Post-operative oral contraceptive use reduces the risk of ovarian endometrioma recurrence after laparoscopic excision.
Post-operative oral contraceptive use reduces the risk of ovarian endometrioma recurrence after laparoscopic excision.
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DOI：
10.1093/humrep/dep297
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发表时间：
2009-12
影响因子：
6.1
通讯作者：
M. Takamura;K. Koga;Yutaka Osuga;Y. Takemura;Kahori Hamasaki;Yasushi Hirota;O. Yoshino;Yuji Taketani
中科院分区：
文献类型：
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作者：
M. Takamura;K. Koga;Yutaka Osuga;Y. Takemura;Kahori Hamasaki;Yasushi Hirota;O. Yoshino;Yuji Taketani
背景：本研究的目的是评估术后口服避孕药（OCs）的使用对腹腔镜卵巢腺瘤切除术后复发率的影响。方法：2005年5月，我们为接受腹腔镜下直肠癌切除术的患者引入了“术后OC建议”。也就是说，在手术的时候，我们给每一个病人提供了关于OC的信息，已知的和可能的好处和风险，让她决定是否服用OC。一项回顾性队列研究纳入了2005年5月后接受腹腔镜检查的87例患者。比较了在整个随访期间使用OC的患者（n = 34）和所有其他患者（n = 53）在24个月时的腺瘤复发率。我们还进行了逻辑回归分析以确定与复发相关的变量。一项前后研究包括另外224名在2005年5月之前接受腹腔镜检查的患者，并比较了引入"术后OC清除"前后的复发率。结果长期使用OC组复发率明显低于"其他"组（2.9%比35.8%，相对危险度0.082，95% CI 0.012-0.58，P <0.001）。术后OC是与低复发相关的独立变量（OR 0.054，95% CI 0.007-0.429，P <0.001）。在"术后OC建议"出台后接受腹腔镜手术的患者的总复发率显著低于在"术后OC建议"出台前接受腹腔镜手术的患者（18.6% vs 33.1%，相对危险度0.56，95% CI 0.32-0.97，P <0.05）。结论：术后使用OC可降低腹腔镜切除术后卵巢腺瘤复发的风险。这些信息将有助于术前和术后管理的适当规划。
BACKGROUND The aim of this study was to evaluate the impact of post-operative oral contraceptives (OCs) use on the rate of recurrence after laparoscopic excision of ovarian endometrioma. METHODS In May 2005, we introduced a 'post-operative OC recommendation' for patients treated with laparoscopic excision of endometrioma. That is, at the time of the operation, we provided each patient with information about OC, known and possible benefits and risks and let her decide whether to take OC. A retrospective cohort study included 87 patients who underwent a laparoscopy after May 2005. The endometrioma recurrence rate at 24 months was compared between those who used OC for the entire follow-up period OC (n = 34) and all of the others (n = 53). We also performed logistic regression analysis to identify variables associated with recurrence. A before-after study included another 224 patients who underwent a laparoscopy before May 2005 and compared the recurrence rate before and after introduction of the 'post-operative OC recommendation'. RESULTS The recurrence rate in those who used OC for the entire period was significantly lower than in the 'others' group (2.9 versus 35.8%, relative risk 0.082, 95% CI 0.012-0.58, P < 0.001). Post-operative OC was determined as an independent variable associated with lower recurrence (OR 0.054, 95% CI 0.007-0.429, P < 0.001). The overall recurrence rate in patients who underwent laparoscopy after the introduction of the 'post-operative OC recommendation' was significantly lower than that in patients who received laparoscopy before the introduction (18.6 versus 33.1%, relative risk 0.56, 95% CI 0.32-0.97, P < 0.05). CONCLUSIONS Post-operative OC use reduces the risk of ovarian endometrioma recurrence after laparoscopic excision. This information will help in appropriate planning of pre- and post-operative management.