Compared with Cystectomy, Is Ovarian Vaporization ofEndometriotic Cysts Truly More Effective in Maintaining Ovarian Reserve?

摘要

Study Objective: To evaluate how endometriotic cystectomy and vaporization affect ovarian reserve after conservative surgery. Design: Prospective study (Canadian Task Force classification II-1). Setting: Hokusetsu General Hospital. Patients: Ninety-nine women who underwent conservative surgery to treat endometriotic cysts from June 2011 to July2013. Interventions: Vaporization with bipolar current was performed in nulligravid women, and cystectomy in those who had a child. In women with endometriotic cysts, bilateral cystectomy was performed in 28, bilateral vaporization in 15, unilateral cystectomy in 40, and unilateral vaporization in 16. In all patients, preoperative and postoperative serum anti-müllerian hormone (AMH) and follicle-stimulating hormone (FSH) concentrations at the early proliferative phase were assayed, and the change in concentrations was evaluated for each operation. Measurement and Main Results: In the bilateral cystectomy group, the mean (SD) postoperative FSH concentration (19.3 [21.8] IU/mL) was statistically higher than the preoperative concentration (9.0 [6.2] IU/mL) (p < .01). AMH significantly declined after all operations to treat endometriotic cysts, and the rate of decline in the AMH concentration was >50% compared with preoperative concentrations. Conclusion: Whether endometriotic cysts are unilateral or bilateral, both cystectomy and vaporization using bipolar current can lower ovarian reserve. Therefore, it is necessary to develop more effective surgical procedures to prevent ovarian damage.