective
study aimed to address this knowledge gap by comparing the effects of these surgical approaches on spontaneous pregnancy rates, time to pregnancy, recurrence rates, and postoperative pain in patients with endometriosis.
OBJECTIVE: To compare the reproductive outcomes and recurrence rates between ovarian preservation and oophorectomy in women undergoing
laparoscopic surgery for endometriosis.
METHODS: This
study was conducted at a tertiary care hospital between January 2019 and December 2023. A total of 312 women aged 18 to 40 years, diagnosed with endometriosis and undergoing
laparoscopic surgery, were included. The patients were categorized into the ovarian preservation group (n = 204) and the oophorectomy group (n = 108). The primary outcome measure was the achievement of spontaneous pregnancy within 24 months post-surgery. Secondary outcomes included time to spontaneous pregnancy, recurrence rates, and postoperative pain scores.
RESULTS: The ovarian preservation group exhibited a significantly higher spontaneous pregnancy rate than that in the oophorectomy group (43.6% vs 28.7%, P = 0.006). Moreover, the median time to spontaneous pregnancy was shorter in the ovarian preservation group (8.2 months vs 11.4 months, P = 0.018). Nonetheless, endometriosis recurrence was more prevalent in the ovarian preservation group (22.1% vs 11.1%, P = 0.014). The postoperative pain scores demonstrated similar improvements in both groups, with no significant differences observed. Subgroup analyses indicated that the benefit of ovarian preservation on spontaneous pregnancy rates was more evident among younger women (≤ 35 years) and those with advanced-stage endometriosis.
CONCLUSIONS: Ovarian preservation is associated with a high spontaneous pregnancy rate and a short time to pregnancy. However, because of the increased risk of recurrence, the decision should be based on age, fertility aspirations, and disease severity.