Follicle Loss During Laparoscopic Cystectomy For Endometrioma

Endometriosis（EM）is a disease defined as presence of endometrium-like tissueoutside the uterus, which was first discovered in the mid-19th century. It is a benigngynecologic disease that is predominantly found in women of reproductive age and inrecent years the incidence is rising, and the incidence rate of approximately6%. Endometriosis is often associated with pelvic pain, infertility, dysmenorrhea and soon, seriously affecting the quality of life of patients. The disease is characters with widedistribution and can be violated in any part of the body, the vast majority located in thepelvic intra-abdominal, uterosacral ligament, uterus rectum pouch, and ovaries as themost common violations of parts, occasionally in the bladder, pericardium membrane andpleural ureter, lung, lymphatic vessels, and other parts. Ovarian endometrial cyst is acommon type of pelvic endometriosis, accounting for about17%to44%. Endometriosisis a benign disease, but its local planting is similar with malignancies, invasive growthability. It also has a higher rate of recurrence.Researches show that owing to endometriosis’ invasive character, infammatorybiologic activity and consequent adhesion formation, proximal ovarian tissue isinevitably removed along with the endometrioma wall during the procedure oflaparoscopic stripping, and the total number of follicle declines, so that the decline inovarian reserve and even POF. Laparoscopic cystectomy is the gold standard approachfor the diagnosis and management of ovarian endometrioma.The aim of the present study was to evaluate and compare the loss of follicles afterlaparoscopic cystectomy to remove both endometriotic and non-endometriotic cysts, andto assess the correlation between follicular loss and age, cyst diameter, and thickness ofcyst capsule in the endometrioma.ObjectiveEvaluate the follicle loss in ovarian tissue after laparoscopic excision inendometrioma and the correlation between follicular loss and age, cyst diameter, andthickness of cyst capsule in the endometrioma.MethodsCystectomy samples obtained from103ovaries from85patients by laparoscopic excision (67endometriomas and36benign non-endometriotic cysts) were evaluated forpresence of ovarian tissue, size of cyst, thickness of capsule, follicular loss and follicularsemiquantitative score. All parameters were compared with those from others. And thecorrelation between age, thickness of capsule, size of cyst, and number of follicles wereanalyzed in all endometriotic patients. All data input statistical software for analysis.Results1. Evaluate and compare the loss of follicles after laparoscopic cystectomy to removeboth endometriotic and non-endometriotic cysts, mean number of primordial, primary, orsecondary follicles and mean Semiquantitative scoring of ovarian tissue in theendometriomas were signifcantly higher than those in the non-endometriotic cysts(P<0.05). The total number of follicles, number of follicles, the folliclessemiquantitative score and the presence of ovarian tissue rate no significantdifference in teratoma, serous cystadenoma, the mucinous cystadenoma。2. Analyzed the correlation between age, thickness of capsule, size of cyst, andnumber of follicles in all endometriotic patients. There was a statistically signifcantinverse correlation between patient age and number of follicles in the histologic section（r=-0.54，P<0.001）and a statistically signifcant Negative correlation between thicknessof cyst capsule and number of follicles in all endometriomas（r=0.258，P<0.05）.3. Observe the ovarian endometriosis specimens for pathological analysis, fibroustissue of cyst wall of young ovarian endometriosis patients is mainly fibrocytic cell,while fibrous tissue of cyst wall of older patients is mainly fibroblast cell.Conclusion1. Inadvertent ovarian follicular loss during laparoscopic cystectomy may beunavoidable, especially for endometrioma, it is more incline to the follicle loss duringlaparoscopic cystectomy compared with the nonendometriotic cysts.2. Young age is a risk factor for losing more follicles.3. The thickness of the capsule maybe a possible predictor of follicular loss.4. Fibrous tissue of cyst wall of young ovarian endometriosis patients is mainlyfibroblasts, while fibrous tissue of cyst wall of older patients is mainly fibrocystic cell.5、Ovarian tissue in laparoscopic ovarian endometriosis cyst wall stripping hasmorphological differences compared with normal ovarian tissue.