GynecologyGynecologyГинекология2079-56962079-5831Consilium Medicum28635ArticlesСтатьиReview ArticleManagement of endometriomasМенеджмент эндометриомDubrovinaS OДубровинаС О

д-р мед. наук, проф., проф. каф. акушерства и гинекологии №1 ФГБОУ ВО РостГМУ, гл. науч. сотр. Научно-исследовательского института акушерства и педиатрии

s.dubrovina@gmail.comBerlimYu DБерлимЮ Д

канд. мед. наук, врач гинекологического отд-ния клиники ФГБОУ ВО РостГМУ

juliaberlim@yandex.ruGimbutV SГимбутВ С

канд. мед. наук, Научно-исследовательский институт акушерства и педиатрии ФГБОУ ВО РостГМУ

secretary@rniiap.ruKrasilnikovaL VКрасильниковаЛ В

аспирант ФГБОУ ВО РостГМУ

cool.dalida2014@yandex.ruAreshyanK AАрешянК А

аспирант Научно-исследовательского института акушерства и педиатрии ФГБОУ ВО РостГМУ

arieshian@bk.ruRostov State Medical UniversityФГБОУ ВО «Ростовский государственный медицинский университет» Минздрава России15082017194VOL 19, NO4 (2017)ТОМ 19, №4 (2017)303509042020Copyright ©; 2017, Consilium MedicumCopyright ©; 2017, ООО "Консилиум Медикум"2017Consilium MedicumООО "Консилиум Медикум"https://creativecommons.org/licenses/by-nc-sa/4.0https://gynecology.orscience.ru/2079-5831/article/view/28635

Ovarian endometriomas could affect up to 44% of women with endometriosis, and are often associated with pelvic pain and infertility. Treatment options include expectant management, medical and/or surgical treatment, and in vitro fertilization. The choice of treatment depends mostly on the associated symptoms. In most cases, surgery is the preferred choice, since endometriomas do not respond to medical treatment, which may only treat associated pain. In case of infertility, in vitro fertilization and embryo transfer may be a suitable alternative to surgery, particularly when there is no associated pain. According to the best available scientific evidence, laparoscopic excision of the endometrioma wall should be considered the procedure of choice. The surgical excision may damage the ovarian reserve. At the same time, recent evidences demonstrate that part of the damage may be due to the presence of the endometrioma itself. Indication to surgical treatment should balance the possible risks of damaging the ovarian reserve with the advantages of surgery in terms of satisfactory pain relief rates and pregnancy rates, and of obtaining tissue specimen for ruling out the rare cases of unexpected ovarian malignancy. A score system to guide the clinician in the decision to perform or withhold surgery and endometriosis fertility index are presented.

Яичниковые эндометриомы могут поражать до 44% всех женщин с эндометриозом, часто ассоциированы с тазовой болью и бесплодием. Выбор лечения включает выжидательную тактику, медикаментозное или хирургическое лечение, а также экстракорпоральное оплодотворение. Предпочтение в методе лечения зависит большей частью от ассоциированных симптомов. В большинстве случаев хирургическое вмешательство является основным выбором, поскольку эндометриомы не отвечают на медикаментозное лечение, способное только облегчить боль. В случае бесплодия экстракорпоральное оплодотворение может быть подходящей альтернативной хирургическому вмешательству, особенно при отсутствии боли. Согласно научным заключениям, лапароскопическое удаление эндометриом может быть рассмотрено как процедура выбора. Однако хирургическое лечение может повредить овариальный резерв. В то же время недавние исследования подтверждают, что частично повреждения могут быть обусловлены самой эндометриомой. При выборе хирургического лечения должны быть взвешены возможные риски повреждения овариального резерва во время операции и преимущества хирургического вмешательства для облегчения болевого синдрома, а также возможность получения тканей для исключения редких случаев малигнизации. В статье представлены таблица подсчета рисков и обоснований, необходимых для клиницистов в принятии решения о необходимости выполнении хирургического лечения, и шкала подсчета индекса фертильности во время оперативного вмешательства при эндометриозе.

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