子宮内膜症性囊胞切除における多角的分析と正中子宮内膜症病巣除去術の意義

抄録

Objective: To consider of the surgery of the endometriotic cyst multifacedly, and to investigate the significance of performing resection of the median pelvic endometriosis (RME).

Design: Retrospective observational study.

Setting: Regional medical support hospital

Patients: A total of 885 patients who underwent laparoscopic surgery for the endometriotic cysts from 2005 to 2016 at Japanese Red Cross Maebashi Hospital were included.

Intervention: Under the diagnosis of endometriotic cyst based on physical findings, ultrasonography, MRI, etc., the cyst was operated by laparoscopic surgery, along with uterine fibroid enucleation or hysterectomy/supracervical hysterectomy, depending on the case. Of those, 420 underwent RME.

Main Outcomes: Pain symptoms were assessed with a 10 cm visual analogue scale (VAS), and the status of pain relief and recurrence after surgery were investigated. Additionally, recurrence of cysts, occurrence of premature menopause, pregnancy, delivery, perinatal complications, ovarian cancer, complications of other organ diseases were investigated.

Results: Resection of endometriotic cysts was effective in improving postoperative menstrual pain and chronic pelvic pain. Pain symptoms were relieved more effectively by performing RME. Postoperative pain recurrence was not related to the RME, and hormone therapy significantly suppressed pain recurrence. Recurrence of ovarian cysts was found in 4.6％. Premature menopause before 40 years of age occurred in 1.53％. Thirty-one ％ of those who wished to have children had at least one pregnancy. Eight patients (0.94％) were found to have ovarian cancer, 7 patients survived on disease free, of those three patients became pregnant and delivered after surgery.

Conclusions: In surgery for endometriotic cysts, combined RME improved pain more effectively.