Assessment of Ovarian Volume and Hormonal Changes after Ovarian Cystectomy in the Different Ovarian Tumor

Joon-Cheol Park, Jin Gon Bae, Jong‐In Kim, Jeong-Ho Rhee
2008 · vol. 35(2) , pp. 155–162 · W2488371169
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Ovarian cystectomy reduced ovarian volume in large endometriomas and non-endometriomas, but hormonal markers of ovarian reserve remained unchanged compared to preoperative values.

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This prospective study assessed ovarian reserve changes after cystectomy for unilateral ovarian tumors in 22 women aged ≤35 with regular cycles, comparing an endometrioma group versus non-endometrioma tumors and stratifying by size (<10 cm vs ≥10 cm). Ovarian volume was measured by transvaginal ultrasound on cycle day 3 within one month pre-surgery and again 3 months post-surgery, while basal FSH and estradiol and a clomiphene citrate challenge test were performed preoperatively and repeated after at least two spontaneous post-surgery cycles; three women who became pregnant within 3 months were excluded. Ovarian volume decreased significantly after surgery in endometriomas and in non-endometriomas ≥10 cm, but not in non-endometriomas <10 cm, whereas basal FSH and cycle day 10 FSH on CCCT showed no significant pre–post or between-group differences. This paper is centrally about endometriosis — it directly investigates ovarian volume and hormonal reserve after cystectomy stratified by endometrioma versus non-endometrioma.

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Abstract

Objectives: The aim of this study was to assess the change of ovarian reserve after removal of ovarian tumor using basal FSH, E2, clomiphene citrate challenge test and ovarian volume.\nMethods: Twenty two patients with unilateral ovarian tumor, ≤35 years old, regular menstrual cycle were collected prospectively and divided into endometrioma or non-endometrioma group. We measured the ovarian volume with transvaginal ultrasonography on the day 3 of menstrual cycle within one month before and 3 months after surgery. Basal (cycle day 3) FSH, E2 and CCCT were checked before surgery and repeated at least 2 spontaneous cycles later after surgery. Three patients that had been pregnant within 3 months after surgery were excluded in analysis.\nResults: The ovarian volume was reduced significantly after surgery in endometrioma and non-endometrioma ≥10 cm group (4.79±2.57 cm3 and 5.21±1.33 cm3, respectively), but not in the non-endometrioma <10 cm group (6.18±2.85 cm3). After surgery, basal FSH and cycle day 10 FSH on CCCT in endometrioma and non-endometrioma were 4.25±0.20 mIU/ml and 3.79±0.80mIU/ml, 4.24±0.85 mIU/ml and 4.28±0.92 mIU/ml, respectively. There were neither significant difference in comparison with the preoperative results nor between two groups.\nConclusions: Enucleation of ovarian mass was associated with a significant reduction in ovarian volume in endometrioma and non-endometrioma larger than 10cm in diameter. Hormonal markers for evaluation of ovarian reserve, such as basal and cycle day 10 FSH on CCCT, were not changed significantly in each group. In reproductive age women, conservative enucleation or cystectomy rather than oophorectomy should be considered even in a large benign tumor and ovarian function could be reserved by meticulous operative technique.
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Methods

Twenty two patients with unilateral ovarian tumor, ≤35 years old, regular menstrual cycle were collected prospectively and divided into endometrioma or non-endometrioma group. We measured the ovarian volume with transvaginal ultrasonography on the day 3 of menstrual cycle within one month before and 3 months after surgery. Basal (cycle day 3) FSH, E2 and CCCT were checked before surgery and repeated at least 2 spontaneous cycles later after surgery. Three patients that had been pregnant within 3 months after surgery were excluded in analysis.

Results

The ovarian volume was reduced significantly after surgery in endometrioma and non-endometrioma ≥10 cm group (4.79±2.57 cm3 and 5.21±1.33 cm3, respectively), but not in the non-endometrioma <10 cm group (6.18±2.85 cm3). After surgery, basal FSH and cycle day 10 FSH on CCCT in endometrioma and non-endometrioma were 4.25±0.20 mIU/ml and 3.79±0.80mIU/ml, 4.24±0.85 mIU/ml and 4.28±0.92 mIU/ml, respectively. There were neither significant difference in comparison with the preoperative results nor between two groups.

Conclusions

Enucleation of ovarian mass was associated with a significant reduction in ovarian volume in endometrioma and non-endometrioma larger than 10cm in diameter. Hormonal markers for evaluation of ovarian reserve, such as basal and cycle day 10 FSH on CCCT, were not changed significantly in each group. In reproductive age women, conservative enucleation or cystectomy rather than oophorectomy should be considered even in a large benign tumor and ovarian function could be reserved by meticulous operative technique. 목적: 난소 용적 측정 및 기저 FSH, $E_2$ 수식 이미지, CCCT 검사를 통하여 가임기 여성에서 난소 낭종 제거술후 난소 배란능의 변화를 평가하고자 하였다. 연구방법: 난소 낭종으로 내원한 환자 중 35세 이하의 여성으로서 비교적 규칙적인 생리주기를 가지며 한쪽 난소에만 낭종을 가진 22명을 대상으로 자궁내막종군과 비자궁내막종군으로 구분하여 전향적 비교 분석을 시행하였다. 질 초음파를 이용하여 수술 1개월 전과 수술 3개월 후 생리주기 3일에 난소의 용적을 측정하였다. 또한 수술 전과, 수술 후 두 번의 정상 생리가 있은 뒤 기저 FSH, E_2, CCCT를 시행하였목적: 난소 용적 측정 및 기저 FSH, E2, CCCT 검사를 통하여 가임기 여성에서 난소 낭종 제거술후 난소 배란능의 변화를 평가하고자 하였다. 연구방법: 난소 낭종으로 내원한 환자 중 35세 이하의 여성으로서 비교적 규칙적인 생리주기를 가지며 한쪽 난소에만 낭종을 가진 22명을 대상으로 자궁내막종군과 비자궁내막종군으로 구분하여 전향적 비교 분석을 시행하였다. 질 초음파를 이용하여 수술 1개월 전과 수술 3개월 후 생리주기 3일에 난소의 용적을 측정하였다. 또한 수술 전과, 수술 후 두 번의 정상 생리가 있은 뒤 기저 FSH, E2, CCCT를 시행하였다. 대상 환자 22명 중 3명은 술후 검사를 계획한 3개월 전에 임신이 됨으로써 연구대상에서 제외하였다. 결과: 수술 후 난소 용적은 자궁내막종군에서 4.79±2.57 cm3, 비자궁내막종군 중 직경 ≥10 cm인 경우에서 5.21±1.33 cm3로서 건측과 비교하여 유의한 감소가 있었으나, 비자궁내막종군 중 직경 <10 cm인 경우는 6.18±2.85cm3로서 유의한 용적 감소가 없었다. 수술후 자궁내막종군의 기저 FSH는 4.25±0.20 mIU/ml, CCCT 10일째 FSH는 3.79±0.80 mIU/ml였고, 비자궁내막종군은 각각 4.24±0.85 mIU/ml, 4.28±0.92 mIU/ml로서 수술 전후의 기저 FSH, CCCT 결과 비교에서 각 군 모두 유의한 차이가 없었으며, 두 군간의 비교에서도 유의한 차이가 없었다. 결 론: 자궁내막종 절제술 및 10 cm 이상의 난소 낭종 절제술 후 난소 용적은 유의한 감소를 보였으나 10 cm 미만의 난소 낭종 제거술에서는 난소 용적의 유의한 감소가 없었다. 난소 배란능을 평가하기 위하여 측정한 기저 FSH, CCCT 검사 결과는 낭종 제거술 후에도 각 군 모두 유의한 차이를 보이지 않았다. 따라서 가임기 여성에서는 난소절제술 보다는 낭종 제거술이 우선 고려되어야 하며, 세심한 주의를 기울인다면 난소 배란능의 손상을 최소화할 수 있을 것으로 사료된다. - Alternative Title - 난소 낭종 제거술후 난소 용적 및 호르몬의 변화 - Publisher - School of Medicine - Citation - Joon-Cheol Park et al. (2008). Assessment of Ovarian Volume and Hormonal Changes after Ovarian Cystectomy in the Different Ovarian Tumor. 대한생식의학회지, 35(2), 155–162. - Type - Article - ISSN - 2233-8233 - Appears in Collections: - 1. School of Medicine (의과대학) > Dept. of Obstetrics & Gynecology (산부인과학) - Files in This Item: - - oak-bbb-2212.pdf 기타 데이터 / 394.82 kB / Adobe PDFDownload - Items in Repository are protected by copyright, with all rights reserved, unless otherwise indicated.

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