자궁내막증과 난소예비력 #1

이번 칼럼에서는 자궁내막증과 난소예비력에 대해서 알아보도록 하겠습니다.

자궁내막증이 난소에 생긴 것을 자궁내막종, 흔히 초콜릿낭종이라고 부르는데요,

자궁내막증이 존재하는 난소의 피질과 정상 난소의 피질을 비교해서 보고한 논문이 있어서 인용해보도록 하겠습니다.

[Ⅰ]

Endometriomas as a possible cause of reduced ovarian reserve in women with endometriosis

Michio Kitajima, M.D., Ph.D., Sylvie Defrère, Ph.D., Marie-Madeleine Dolmans, M.D., Ph.D., Sebastien Colette, Ph.D., Jean Squifflet, M.D., Ph.D., Anne Van Langendonckt, Ph.D., Jacques Donnez, M.D., Ph.D.

Objective: To evaluate the adverse effects of endometriomas on ovarian reserve.

Design: Analysis of prospectively collected biopsy samples.

Setting: Gynecology research unit in a university hospital.

Patient(s): Women younger than age 35 years with endometriomas.

Intervention(s): Biopsy of normal cortex from ovaries affected by endometriomas (≤4 cm) and contralateral ovaries without cysts.

Main Outcome Measure(s): Presence of cortex-specific stroma, observation of superficial endometriosis, follicular density, and presence of fibrosis.

Result(s): Twenty samples of cortical tissue from ovaries with endometriomas and 11 from contralateral ovaries without cysts were analyzed. Follicular density was significantly lower in cortex from ovaries with endometriomas than in cortex from contralateral ovaries without cysts (mean ± SD = 6.3 ± 4.1/mm3 vs 25.1 ± 15.0/mm3). Eleven (55%) cortical samples from ovaries with endometriomas showed fibrosis and concomitant loss of cortex-specific stroma, not observed in contralateral normal ovaries. Multivariate analysis revealed that the presence of endometrioma and fibrosis were significantly and independently associated with follicular density.

Conclusion(s): Endometriotic cyst formation and associated structural tissue alterations in apparently normal ovarian cortex may be a cause of reduced ovarian reserve. Early diagnosis and intervention may be beneficial in women with endometriomas to protect their ovarian function.

Key Words: Endometriosis; endometrioma; ovarian reserve; follicular density; fibrosis; ovarian stroma

M.K. has nothing to disclose. S.D. has nothing to disclose. M.-M.D. has nothing to disclose. S.C. has nothing to disclose. J.S. has nothing to disclose. A.V.L. has nothing to disclose. J.D. has nothing to disclose.

Supported by the Fonds de la Recherche Scientifique, Belgium (No. 1.5015.11), the Région Wallonne, Viscount Philippe de Spoelberch, Baron Albert Frère, and Mr Pietro Ferrero.

위의 내용을 해석하자면 내막종이 없는 난소의 피질과 비교 했을 때 자궁내막종이 있는 부위의 난포 밀도가 유의하게 낮았으며 11개의 난소 피질 샘플에서 섬유화와 동시에 난소 피질 특유 기질의 감소가 보였다고 보고하고 있습니다. 물론 정상 난소 쪽에는 그러한 변화는 없었습니다.

다변량 해석으로 알려진 바에 의하면 자궁내막종과 섬유화의 존재는 유의하고 독립적으로는 난포 밀도와 관련되어 있으며 내막종 구조와 연관된 구조조직 변성은 난소 예비력의 감소원인이 된다고 말하고 있습니다.

결국 자궁내막종이 난소 예비력의 감소에 영향을 미친다는 것입니다.

그것에 대한 대처방법으로 자궁내막종의 제거를 말하고 있는데요,

아래에 다른 논문을 하나 더 인용해보도록 하겠습니다.

[Ⅱ]

J Minim Invasive Gynecol. 2009 Mar-Apr;16(2):142-8. doi: 10.1016/j.jmig.2008.12.013.

Endometrioma excision and ovarian reserve: a dangerous relation.

Busacca M1, Vignali M.

Author information

Abstract

Endometrioma is one of the most frequent pathologies in gynecologic surgery. Laparoscopic cyst excision is considered the best treatment in terms of lower recurrence and improved fertility. However, it was recently questioned whether the excision of the endometrioma could decrease the function of the operated ovary and if it could affect the subsequent fertility. Even if a consistent amount of ovarian tissue is unintentionally removed together with the capsule of the cyst, resulting in does not show the follicular pattern observed in working ovaries. Currently, no definitive data clarify whether the damage to the ovarian reserve, observed in patient with endometrioma, is related to the surgical procedure, to the previous presence of the cyst, or both. Electrosurgial coagulation during hemostasis could play an important role in terms of damage to ovarian stroma and vascularization. Particular attention must be paid in presence of bilateral endometriotic cysts. In fact, an increase in premature ovarian failure rate was reported when both the ovaries are involved in surgery. Incase of assisted reproductive techniques, no clear evidence indicates which is the best approach for concomitant endometriotic cyst. On the base of these considerations endometriomas Should be treated only in case of pain, infertility, and in asymptomatic patients if the cyst diameter is greater than 4 cm.

요점만 번역하자면 ‘자궁내막종 환자에서 관찰된 난소예비력의 손상이 난종의 존재나 수술 절차와의 연관성 또는 두 가지 모두에 관련이 있는지 여부에 대해서는 명확한 데이터가 없는 상태다’ 라고 말하고 있습니다.

자궁내막종과 난소의 기능에 대해서 연구를 해둔 두가지 논문인데요,
이것에 이어서 한가지 논문을 더 인용해 보도록 하겠습니다.
연결해서 읽어보시면 참고가 될 것 같아 다음 포스트에 이어서 올리도록 하겠습니다.


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