The outcomes of repeat surgery for recurrent symptomatic endometriosis
The outcomes of repeat surgery for recurrent symptomatic endometriosis
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DOI：
10.1097/gco.0b013e32833bea15
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发表时间：
2010-08-01
影响因子：
2.1
通讯作者：
Fedele, Luigi
中科院分区：
文献类型：
--
作者：
Berlanda, Nicola;Vercellini, Paolo;Fedele, Luigi
回顾的目的评价二线手术治疗复发性子宫内膜异位症的疗效。最近的发现复发性子宫内膜异位症重复保守手术后疼痛复发的长期概率在20 - 40%之间。骶前神经切除术与子宫内膜异位症治疗的相关性可能在减轻中线疼痛方面有效;然而，没有研究在复发性疾病患者中评估该手术。子宫切除术治疗子宫内膜异位症相关疼痛的中期结局相当令人满意;然而，子宫切除术后疼痛持续性的概率为15%，疼痛恶化的风险为3- 5%，与卵巢切除术相比，保留卵巢的患者进一步手术的风险高6倍。因复发性子宫内膜异位症合并不孕症而接受重复手术的妇女的受孕率为26%，而初次手术后的总粗妊娠率为41%。总结重复保守手术治疗复发性子宫内膜异位症合并盆腔疼痛与初次手术具有相同的疗效和局限性。相反，在不孕症的重复保守手术后，妊娠率几乎是初次手术后妊娠率的一半。需要更多的数据来确定复发性子宫内膜异位症女性的最佳治疗选择，包括疼痛缓解，妊娠率和患者依从性。
Purpose of reviewTo evaluate the efficacy of second-line surgery in the management of recurrent endometriosis.Recent findingsLong-term probability of pain recurrence after repeat conservative surgery for recurrent endometriosis varies between 20 and 40%. The association of presacral neurectomy to the treatment of endometriosis might be effective in reducing midline pain; however, no studies have evaluated this procedure among patients with recurrent disease. The medium-term outcome of hysterectomy for endometriosis-associated pain is quite satisfactory; nevertheless, probability of pain persistence after hysterectomy is 15% and risk of pain worsening 3-5%, with a six times higher risk of further surgery in patients with ovarian preservation as compared to ovarian removal. The conception rate among women undergoing repetitive surgery for recurrent endometriosis associated with infertility is 26%, whereas the overall crude pregnancy rate after a primary procedure is 41%.SummaryRepeat conservative surgery for pelvic pain associated with recurrent endometriosis has the same efficacy and limitations as primary surgery. Conversely, after repeat conservative surgery for infertility, the pregnancy rate is almost half the rate obtained after primary surgery. More data are needed to define the best therapeutic option in women with recurrent endometriosis, in terms of pain relief, pregnancy rate and patient compliance.