卵巢子宫内膜异位囊肿卵巢功能保护研究进展

doi:10.12280/gjfckx.20230111

摘要/Abstract

摘要：

卵巢子宫内膜异位囊肿是育龄期妇女子宫内膜异位症的常见表现形式，严重威胁女性生殖健康，降低患者生育力，给患者心理及经济造成重大负担。目前，卵巢子宫内膜异位囊肿仍面临着诊断延迟、疾病进展及后续治疗损伤卵巢储备功能、术后高复发率等问题，这些原因都直接或间接降低女性生育力。但临床尚无关于卵巢子宫内膜异位囊肿卵巢储备功能保护的统一标准治疗方案。从评估卵巢储备功能、卵巢子宫内膜异位囊肿早诊断及药物治疗、适合的手术方式及生育力保存方式选择、术后管理等方面，综述关于卵巢子宫内膜异位囊肿卵巢储备功能保护的最新研究进展，以期在最大程度保护卵巢储备功能的基础上，为卵巢子宫内膜异位囊肿女性选择合适的治疗方案。

关键词: 卵巢囊肿, 子宫内膜异位症, 卵巢储备功能, 诊断, 治疗

Abstract:

Ovarian endometriosis cyst are a common manifestation of endometriosis in women of childbearing age, which seriously threatens women′s reproductive health, reduces patients′ fertility and causes great psychological and economic burden to patients. Currently, ovarian endometriosis cyst still face problems such as delayed diagnosis, disease progression and subsequent treatment that impair ovarian reserve function, and high recurrence rate after surgery, all of which directly or indirectly reduce female fertility. However, there is no uniform standard clinical treatment scheme for the protection of ovarian reserve function of ovarian endometriosis cysts. In this paper, the latest research progress on the protection of ovarian reserve function in ovarian endometriosis cyst is reviewed from the aspects of evaluation of ovarian reserve function, early diagnosis and drug treatment of ovarian endometriosis cysts, selection of suitable surgical methods and fertility preservation methods, and postoperative management, with the aim of selecting appropriate treatment options for women with ovarian endometriosis cysts based on the maximum protection of ovarian reserve function.

Key words: Ovarian cysts, Endometriosis, Ovarian reserve, Diagnosis, Therapy

闫真真, 张琪, 赵烨. 卵巢子宫内膜异位囊肿卵巢功能保护研究进展[J]. 国际妇产科学杂志, 2023, 50(4): 461-465.

YAN Zhen-zhen, ZHANG Qi, ZHAO Ye. Research Progress on Ovarian Function Protection of Ovarian Endometriosis Cyst[J]. Journal of International Obstetrics and Gynecology, 2023, 50(4): 461-465.

参考文献 34

[1]	Zondervan KT, Becker CM, Missmer SA. Endometriosis[J]. N Engl J Med, 2020, 382(13):1244-1256. doi: 10.1056/NEJMra1810764. doi: 10.1056/NEJMra1810764
[2]	Stuparich MA, Donnellan NM, Sanfilippo JS. Endometriosis in the Adolescent Patient[J]. Semin Reprod Med, 2017, 35(1):102-109. doi: 10.1055/s-0036-1597121. doi: 10.1055/s-0036-1597121 pmid: 27992932
[3]	Moradi Y, Shams-Beyranvand M, Khateri S, et al. A systematic review on the prevalence of endometriosis in women[J]. Indian J Med Res, 2021, 154(3):446-454. doi: 10.4103/ijmr.IJMR_817_18. doi: 10.4103/ijmr.IJMR_817_18 pmid: 35345070
[4]	Llarena NC, Falcone T, Flyckt RL. Fertility Preservation in Women With Endometriosis[J]. Clin Med Insights Reprod Health, 2019, 13:1179558119873386. doi: 10.1177/1179558119873386. doi: 10.1177/1179558119873386
[5]	Oh SR, Choe SY, Cho YJ. Clinical application of serum anti-Müllerian hormone in women[J]. Clin Exp Reprod Med, 2019, 46(2):50-59. doi: 10.5653/cerm.2019.46.2.50. doi: 10.5653/cerm.2019.46.2.50 pmid: 31181872
[6]	Samartzis K, Kathopoulis N, Loutradis D, et al. Do techniques of surgical management of ovarian endometrioma affect ovarian reserve? A narrative review[J]. J Obstet Gynaecol, 2022, 42(5):778-784. doi: 10.1080/01443615.2021.1962817. doi: 10.1080/01443615.2021.1962817
[7]	Becker CM, Bokor A, Heikinheimo O, et al. ESHRE guideline: endometriosis[J]. Hum Reprod Open, 2022, 2022(2): hoac009. doi: 10.1093/hropen/hoac009. doi: 10.1093/hropen/hoac009
[8]	Russo G, Notarstefano V, Montik N, et al. Evaluation of Controlled Ovarian Stimulation Protocols in Patients with Normal and Low Ovarian Reserve: Analyses of miRNAs and Selected Target Genes Involved in the Proliferation of Human Cumulus Cells and Oocyte Quality[J]. Int J Mol Sci, 2022, 23(3):1713. doi: 10.3390/ijms23031713. doi: 10.3390/ijms23031713
[9]	Moein Mahini S, Younesi M, Mortazavi G, et al. Non-invasive diagnosis of endometriosis: Immunologic and genetic markers[J]. Clin Chim Acta, 2023, 538:70-86. doi: 10.1016/j.cca.2022.11.013. doi: 10.1016/j.cca.2022.11.013
[10]	黄薇, 冷金花, 裴天骄, 等. 子宫内膜异位症患者生育力保护的中国专家共识(2022版)[J]. 中华妇产科杂志, 2022, 57(10):733-739. doi: 10.3760/cma.j.cn112141-20220427-00329. doi: 10.3760/cma.j.cn112141-20220427-00329
[11]	Zondervan KT, Becker CM, Koga K, et al. Endometriosis[J]. Nat Rev Dis Primers, 2018, 4(1):9. doi: 10.1038/s41572-018-0008-5. doi: 10.1038/s41572-018-0008-5 pmid: 30026507
[12]	Mansouri G, Safinataj M, Shahesmaeili A, et al. Effect of laparoscopic cystectomy on ovarian reserve in patients with ovarian cyst[J]. Front Endocrinol (Lausanne), 2022, 13:964229. doi: 10.3389/fendo.2022.964229. doi: 10.3389/fendo.2022.964229
[13]	Tian Z, Zhang Y, Zhang C, et al. Antral follicle count is reduced in the presence of endometriosis: a systematic review and meta-analysis[J]. Reprod Biomed Online, 2021, 42(1):237-247. doi: 10.1016/j.rbmo.2020.09.014. doi: 10.1016/j.rbmo.2020.09.014 pmid: 33168492
[14]	Biniasch M, Laubender RP, Hund M, et al. Intra- and inter-cycle variability of anti-Müllerian hormone (AMH) levels in healthy women during non-consecutive menstrual cycles: the BICYCLE study[J]. Clin Chem Lab Med, 2022, 60(4):597-605. doi: 10.1515/cclm-2021-0698. doi: 10.1515/cclm-2021-0698
[15]	Lee J, Hong DG. Serum anti-Müllerian hormone recovery after ovarian cystectomy for endometriosis: A retrospective study among Korean women[J]. Medicine (Baltimore), 2022, 101(40):e30977. doi: 10.1097/MD.0000000000030977. doi: 10.1097/MD.0000000000030977
[16]	Moolhuijsen L, Visser JA. Anti-Müllerian Hormone and Ovarian Reserve: Update on Assessing Ovarian Function[J]. J Clin Endocrinol Metab, 2020, 105(11):3361-3373. doi: 10.1210/clinem/dgaa513. doi: 10.1210/clinem/dgaa513
[17]	Steiner AZ, Pritchard D, Stanczyk FZ, et al. Association Between Biomarkers of Ovarian Reserve and Infertility Among Older Women of Reproductive Age[J]. JAMA, 2017, 318(14):1367-1376. doi: 10.1001/jama.2017.14588. doi: 10.1001/jama.2017.14588 pmid: 29049585
[18]	ACOG Committee Opinion No. 773 Summary: The Use of Antimüllerian Hormone in Women Not Seeking Fertility Care[J]. Obstet Gynecol, 2019, 133(4):840-841. doi: 10.1097/AOG.0000000000003163. doi: 10.1097/AOG.0000000000003163 pmid: 30913192
[19]	Arroyo A, Kim B, Yeh J. Luteinizing Hormone Action in Human Oocyte Maturation and Quality: Signaling Pathways, Regulation, and Clinical Impact[J]. Reprod Sci, 2020, 27(6):1223-1252. doi: 10.1007/s43032-019-00137-x. doi: 10.1007/s43032-019-00137-x pmid: 32046451
[20]	Xu H, Feng G, Wang H, et al. A novel mathematical model of true ovarian reserve assessment based on predicted probability of poor ovarian response: a retrospective cohort study[J]. J Assist Reprod Genet, 2020, 37(4):963-972. doi: 10.1007/s10815-020-01700-1. doi: 10.1007/s10815-020-01700-1
[21]	Gruber TM, Mechsner S. Pathogenesis of Endometriosis: The Origin of Pain and Subfertility[J]. Cells, 2021, 10(6):1381. doi: 10.3390/cells10061381. doi: 10.3390/cells10061381
[22]	Guo M, Bafligil C, Tapmeier T, et al. Mass cytometry analysis reveals a distinct immune environment in peritoneal fluid in endometriosis: a characterisation study[J]. BMC Med, 2020, 18(1):3. doi: 10.1186/s12916-019-1470-y. doi: 10.1186/s12916-019-1470-y pmid: 31907005
[23]	Wang L, Li L, Li Y, et al. A History of Endometriosis Is Associated With Decreased Peripheral NK Cytotoxicity and Increased Infiltration of Uterine CD68+ Macrophages[J]. Front Immunol, 2021, 12:711231. doi: 10.3389/fimmu.2021.711231. doi: 10.3389/fimmu.2021.711231
[24]	O D, Waelkens E, Vanhie A, et al. The Use of Antibody Arrays in the Discovery of New Plasma Biomarkers for Endometriosis[J]. Reprod Sci, 2020, 27(2):751-762. doi: 10.1007/s43032-019-00081-w. doi: 10.1007/s43032-019-00081-w pmid: 32016799
[25]	Králíčková M, Vetvicka V, Fiala L, et al. The Search for Biomarkers in Endometriosis: a Long and Windy Road[J]. Reprod Sci, 2022, 29(6):1667-1673. doi: 10.1007/s43032-021-00668-2. doi: 10.1007/s43032-021-00668-2
[26]	Wu Y, Yuan W, Ding H, et al. Serum exosomal miRNA from endometriosis patients correlates with disease severity[J]. Arch Gynecol Obstet, 2022, 305(1):117-127. doi: 10.1007/s00404-021-06227-z. doi: 10.1007/s00404-021-06227-z
[27]	Huang H, Zhu Z, Song Y. Downregulation of lncrna uca1 as a diagnostic and prognostic biomarker for ovarian endometriosis[J]. Rev Assoc Med Bras (1992), 2019, 65(3):336-341. doi: 10.1590/1806-9282.65.3.336. doi: 10.1590/1806-9282.65.3.336
[28]	Murakami M, Osuka S, Muraoka A, et al. Effectiveness of NLRP3 Inhibitor as a Non-Hormonal Treatment for ovarian endometriosis[J]. Reprod Biol Endocrinol, 2022, 20(1):58. doi: 10.1186/s12958-022-00924-3. doi: 10.1186/s12958-022-00924-3
[29]	Santulli P, Bourdon M, Koutchinsky S, et al. Fertility preservation for patients affected by endometriosis should ideally be carried out before surgery[J]. Reprod Biomed Online, 2021, 43(5):853-863. doi: 10.1016/j.rbmo.2021.08.023. doi: 10.1016/j.rbmo.2021.08.023 pmid: 34649771
[30]	Mohammad NS, Nazli R, Zafar H, et al. Effects of lipid based Multiple Micronutrients Supplement on the birth outcome of underweight pre-eclamptic women: A randomized clinical trial[J]. Pak J Med Sci, 2022, 38(1):219-226. doi: 10.12669/pjms.38.1.4396. doi: 10.12669/pjms.38.1.4396 pmid: 35035429
[31]	Shi X, Chen S, Yang Y, et al. Laparoscopic surgeries for uterine fibroids and ovarian cysts reduce ovarian reserve via age- and surgical type-manner[J]. Gynecol Endocrinol, 2022, 38(12):1068-1072. doi: 10.1080/09513590.2022.2128104. doi: 10.1080/09513590.2022.2128104
[32]	Park SJ, Seol A, Lee N, et al. A randomized controlled trial of ovarian reserve preservation and hemostasis during ovarian cystectomy[J]. Sci Rep, 2021, 11(1):8495. doi: 10.1038/s41598-021-87965-7. doi: 10.1038/s41598-021-87965-7 pmid: 33875738
[33]	Guo SW, Martin DC. The perioperative period: a critical yet neglected time window for reducing the recurrence risk of endometriosis?[J]. Hum Reprod, 2019, 34(10):1858-1865. doi: 10.1093/humrep/dez187. doi: 10.1093/humrep/dez187
[34]	中国医师协会妇产科医师分会, 中华医学会妇产科学分会子宫内膜异位症协作组. 子宫内膜异位症诊治指南(第三版)[J]. 中华妇产科杂志, 2021, 56(12):812-824. doi: 10.3760/cma.j.cn112141-20211018-00603. doi: 10.3760/cma.j.cn112141-20211018-00603