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

IF 3.5 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Journal of minimally invasive gynecology Pub Date : 2025-02-01 DOI:10.1016/j.jmig.2024.09.367

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

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引用次数: 0

Abstract

Study Objective

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.

Design

Retrospective study.

Setting

Italian tertiary center from October 2023 to February 2024.

Patients

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.

Intervention

Ovarian endometriomas were vaporized through laparoscopic CO₂ fiber laser. After surgery, patients were included in a surveillance program with periodic clinical follow-ups.

Measurements and Main Results

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%).

Conclusion

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.

查看原文本刊更多论文

子宫内膜异位症二氧化碳激光汽化术后长期复发率和生育率：5 年随访经验。

研究目的尽管子宫内膜异位症手术治疗的金标准仍是膀胱切除术，但人们对其对卵巢储备功能的负面影响的担忧却在不断增加。子宫内膜异位症激光二氧化碳气化术在卵巢储备保留、术后妊娠率和复发率方面显示出令人鼓舞的数据。本研究旨在评估通过二氧化碳光纤激光气化术治疗的子宫内膜异位症患者在术后至少5年后的术后复发率和妊娠率：设计：回顾性研究：研究时间：2023年10月至2024年2月，地点：意大利三级医疗中心：我们纳入了年龄大于 18 岁、因子宫内膜异位症接受腹腔镜 CO2 光纤激光气化术的女性。年龄≥40岁、既往接受过卵巢手术、既往接受过输卵管切除术或子宫切除术、子宫内膜异位症组织学检查阴性或组织学检查发现任何恶性肿瘤均为排除标准：干预措施：通过腹腔镜二氧化碳光纤激光对卵巢子宫内膜异位症进行气化。干预措施：通过腹腔镜二氧化碳光纤激光对卵巢子宫内膜异位症进行气化，术后对患者进行定期临床随访：共纳入 78 例患者。平均年龄为（33.2±4.6）岁，基础 AMH 为（2.7±1.9）纳克/毫升，子宫内膜异位症的中位直径为 4（3-5）厘米。随访时间的中位数为 72.5 个月（67-84.5 个月）。手术后，65.5%（36 人）有生育要求的妇女成功怀孕，其中 55.6% 自然怀孕，44.4% 通过辅助生殖技术怀孕，平均怀孕时间为 17.7±18.1 个月。7例同侧复发患者的卡普兰-梅耶尔曲线显示，复发的中位时间为26个月，100个月时的无病率估计为91.03%（95% CI为82.10%-95.62%）：CO2光纤激光汽化术是一种有效、安全的卵巢子宫内膜异位症手术治疗方法，它具有保留卵巢组织的优势，术后长期复发率与文献中描述的膀胱切除术相当。

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来源期刊

Journal of minimally invasive gynecology 医学-妇产科学

CiteScore

5.00

自引率

7.30%

发文量

272

审稿时长

37 days

期刊介绍： The Journal of Minimally Invasive Gynecology, formerly titled The Journal of the American Association of Gynecologic Laparoscopists, is an international clinical forum for the exchange and dissemination of ideas, findings and techniques relevant to gynecologic endoscopy and other minimally invasive procedures. The Journal, which presents research, clinical opinions and case reports from the brightest minds in gynecologic surgery, is an authoritative source informing practicing physicians of the latest, cutting-edge developments occurring in this emerging field.