Dienogest therapy during the early stages of recurrence of endometrioma might be an alternative therapeutic option to avoid repeat surgeries
Dienogest therapy during the early stages of recurrence of endometrioma might be an alternative therapeutic option to avoid repeat surgeries
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DOI：
10.1111/jog.13725
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发表时间：
2018-10-01
影响因子：
1.6
通讯作者：
Kitawaki, Jo
中科院分区：
文献类型：
--
作者：
Koshiba, Akemi;Mori, Taisuke;Kitawaki, Jo
目的：我们旨在评估卵巢子宫内膜异位症术后复发后立即进行激素治疗是否可以控制疾病进展，并可以作为避免多次重复手术的替代治疗选择。方法：我们招募了 2009 年至 2015 年间在京都府立医科大学附属医院接受子宫内膜异位症治疗的 146 名患者。对于浸润性子宫内膜异位病灶，患者要么不接受任何治疗（n = 83），要么接受口服避孕药（OC；n = 32）或地诺孕素（DNG；n = 27），具体取决于他们的病史。四名患者因在随访期间改变治疗方案而被排除。所有患者每 3 个月进行一次随访。子宫内膜瘤复发的患者立即接受 DNG、OC 或促性腺激素释放激素激动剂治疗。结果：总体而言，16 名患者出现子宫内膜瘤复发（非治疗组 12 名，OC 组 3 名，DNG 组 1 名）。 11 例复发患者在诊断为复发性子宫内膜异位症后立即接受 DNG 治疗。其中，7名患者继续接受DNG（2 mg）治疗24个月。经过 24 个月的 DNG 治疗后，7 名患者中有 4 名 (57.1%) 的复发性子宫内膜异位症完全消退。接受 OC 的 3 名患者和接受二次手术的 1 名患者的情况没有改善。结论：子宫内膜异位瘤术后复发后早期进行 DNG 治疗似乎可以降低重复手术的风险。
Aim: We aimed to evaluate whether hormonal therapy immediately after postsurgical recurrence of ovarian endometrioma controls disease progression and can be an alternative therapeutic option to avoid multiple repeat surgeries.Methods: We enrolled 146 patients treated for endometrioma at the University Hospital of Kyoto Prefectural University of Medicine between 2009 and 2015. After laparoscopic cystectomy using the stripping technique, opening of cul-de-sac obliterations and complete resection of the deep infiltrating endometriosis lesions, the patients either received no treatment (n = 83), oral contraceptives (OC; n = 32) or dienogest (DNG; n = 27), depending on their medical history. Four patients were excluded because they changed their regimens during the follow-up period. All patients were followed up every 3 months. Patients who developed recurrence of endometrioma immediately received DNG, OC or gonadotropin-releasing hormone agonist.Results: Overall, 16 patients developed a recurrence of the endometrioma (12 in the nontreatment group, three in the OC group and one in the DNG group). The 11 patients with recurrence were treated with DNG immediately after the diagnosis of recurrent endometrioma. Among them, seven patients continued treatment with DNG (2 mg) for 24 months. After 24 months of treatment with DNG, complete resolution of recurrent endometrioma was achieved in four (57.1%) of seven patients. There was no improvement in the three patients who received OC and one patient who underwent secondary surgery.Conclusion: DNG therapy early after recurrence of postsurgical endometrioma appears to be viable for reducing the risk of repeated surgery.