腹腔鏡下卵巣チョコレート嚢胞摘出術における術前薬物療法の検討

抄録

  The preservation of ovarian function during tumor removal is an important problem because ovarian endometrioma is most common in young women of reproductive age. The aim of this study was to evaluate the effect and value of hormonal treatment before laparoscopic surgery. Thirty patients scheduled to undergo laparoscopy for ovarian endometrioma from 2010 to 2013 were randomly assigned to three groups: the GnRH analog for preoperative treatment group (G group), dienogest for preoperative treatment group (D group), and no treatment group (non-T group). Operative time, total amount of bleeding, cystic wall peeling time, coagulation time, and number of primary follicles (assessed pathologically) were compared among the groups. There were no differences in the size of the endometrioma, revised American Society for Reproductive Medicine score, or amount of bleeding among the three groups. Operative time was shorter in the D group (44.6 min) compared to that in the G group (61.2 min) and non-T group (52.2 min). Coagulation time was shorted in the D group (34.3 s) than that in the G group (62.5 s) and non-T group (89.3 s). The number of follicles in the resected specimen was lower in the D group (0.8 follicles per microscopic field) than that in the G group (1.7 follicles per microscopic field) and non-T group (4.0 follicles per microscopic field). The use of dienogest for preoperative treatment facilitates minimally invasive surgery for ovarian endometrioma by shortening the coagulation time and reducing the number of primary follicles in the resected specimen.