Surgical technique of endometrioma excision impacts on the ovarian reserve. Single-port access laparoscopy versus multiport access laparoscopy: a case control study
Surgical technique of endometrioma excision impacts on the ovarian reserve. Single-port access laparoscopy versus multiport access laparoscopy: a case control study
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DOI：
10.3109/09513590.2015.1017812
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发表时间：
2015-06-01
影响因子：
2
通讯作者：
Nappi, Luigi
中科院分区：
文献类型：
--
作者：
Angioni, Stefano;Pontis, Alessandro;Nappi, Luigi
最近的几项研究报告了子宫内膜异位症切除对卵巢储备的不利影响。手术技术和过度使用双极电凝可能是关键因素。据报道，单孔腹腔镜（SPAL）卵巢囊肿切除术在手术结果方面与传统腹腔镜手术相当。本研究的目的是评估腹腔镜卵巢囊肿切除术治疗单侧子宫内膜异位症时单孔手术是否影响卵巢储备。这是一项针对 99 名患有单侧子宫内膜异位症的女性的前瞻性病例对照研究。 49 名女性接受了单孔膀胱切除术，50 名女性接受了多孔腹腔镜 (MPL) 传统膀胱切除术。主要结果是卵巢储备的评估。我们评估了术前、术后4-6周和3个月的血清抗苗勒管激素（AMH）水平。在 T2，我们对窦卵泡计数 (AFC) 进行了超声评估。我们注意到，与传统腹腔镜组相比，SPAL 组在 4-6 周和 3 个月的随访中平均 AMH 值和 AFC 显着降低，具有统计学意义。总之，我们的结果表明，不应该向那些想要保留生育能力的接受子宫内膜异位囊肿切除手术的患者推荐 SPAL 膀胱切除术。
Several recent studies report the detrimental effect of endometrioma excision on the ovarian reserve. Surgical technique and the excessive use of bipolar coagulation could be the key factors. Single-port access laparoscopy (SPAL) ovarian cystectomy has been reported as a comparable procedure to conventional laparoscopy in terms of operative outcomes. The aim of this study was to evaluate whether the single-port surgery affects the ovarian reserve whilst performing laparoscopic ovarian cystectomy for unilateral endometrioma. This was a prospective, case-control study of 99 women with unilateral endometrioma. Forty-nine women underwent single-port cystectomy and 50 women underwent multiport laparoscopic (MPL) conventional cystectomy. The primary outcome was the assessment of the ovarian reserve. We evaluated the serum anti-Mullerian hormone (AMH) levels before, 4-6 weeks and 3 months after surgery. At T2 we performed an ultrasound assessment of the antral follicular count (AFC). We have drawn attention to a statistically significant decrease of the mean AMH value and AFC in the SPAL group at the 4-6-week and 3-month follow-up compared to the conventional laparoscopy group. In conclusion, our results suggest that SPAL cystectomy should not be recommended to patients undergoing surgery for endometrioma excision who want to preserve their fertility.