子宫内膜囊肿 CO2 激光蒸发术后的长期复发率及生育结局：五年随访经验

Long-Term Postoperative Recurrence Rates and Fertility Outcomes After Endometrioma CO2-Laser Vaporization: A Five-Year Follow-Up Experience

Journal of Minimally Invasive Gynecology

影响因子:3.3

分区:医学2区 / 妇产科学2区

发表日期:2025 Feb

作者: Stefano M Ferrari, Carolina Dolci, Iacopo Tandoi, Matteo Schimberni, Ludovica Bartiromo, Noemi Salmeri, Sara D'Alessandro, Giulia Carnemolla, Giorgia Grisafi, Massimo Candiani

DOI: 10.1016/j.jmig.2024.09.367

摘要

尽管子宫内膜囊肿的手术治疗以囊切除术为金标准，但对卵巢储备能力的负面影响引发关注。激光 CO2 蒸发术在保护卵巢储备、术后妊娠率和复发方面显示出令人鼓舞的数据。本研究旨在评估接受 CO2 光纤激光蒸发术治疗的子宫内膜囊肿患者，术后至少五年随访中的复发率及妊娠率。为回顾性研究，地点为意大利三级中心，时间为 2023 年 10 月至 2024 年 2 月。纳入年龄 ≥18 岁，接受腹腔镜 CO2 光纤激光蒸发术治疗的子宫内膜囊肿患者。排除标准包括年龄 ≥40 岁、既往卵巢手术、输卵管切除术或子宫切除术、组织学未发现子宫内膜异位症或存在恶性肿瘤证据。通过腹腔镜采用 CO2 光纤激光蒸发卵巢内膜异位症囊肿，术后患者加入定期随访计划。共纳入78例患者，平均年龄33.2 ± 4.6岁，基础抗苗勒激素水平为2.7 ± 1.9 ng/mL，囊肿直径中位数为4（3-5）cm，随访中位时间为72.5个月（67-84.5）。术后，具有生育意愿的患者中，65.5%（n=36）成功怀孕，天然怀孕占55.6%，辅助生殖技术占44.4%，平均孕期为17.7 ± 18.1个月。7例复发患者的Kaplan-Meier 曲线显示，复发中位时间为26个月，100个月时无病生存率估计为91.03%（95% CI：82.10%-95.62%）。CO2 光纤激光蒸发术是一种安全有效的治疗卵巢子宫内膜异位症的手术方法，兼具保护卵巢组织的优势，其长期术后复发率与文献报道的囊切除术相当。

Abstract

Although cystectomy remains the gold standard for the surgical treatments of endometriomas, concerns about the negative effect on ovarian reserve are rising. Laser-CO2 vaporization of endometriomas has shown encouraging data on ovarian reserve preservation, postoperative pregnancy rates, and recurrence. The aim of this study was to assess postoperative recurrence rate and pregnancy rate in patients with endometriomas managed by CO2 fiber laser vaporization after at least 5 years following surgery.Retrospective study.Italian tertiary center from October 2023 to February 2024.We included women aged >18 years who underwent laparoscopic CO2 fiber laser vaporization for endometriomas. Age ≥40 years, previous ovarian surgery, previous salpingectomy or hysterectomy, negative histologic finding for endometriosis, or any findings of malignancy at histology were exclusion criteria.Ovarian endometriomas were vaporized through laparoscopic CO2 fiber laser. After surgery, patients were included in a surveillance program with periodic clinical follow-ups.Seventy-eight patients were included. The mean age was 33.2 ± 4.6 years, the basal anti-Müllerian hormone was 2.7 ± 1.9 ng/mL, and the median diameter of the endometriomas was 4 (3-5) cm. The median duration of follow-up was 72.5 months (67-84.5). After surgery, 65.5% (n = 36) of women with reproductive desire achieved a pregnancy, 55.6% spontaneously, and 44.4% through Assisted Reproduction Techniques, with a mean time to pregnancy of 17.7 ± 18.1 months. A Kaplan-Meier curve for the 7 patients who experienced an ipsilateral recurrence showed that the median time to recurrence was 26 months and the estimated rate of disease-free patients was 91.03% at 100 months (95% confidence interval 82.10%-95.62%).CO2 fiber laser vaporization is an effective and safe surgical treatment of ovarian endometriomas, combining the advantage of being an ovarian tissue-sparing technique with long-term postoperative recurrence rate comparable with that described in literature for the cystectomy.