Aim of the studywas an evaluation of the effects, exerted by obtained haemostasis on ovarian reserve, depending on haemostasis technique, applied after laparoscopic enucleation of endometrial cysts.Material and methodsSixty-six female patients, at the age of 20-35 years, were included into the study. The diameters of the cystic lesions were within 40-70 mm. The patients were randomly assigned to two study groups. Group 1 involved patients after laparoscopic enucleation of ovarian cysts, in whom haemostasis was achieved by ovary suturing, while Group 2 included patients with haemostasis achieved by bipolar coagulation technique. Cyst enucleation was performed in all the patients by the stripping method. Ovarian reserve markers: AFC (antral follicle count), AMH (anti-Müllerian hormone), and inhibin B were assayed before and three months after the surgery.ResultsThe preoperative values of AMH, AFC, and inhibin B were similar in both studied groups. After a three-month follow up, the post-operative levels of AMH and inhibin B were significantly lower (p < 0.05), while the numbers of antral follicles did not reveal any statistical differences (p > 0.05). While comparing endometrial and dermoid cysts in the sutured group of patients, the difference, regarding AMH, was statistically significant (2.13 vs. 4.69, p = 0.03). In the group of patients after bipolar coagulation, the corresponding differences did not attain statistical significance (2.21 vs. 6.51, p = 0.86)ConclusionsComparing pre- and post-operative levels of AMH and inhibin B, regardless of the applied haemostasis technique, a statistically significant reduction of the ovarian reserve was observed in either group. Comparing both haemostasis techniques, no method was demonstrated that would have decreased less the levels of AMH, AFC, or inhibin B.
StreszczenieEndometrioza, definiowana jako pozamaciczne występowanie komórek gruczołowych i podścieliska błony śluzowej macicy, nadal stanowi wielkie wyzwanie dla lekarzy ginekologów, zwłaszcza w zakresie płodności oraz dolegliwości bólowych. Częstym miejscem występowania endometriozy jest jajnik. Analizując ryzyko nawrotu torbieli, ryzyko nawrotu dolegliwości bólowych oraz współczynnik zajścia w ciążę, można uznać, że laparoskopia jest metodą z wyboru w leczeniu operacyjnym torbieli endometrialnych, wypierając tym samym klasyczną laparotomię. W wielu pracach zostały opisane różne techniki leczenia endoskopowego endometriozy jajnika, ale wydaje się, że standardem w leczeniu operacyjnym powinno być wyłuszczenie pseudotorebki. Każda operacja przeprowadzona z powodu torbieli endometrialnej pociąga za sobą ryzyko jatrogennego uszkodzenia jajnika, a tym samym -zmniejszenie rezerwy jajnikowej. Według danych klinicznych obecnie najlepszymi metodami oceny rezerwy jajnikowej są: liczba pęcherzyków antralnych (antral follicle count -AFC) oraz stężenie hormonu antymüllerowskiego (anti-müllerian hormone -AMH) w surowicy. Stężenie AMH silnie koreluje z AFC widocznych w badaniu ultrasonograficznym (USG). Mniejszą wartość diagnostyczną w ocenie rezerwy jajnikowej ma oznaczenie stężeń folikulotropiny (follicle-stimulating hormone -FSH), luteiny (luteinizing hormone -LH), estradiolu (E 2 ) oraz inhibiny w surowicy. Potrzeba dalszych badań oceniających wpływ energii elektrycznej i szycia jajnika jako metod uzyskania hemostazy na rezerwę jajnikową.Słowa kluczowe: endometrioza, torbiele, rezerwa jajnikowa. SummaryEndometriosis is defined as extra-uterine occurrence of endometrial glandular cells and endometrial stroma, and still represents a great challenge to gynecologists, especially in respect to fertility and pain. Endometriosis often occurs in ovaries. If you analyze the risk of cystic recurrence, the risk of pain recurrence and the pregnancy rate, you may consider that the laparoscopy is the method of choice in surgical treatment of endometrial cysts; correspondingly, it replaces the classical laparotomy. Many studies have described various techniques of endoscopic treatment of ovarian endometriosis, but it seems that the pseudocapsular enucleation should be the standard in surgical treatment. Every surgery carried out due to an endometrial cyst implies a risk of iatrogenic ovarian damage and, by the same token, a reduction in ovarian reserve. According to the newest clinical data, the best methods of assessing the ovarian reserve are: Antral Follicle Count (AFC) and serum concentration of Anti-Müllerian hormone (AMH). Concentration of AMH is highly correlated with the antral follicle count visible in the ultrasound examination. The evaluation of the serum concentration of FSH, LH, E2 and inhibin have a lower diagnostic value in the assessment of ovarian reserve. Further investigations are necessary to assess the impact of electric energy and of ovarian suture -as methods of achieving hemostasis -on the ovarian reserve.
This article has been peer reviewed and published immediately upon acceptance.It is an open access article, which means that it can be downloaded, printed, and distributed freely, provided the work is properly cited. Articles in "Ginekologia Polska" are listed in PubMed.
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