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Рецидивы эндометриоидных кист яичников и возможные пути их снижения
Рецидивы эндометриоидных кист яичников и возможные пути их снижения
Гусев Д.В., Прилуцкая В.Ю., Чернуха Г.Е. Рецидивы эндометриоидных кист яичников и возможные пути их снижения. Гинекология. 2020; 22 (3): 34–38. DOI:10.26442/20795696.2020.3.200144
DOI: 10.26442/20795696.2020.3.200144
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DOI: 10.26442/20795696.2020.3.200144
Материалы доступны только для специалистов сферы здравоохранения. Авторизуйтесь или зарегистрируйтесь.
Аннотация
Цель. Сравнительная оценка эффективности различных видов гормонотерапии для профилактики рецидивов эндометриоидных кист (ЭК), основанная на клиническом наблюдении и анализе данных.
Материалы и методы. Ретроспективный анализ течения заболевания 122 пациенток (средний возраст – 31,7±6,12 года) после лапароскопии с удалением ЭК яичников. Пациентки были распределены на 3 группы в соответствии с проводимым лечением: диеногест (Визанна®) (n=56), комбинированные оральные контрацептивы – КОК (n=13) или агонисты гонадотропин-рилизинг-гормона – аГнРГ (n=11), группу сравнения составили 42 пациентки, не получавшие гормонотерапию.
Результаты. На фоне гормонотерапии частота рецидивов ЭК составила 3,75%, среди не получавших терапию – 38,1%. Среди больных без терапии кумулятивная частота рецидивов к концу 1-го года составила 11,9%, к концу 3-го года – 26,2%, к 5-му – 38,1%. После отмены супрессивной гормонотерапии частота рецидивов в группе аГнРГ составила 63,6%, КОК – 50%, диеногеста – 24%.
Выводы. Тактика ведения пациенток с ЭК должна включать длительное назначение диеногеста в качестве противорецидивной терапии.
Ключевые слова: эндометриоз, эндометриоидная киста, диеногест, агонисты гонадотропин-рилизинг-гормона
Materials and methods. Retrospective analysis of 122 patients (the average age 31.7±6.12 years) with laparoscopically confirmed endometriosis. Patients were divided into groups, according to the treatment options – aGnRH (n=11), COCs (n=13), dienogest (Visanne®) (n=56). A comparison group included 42 patients who did not receive hormone therapy. There were evaluated the number of reccurence in the group without therapy and in groups with different options for hormonal therapy.
Results. Among patients treated with hormone therapy, the recurrence rate of EC was 3.75%, among those who have not received therapy – 38.1%. Of these, 31.1% of patients had recurrence rate of EC during the first year, 37.8% during 3 years, and 31.1% after 3 years. After suppressive therapy was discontinued, the relapse rate in the aGnRH group was 63.6%, COC – 50%, dienogest – 24%.
Conclusions. In addition to evaluating the ovarian reserve before and after surgical treatment, management tactics for patients with EC should include the long-term administration of dienogest as an anti-relapse therapy.
Key words: endometriosis, endometrioid cyst, dienogest, GnRH agonists.
Материалы и методы. Ретроспективный анализ течения заболевания 122 пациенток (средний возраст – 31,7±6,12 года) после лапароскопии с удалением ЭК яичников. Пациентки были распределены на 3 группы в соответствии с проводимым лечением: диеногест (Визанна®) (n=56), комбинированные оральные контрацептивы – КОК (n=13) или агонисты гонадотропин-рилизинг-гормона – аГнРГ (n=11), группу сравнения составили 42 пациентки, не получавшие гормонотерапию.
Результаты. На фоне гормонотерапии частота рецидивов ЭК составила 3,75%, среди не получавших терапию – 38,1%. Среди больных без терапии кумулятивная частота рецидивов к концу 1-го года составила 11,9%, к концу 3-го года – 26,2%, к 5-му – 38,1%. После отмены супрессивной гормонотерапии частота рецидивов в группе аГнРГ составила 63,6%, КОК – 50%, диеногеста – 24%.
Выводы. Тактика ведения пациенток с ЭК должна включать длительное назначение диеногеста в качестве противорецидивной терапии.
Ключевые слова: эндометриоз, эндометриоидная киста, диеногест, агонисты гонадотропин-рилизинг-гормона
________________________________________________
Materials and methods. Retrospective analysis of 122 patients (the average age 31.7±6.12 years) with laparoscopically confirmed endometriosis. Patients were divided into groups, according to the treatment options – aGnRH (n=11), COCs (n=13), dienogest (Visanne®) (n=56). A comparison group included 42 patients who did not receive hormone therapy. There were evaluated the number of reccurence in the group without therapy and in groups with different options for hormonal therapy.
Results. Among patients treated with hormone therapy, the recurrence rate of EC was 3.75%, among those who have not received therapy – 38.1%. Of these, 31.1% of patients had recurrence rate of EC during the first year, 37.8% during 3 years, and 31.1% after 3 years. After suppressive therapy was discontinued, the relapse rate in the aGnRH group was 63.6%, COC – 50%, dienogest – 24%.
Conclusions. In addition to evaluating the ovarian reserve before and after surgical treatment, management tactics for patients with EC should include the long-term administration of dienogest as an anti-relapse therapy.
Key words: endometriosis, endometrioid cyst, dienogest, GnRH agonists.
Полный текст
Список литературы
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DOI: 10.1016/s1074-3804(03)80035-x
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13. Bozdag G. Recurrence of Endometriosis: Risk Factors, Mechanisms and Biomarkers. Women’s Health 2015; 11 (5): 693–9. DOI: 10.2217/whe.15.56
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15. Busacca M, Marana R, Caruana P et al. Recurrence of ovarian endometrioma after laparoscopic excision. Am J Obstet Gynecol 1999; 180: 519–23. DOI: 10.1016/s0002-9378(99)70247-4
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22. Koga K, Takemura Y, Osuga Y et al. Recurrence of ovarian endometrioma after laparoscopic excision. Hum Reprod 2006; 21: 2171–4.
23. Vignali M, Bianchi S, Candiani M et al. Surgical treatment of deep endometriosis and risk of recurrence. J Minim Invasive Gynecol 2005; 12: 508–13.
24. Porpora MG, Pallante D, Ferro A et al. Pain and ovarian endometrioma recurrence after laparoscopic treatment of endometriosis: a long-term prospective study. Fertil Steril 2010; 93: 716–21.
DOI: 10.1016/j.fertnstert.2008.10.018
25. Fedele L, Bianchi S, Zanconato G et al. Long-term follow-up after conservative surgery for bladder endometriosis. Fertil Steril 2005; 83: 1729–33. DOI: 10.1016/j.fertnstert.2004.12.047
26. Parazzini F, Bertulessi C, Pasini A et al. Determinants of short term recurrence rate of endometriosis. Eur J Obstet Gynecol Reprod Biol 2005; 121: 216–9. DOI: 10.1016/j.ejogrb.2004.11.033
27. Busacca M, Chiaffarino F, Candiani M et al. Determinants of long-term clinically detected recurrence rates of deep, ovarian, and pelvic endometriosis. Am J Obstet Gynecol 2006; 195: 426–32. DOI: 10.1016/j.ajog.2006.01.078
28. Liu X, Yuan L, Shen F et al. Patterns of and risk factors for recurrence in women with ovarian endometriomas. Obstet Gynecol. 2007;109:1411–20. DOI: 10.1097/01.AOG.0000265215.87717.8b
29. Ho HY, Lee RK, Hwu YM et al. Poor response of ovaries with endometrioma previously treated with cystectomy to controlled ovarian hyperstimulation. J Assist Reprod Genet 2002; 19: 507–11. DOI: 10.1023/A:1020970417778
30. Muzii L, Marana R, Caruana P et al. Postoperative administration of monophasic combined oral contraceptives after laparoscopic treatment of ovarian endometriomas: a prospective, randomized trial. Am J Obstet Gynecol 2000; 183: 588–92.
DOI: 10.1067/mob.2000.106817
31. Seracchioli R, Mabrouk M, Frasca C et al. Long-term cyclic and continuous oral contraceptive therapy and endometrioma recurrence: a randomized controlled trial. Fertil Steril 2010; 93 (1): 52–56.
DOI: 10.1016/j.fertnstert.2008.09.052.
32. Ota Y, Andou M, Yanai S et al. Long-term administration of dienogest reduces recurrence after excision of endometrioma. J Endometr 2015; 7 (2): 63–7. DOI: 10.5301/je.5000219
2. Parasar P, Ozcan P, Terry KL. Endometriosis: Epidemiology, Diagnosis and Clinical Management. Curr Obstet Gynecol Rep 2017; 6 (1): 34–41. DOI: 10.1007/s13669-017-0187-1
3. Zegers-Hochschild F, Adamson GD, Dyer S et al. The International Glossary on Infertility and Fertility Care 2017. Fertil Steril 2017; 108 (3): 393–406.
4. Kavoussi SK, Odenwald KC, As-Sanie S, Lebovic DI. Incidence of ovarian endometrioma among women with peritoneal endometriosis with and without a history of hormonal contraceptive use. Eur J Obstet Gynecol Reprod Biol 2017; 215: 220–3. DOI: 10.1016/j.ejogrb.2017.06.028
5. Eisenberg V, Weil C, Chodick G, Shalev V. Epidemiology of endometriosis: a large population-based database study from a healthcare provider with 2 million members. BJOG: An Int J Obstet Gynaecol 2017; 125 (1): 55–62. DOI: 10.1111/1471-0528.14711
6. Abbas S, Ihle P, Koster I, Schubert I. Prevalence and incidence of diagnosed endometriosis and risk of endometriosis in patients with endometriosis-related symptoms: findings from a statutory health insurance-based cohort in Germany. European journal of obstetrics, gynecology, and reproductive biology 2012; 160 (1): 79–83.
7. Lee JH, Song JY, Yi KW et al. Effectiveness of Dienogest for Treatment of Recurrent Endometriosis: Multicenter Data. Reprod Sci 2018; 193371911877973
8. Li X-Y, Chao X-P, Leng J-H et al. Risk factors for postoperative recurrence of ovarian endometriosis: long-term follow-up of 358 women. Journal of Ovarian Research 2019, 12(1). DOI: 10.1186/s13048-019-0552-y
9. ACOG Practice Bulletin. December 1999;
10. Exacoustos C, Lanzi G, Romanini E et al. Laparoscopic removal of endometriomas: Sonographic evaluation of residual functioning ovarian tissue. J Am Assoc Gynecol Laparoscop 2003; 10 (3): S12.
DOI: 10.1016/s1074-3804(03)80035-x
11. Exacoustos C, Zupi E, Amadio A et al. Recurrence of endometriomas after laparoscopic removal: Sonographic and clinical follow-up and indication for second surgery. J Minimally Invasive Gynecol 2006; 13 (4): 281–8. DOI: 10.1016/j.jmig.2006.03.002
12. Selcuk İ, Bozdag G. Recurrence of endometriosis; risk factors, mechanisms and biomarkers; review of the literature. J Turk Ger Gynecol Assoc 2013; 14 (2): 98–103. DOI: 10.5152/jtgga.2013.52385
13. Bozdag G. Recurrence of Endometriosis: Risk Factors, Mechanisms and Biomarkers. Women’s Health 2015; 11 (5): 693–9. DOI: 10.2217/whe.15.56
14. Velebil P, Wingo PA, Xia Z et al. Rate of hospitalization for gynecologic disorders among reproductive-age women in the United States. Obstet Gynecol 1995; 86: 764–9. DOI: 10.1016/0029-7844(95)00252-m
15. Busacca M, Marana R, Caruana P et al. Recurrence of ovarian endometrioma after laparoscopic excision. Am J Obstet Gynecol 1999; 180: 519–23. DOI: 10.1016/s0002-9378(99)70247-4
16. Morgante G, Ditto A, La Marca A, De Leo V. Low-dose danazol after combined surgical and medical therapy reduces the incidence of pelvic pain in women with moderate and severe endometriosis. DOI: 10.1093/humrep/14.9.2371
17. Guo SW. Recurrence of endometriosis and its control. Hum Reprod Update 2009; 15: 441–61. DOI: 10.1093/humupd/dmp007
18. Jain S, Dalton ME. Chocolate cysts from ovarian follicles. Fertil Steril 1999; 72: 852–6. DOI: 10.1016/s0015-0282(99)00367-2
19. Maeda N, Izumiya C, Kusum T et al. Killer inhibitory receptor CD158a overexpression among natural killer cells in women with endometriosis is undiminished by laparoscopic surgery and gonadotropin releasing hormone agonist treatment. Am J Reprod Immunol 2004; 51: 364–72. DOI: 10.1111/j.1600-0897.2004.00170.x
20. Saleh A, Tulandi T. Reoperation after laparoscopic treatment of ovarian endometriomas by excision and by fenestration. Fertil Steril 1999; 72: 322–4.
21. Ouchi N, Akira S, Mine K et al. Recurrence of ovarian endometrioma after laparoscopic excision: Risk factors and prevention. J Obstet Gynaecol Res 2013; 40 (1): 230–6. DOI: 10.1111/jog.12164
22. Koga K, Takemura Y, Osuga Y et al. Recurrence of ovarian endometrioma after laparoscopic excision. Hum Reprod 2006; 21: 2171–4.
23. Vignali M, Bianchi S, Candiani M et al. Surgical treatment of deep endometriosis and risk of recurrence. J Minim Invasive Gynecol 2005; 12: 508–13.
24. Porpora MG, Pallante D, Ferro A et al. Pain and ovarian endometrioma recurrence after laparoscopic treatment of endometriosis: a long-term prospective study. Fertil Steril 2010; 93: 716–21. DOI: 10.1016/j.fertnstert.2008.10.018
25. Fedele L, Bianchi S, Zanconato G et al. Long-term follow-up after conservative surgery for bladder endometriosis. Fertil Steril 2005; 83: 1729–33. DOI:10.1016/j.fertnstert.2004.12.047
26. Parazzini F, Bertulessi C, Pasini A et al. Determinants of short term recurrence rate of endometriosis. Eur J Obstet Gynecol Reprod Biol 2005; 121: 216–9. DOI:10.1016/j.ejogrb.2004.11.033
27. Busacca M, Chiaffarino F, Candiani M et al. Determinants of long-term clinically detected recurrence rates of deep, ovarian, and pelvic endometriosis. Am J Obstet Gynecol 2006; 195: 426–32. DOI: 10.1016/j.ajog.2006.01.078
28. Liu X, Yuan L, Shen F et al. Patterns of and risk factors for recurrence in women with ovarian endometriomas. Obstet Gynecol. 2007;109:1411–20. DOI: 10.1097/01.AOG.0000265215.87717.8b
29. Ho HY, Lee RK, Hwu YM et al. Poor response of ovaries with endometrioma previously treated with cystectomy to controlled ovarian hyperstimulation. J Assist Reprod Genet 2002; 19: 507–11. DOI: 10.1023/A:1020970417778
30. Muzii L, Marana R, Caruana P et al. Postoperative administration of monophasic combined oral contraceptives after laparoscopic treatment of ovarian endometriomas: a prospective, randomized trial. Am J Obstet Gynecol 2000; 183: 588–92.
DOI: 10.1067/mob.2000.106817
31. Seracchioli R, Mabrouk M, Frasca C et al. Long-term cyclic and continuous oral contraceptive therapy and endometrioma recurrence: a randomized controlled trial. Fertil Steril 2010; 93 (1): 52–56.
DOI: 10.1016/j.fertnstert.2008.09.052.
32. Ota Y, Andou M, Yanai S et al. Long-term administration of dienogest reduces recurrence after excision of endometrioma. J Endometr 2015; 7 (2): 63–7. DOI:10.5301/je.5000219
2. Parasar P, Ozcan P, Terry KL. Endometriosis: Epidemiology, Diagnosis and Clinical Management. Curr Obstet Gynecol Rep 2017; 6 (1): 34–41. DOI: 10.1007/s13669-017-0187-1
3. Zegers-Hochschild F, Adamson GD, Dyer S et al. The International Glossary on Infertility and Fertility Care 2017. Fertil Steril 2017; 108 (3): 393–406.
4. Kavoussi SK, Odenwald KC, As-Sanie S, Lebovic DI. Incidence of ovarian endometrioma among women with peritoneal endometriosis with and without a history of hormonal contraceptive use. Eur J Obstet Gynecol Reprod Biol 2017; 215: 220–3. DOI: 10.1016/j.ejogrb.2017.06.028
5. Eisenberg V, Weil C, Chodick G, Shalev V. Epidemiology of endometriosis: a large population-based database study from a healthcare provider with 2 million members. BJOG: An Int J Obstet Gynaecol 2017; 125 (1): 55–62. DOI: 10.1111/1471-0528.14711
6. Abbas S, Ihle P, Koster I, Schubert I. Prevalence and incidence of diagnosed endometriosis and risk of endometriosis in patients with endometriosis-related symptoms: findings from a statutory health insurance-based cohort in Germany. European journal of obstetrics, gynecology, and reproductive biology 2012; 160 (1): 79–83.
7. Lee JH, Song JY, Yi KW et al. Effectiveness of Dienogest for Treatment of Recurrent Endometriosis: Multicenter Data. Reprod Sci 2018; 193371911877973
8. Li X-Y, Chao X-P, Leng J-H et al. Risk factors for postoperative recurrence of ovarian endometriosis: long-term follow-up of 358 women. Journal of Ovarian Research 2019, 12(1). DOI: 10.1186/s13048-019-0552-y
9. ACOG Practice Bulletin. December 1999;
10. Exacoustos C, Lanzi G, Romanini E et al. Laparoscopic removal of endometriomas: Sonographic evaluation of residual functioning ovarian tissue. J Am Assoc Gynecol Laparoscop 2003; 10 (3): S12.
DOI: 10.1016/s1074-3804(03)80035-x
11. Exacoustos C, Zupi E, Amadio A et al. Recurrence of endometriomas after laparoscopic removal: Sonographic and clinical follow-up and indication for second surgery. J Minimally Invasive Gynecol 2006; 13 (4): 281–8. DOI:10.1016/j.jmig.2006.03.002
12. Selcuk İ, Bozdag G. Recurrence of endometriosis; risk factors, mechanisms and biomarkers; review of the literature. J Turk Ger Gynecol Assoc 2013; 14 (2): 98–103. DOI:10.5152/jtgga.2013.52385
13. Bozdag G. Recurrence of Endometriosis: Risk Factors, Mechanisms and Biomarkers. Women’s Health 2015; 11 (5): 693–9. DOI: 10.2217/whe.15.56
14. Velebil P, Wingo PA, Xia Z et al. Rate of hospitalization for gynecologic disorders among reproductive-age women in the United States. Obstet Gynecol 1995; 86: 764–9. DOI: 10.1016/0029-7844(95)00252-m
15. Busacca M, Marana R, Caruana P et al. Recurrence of ovarian endometrioma after laparoscopic excision. Am J Obstet Gynecol 1999; 180: 519–23. DOI: 10.1016/s0002-9378(99)70247-4
16. Morgante G, Ditto A, La Marca A, De Leo V. Low-dose danazol after combined surgical and medical therapy reduces the incidence of pelvic pain in women with moderate and severe endometriosis. DOI: 10.1093/humrep/14.9.2371
17. Guo SW. Recurrence of endometriosis and its control. Hum Reprod Update 2009; 15: 441–61. DOI: 10.1093/humupd/dmp007
18. Jain S, Dalton ME. Chocolate cysts from ovarian follicles. Fertil Steril 1999; 72: 852–6. DOI: 10.1016/s0015-0282(99)00367-2
19. Maeda N, Izumiya C, Kusum T et al. Killer inhibitory receptor CD158a overexpression among natural killer cells in women with endometriosis is undiminished by laparoscopic surgery and gonadotropin releasing hormone agonist treatment. Am J Reprod Immunol 2004; 51: 364–72. DOI: 10.1111/j.1600-0897.2004.00170.x
20. Saleh A, Tulandi T. Reoperation after laparoscopic treatment of ovarian endometriomas by excision and by fenestration. Fertil Steril 1999; 72: 322–4.
21. Ouchi N, Akira S, Mine K et al. Recurrence of ovarian endometrioma after laparoscopic excision: Risk factors and prevention. J Obstet Gynaecol Res 2013; 40 (1): 230–6. DOI: 10.1111/jog.12164
22. Koga K, Takemura Y, Osuga Y et al. Recurrence of ovarian endometrioma after laparoscopic excision. Hum Reprod 2006; 21: 2171–4.
23. Vignali M, Bianchi S, Candiani M et al. Surgical treatment of deep endometriosis and risk of recurrence. J Minim Invasive Gynecol 2005; 12: 508–13.
24. Porpora MG, Pallante D, Ferro A et al. Pain and ovarian endometrioma recurrence after laparoscopic treatment of endometriosis: a long-term prospective study. Fertil Steril 2010; 93: 716–21.
DOI: 10.1016/j.fertnstert.2008.10.018
25. Fedele L, Bianchi S, Zanconato G et al. Long-term follow-up after conservative surgery for bladder endometriosis. Fertil Steril 2005; 83: 1729–33. DOI: 10.1016/j.fertnstert.2004.12.047
26. Parazzini F, Bertulessi C, Pasini A et al. Determinants of short term recurrence rate of endometriosis. Eur J Obstet Gynecol Reprod Biol 2005; 121: 216–9. DOI: 10.1016/j.ejogrb.2004.11.033
27. Busacca M, Chiaffarino F, Candiani M et al. Determinants of long-term clinically detected recurrence rates of deep, ovarian, and pelvic endometriosis. Am J Obstet Gynecol 2006; 195: 426–32. DOI: 10.1016/j.ajog.2006.01.078
28. Liu X, Yuan L, Shen F et al. Patterns of and risk factors for recurrence in women with ovarian endometriomas. Obstet Gynecol. 2007;109:1411–20. DOI: 10.1097/01.AOG.0000265215.87717.8b
29. Ho HY, Lee RK, Hwu YM et al. Poor response of ovaries with endometrioma previously treated with cystectomy to controlled ovarian hyperstimulation. J Assist Reprod Genet 2002; 19: 507–11. DOI: 10.1023/A:1020970417778
30. Muzii L, Marana R, Caruana P et al. Postoperative administration of monophasic combined oral contraceptives after laparoscopic treatment of ovarian endometriomas: a prospective, randomized trial. Am J Obstet Gynecol 2000; 183: 588–92.
DOI: 10.1067/mob.2000.106817
31. Seracchioli R, Mabrouk M, Frasca C et al. Long-term cyclic and continuous oral contraceptive therapy and endometrioma recurrence: a randomized controlled trial. Fertil Steril 2010; 93 (1): 52–56.
DOI: 10.1016/j.fertnstert.2008.09.052.
32. Ota Y, Andou M, Yanai S et al. Long-term administration of dienogest reduces recurrence after excision of endometrioma. J Endometr 2015; 7 (2): 63–7. DOI: 10.5301/je.5000219
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Авторы
Д.В. Гусев*1, В.Ю. Прилуцкая2, Г.Е. Чернуха1
1 ФГБУ «Национальный медицинский исследовательский центр акушерства, гинекологии и перинатологии имени академика В.И. Кулакова» Минздрава России, Москва, Россия;
2 ФГАОУ ВО «Первый Московский государственный медицинский университет имени И.М. Сеченова» Минздрава России (Сеченовский Университет), Москва, Россия
*doctor.dgusev@gmail.com
1 Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Moscow, Russia;
2 Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
*doctor.dgusev@gmail.com
1 ФГБУ «Национальный медицинский исследовательский центр акушерства, гинекологии и перинатологии имени академика В.И. Кулакова» Минздрава России, Москва, Россия;
2 ФГАОУ ВО «Первый Московский государственный медицинский университет имени И.М. Сеченова» Минздрава России (Сеченовский Университет), Москва, Россия
*doctor.dgusev@gmail.com
________________________________________________
1 Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Moscow, Russia;
2 Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
*doctor.dgusev@gmail.com
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