臨床婦人科産科74巻6号

2020年06月発行

今月の臨床 外来でみる子宮内膜症診療―患者特性に応じた管理・投薬のコツ ライフステージに応じた患者への対応

チョコレート囊胞合併不妊で囊胞摘除は勧めてよいのか？

著者： 小林未央¹ 北原慈和¹ 岩瀬明¹

所属機関： ¹群馬大学大学院医学系研究科産科婦人科学講座

ページ範囲：P.574 - P.578

●囊胞摘出術は術後の自然妊娠率を改善するが，体外受精・顕微授精による妊娠率改善には寄与しない．

●囊胞摘出術では卵巣予備能が低下し，両側手術で顕著である．手術方法，止血方法により低下の程度は異なる．

●手術により卵巣予備能が著しく低下した場合は，その後の妊娠率に影響を及ぼすリスクがある．

参考文献

1）Hart RJ, et al : Excisional surgery versus ablative surgery for ovarian endometriomata. Cochrane Database Syst Rev （2） : CD004992, 2008

2）Alborzi S, et al : A prospective, randomized study comparing laparoscopic ovarian cystectomy versus fenestration and coagulation in patients with endometriomas. Fertil Steril 82 : 1633-1637, 2004

3）Beretta P, et al : Randomized clinical trial of two laparoscopic treatments of endometriomas : cystectomy versus drainage and coagulation. Fertil Steril 70 : 1176-1180, 1998

4）Dan H, et al : Laparoscopic ovarian cystectomy versus fenestration/coagulation or laser vaporization for the treatment of endometriomas : a meta-analysis of randomized controlled trials. Gynecol Obstet Invest 76 : 75-82, 2013

5）Carmona F, et al : Ovarian cystectomy versus laser vaporization in the treatment of ovarian endometriomas : a randomized clinical trial with a five-year follow-up. Fertil Steril 96 : 251-254, 2011

6）Benschop L, et al : Interventions for women with endometrioma prior to assisted reproductive technology. Cochrane Database Syst Rev （11） : CD008571, 2010

7）Demirol A, et al : Effect of endometrioma cystectomy on IVF outcome : a prospective randomized study. Reprod Biomed Online 12 : 639-643, 2006

8）Hamdan M, et al : The impact of endometrioma on IVF/ICSI outcomes : a systematic review and meta-analysis. Hum Reprod Update 21 : 809-825, 2015

9）Nickkho-Amiry M, et al : The effect of surgical management of endometrioma on the IVF/ICSI outcomes when compared with no treatment? A systematic review and meta-analysis. Arch Gynecol Obstet 297 : 1043-1057, 2018

10）Brink Laursen J, et al : Surgery versus conservative management of endometriomas in subfertile women. A systematic review. Acta Obstet Gynecol Scand 96 : 727-735, 2017

11）Tao X, et al : Weigh the pros and cons to ovarian reserve before stripping ovarian endometriomas prior to IVF/ICSI : a meta-analysis. PLoS One 12 : e0177426, 2017

12）Hirokawa W, et al : The post-operative decline in serum anti-Mullerian hormone correlates with the bilaterality and severity of endometriosis. Hum Reprod 26 : 904-910, 2011

13）Iwase A, et al : Serum anti-Mullerian hormone level is a useful marker for evaluating the impact of laparoscopic cystectomy on ovarian reserve. Fertil Steril 94 : 2846-2849, 2010

14）Raffi F, et al : The impact of excision of ovarian endometrioma on ovarian reserve : a systematic review and meta-analysis. J Clin Endocrinol Metab 97 : 3146-3154, 2012

15）Younis JS, et al : Impact of unilateral versus bilateral ovarian endometriotic cystectomy on ovarian reserve : a systematic review and meta-analysis. Hum Reprod Update 25 : 375-391, 2019

16）Muzii L, et al : The effect of surgery for endometrioma on ovarian reserve evaluated by antral follicle count : a systematic review and meta-analysis. Hum Reprod 29 : 2190-2198, 2014

17）Ata B, et al : Effect of hemostatic method on ovarian reserve following laparoscopic endometrioma excision ; comparison of suture, hemostatic sealant, and bipolar dessication. A systematic review and meta-analysis. J Minim Invasive Gynecol 22 : 363-372, 2015

18）Ding W, et al : The impact on ovarian reserve of haemostasis by bipolar coagulation versus suture following surgical stripping of ovarian endometrioma : a meta-analysis. Reprod Biomed Online 30 : 635-642, 2015

19）Deckers P, et al : Systematic review and meta-analysis of the effect of bipolar electrocoagulation during laparoscopic ovarian endometrioma stripping on ovarian reserve. Int J Gynaecol Obstet 140 : 11-17, 2018

20）Giampaolino P, et al : Endometrioma size is a relevant factor in selection of the most appropriate surgical technique : a prospective randomized preliminary study. Eur J Obstet Gynecol Reprod Biol 195 : 88-93, 2015

21）Candiani M, et al : Assessment of ovarian reserve after cystectomy versus ‘one-step’ laser vaporization in the treatment of ovarian endometrioma : a small randomized clinical trial. Hum Reprod 33 : 2205-2211, 2018

22）Roustan A, et al : Surgical diminished ovarian reserve after endometrioma cystectomy versus idiopathic DOR : comparison of in vitro fertilization outcome. Hum Reprod 30 : 840-847, 2015

23）Ozaki R, et al : Evaluation of factors predicting diminished ovarian reserve before and after laparoscopic cystectomy for ovarian endometriomas : a prospective cohort study. J Ovarian Res 9 : 37, 2016

24）日本産科婦人科学会（編） : 子宮内膜症取扱い規約，第2部治療編・診療編，第2版，金原出版，2010

25）Practice Committee of the American Society for Reproductive Medicine : Endometriosis and infertility : a committee opinion. Fertil Steril 98 : 591-598, 2012

26）Dunselman GA, et al : ESHRE guideline : management of women with endometriosis. Hum Reprod 29 : 400-412, 2014

27）National Institute for Health and Care Excellence : Endometriosis : diagnosis and management. NICE guideline［NG73］. London, UK, 2017

28）Collinet P, et al : Management of endometriosis : CNGOF/HAS clinical practice guidelines-short version. J Gynecol Obstet Hum Reprod 47 : 265-274, 2018