akusherstvoObstetrics, Gynecology and ReproductionАкушерство, Гинекология и Репродукция2313-73472500-3194IRBIS LLC10.17749/2313-7347/ob.gyn.rep.2026.758akusherstvo-2907Research ArticleREVIEW ARTICLEНАУЧНЫЙ ОБЗОРPersonalized endometriosis therapy: efficacy of surgical treatment and long-term medical controlПерсонализированная терапия эндометриоза: эффективность хирургического лечения и долгосрочного медикаментозного контроляЧинченкоМ. А.ChinchenkoM. A.

Чинченко Мария Александровна

214019 Смоленск, ул. Крупской, д. 28

Maria A. Chinchenko

28 Krupskaya Str., Smolensk 214019

maria.gri2001@gmail.comhttps://orcid.org/0009-0001-3322-2617ЕмельяноваВ. О.EmelyanovaV. O.

Емельянова Валерия Олеговна

452710 село Буздяк, ул. В. Ахмадеева, д. 31

Valeriya O. Emelyanova, MD

31 V. Akhmadeev Str., Buzdyak Village 452710

https://orcid.org/0009-0007-3191-850XАккубековаА. А.AkkubekovaA. A.

Аккубекова Аделя Аликовна

453380 село Исянгулово, ул. Больничная, д. 14

Adelya A. Akkubekova, MD

14 Bolnichnaya Str., Isyangulovo Village 453380

https://orcid.org/0009-0008-1725-1494ИсламоваЭ. И.IslamovaE. I.

Исламова Элина Илшатовна

452860 село Калтасы, ул. Матросова, 30

Elina I. Islamova, MD

30 Matrosova Str., Kaltasy Village 452860

https://orcid.org/0009-0006-6039-0794КимЕ. Г.KimE. G.

Ким Елена Георгиевна 

344091 Ростов-на-Дону, Коммунистический проспект, д. 39

Elena G. Kim, MD

39 Kommunistichesky Prospekt, Rostov-on-Don 344091

https://orcid.org/0009-0005-3136-0206РомановаМ. В.RomanovaM. V.

Романова Мария Владимировна

603005 Нижний Новгород, площадь Минина и Пожарского, д. 10/1 

Maria V. Romanova

10/1 Minin and Pozharsky Square, Nizhny Novgorod 603005

https://orcid.org/0009-0000-6322-873XКокуринаЕ. В.KokurinaE. V.

Кокурина Есения Владимировна

603005 Нижний Новгород, площадь Минина и Пожарского, д. 10/1

Eseniya V. Kokurina

10/1 Minin and Pozharsky Square, Nizhny Novgorod 603005

https://orcid.org/0009-0009-5377-189XРябцеваА. А.RyabtsevaA. A.

Рябцева Анна Андреевна

620028 Екатеринбург, ул. Репина, д. 3

Anna A. Ryabtseva

3 Repin Str., Ekaterinburg 620028

https://orcid.org/0009-0000-5938-6866ВласоваА. А.VlasovaA. A.

Власова Анастасия Андреевна

620028 Екатеринбург, ул. Репина, д. 3

Anastasia A. Vlasova

3 Repin Str., Ekaterinburg 620028

https://orcid.org/0009-0003-9237-6899ОзорнинаС. В.OzorninaS. V.

Озорнина Софья Вадимовна

620028 Екатеринбург, ул. Репина, д. 3

Sofya V. Ozornina

3 Repin Str., Ekaterinburg 620028

https://orcid.org/0009-0002-6668-8162ГребенюкА. И.GrebenyukA. I.

Гребенюк Анна Ивановна

400131 Волгоград, площадь Павших Борцов, д. 1

Anna I. Grebenyuk

1 Pavshikh Bortsov Sq., Volgograd, 400131

https://orcid.org/0009-0000-1078-8397АнтонянР. В.AntonyanR. V.

Антонян Роберт Вартанович

400131 Волгоград, площадь Павших Борцов, д. 1

Robert V. Antonyan

1 Pavshikh Bortsov Sq., Volgograd, 400131

https://orcid.org/0009-0004-5214-9103АбастоваИ. М.AbastovaI. M.

Абастова Иман Муслимовна

Iman M. Abastova, MD

ФГБОУ ВО «Смоленский государственный медицинский университет» Министерства здравоохранения Российской ФедерацииРоссияSmolensk State Medical University, Ministry of Health of the Russian FederationRussian FederationГБУЗ Республики Башкортостан «Буздякская центральная районная больница»РоссияBuzdyak Central District Hospital, Republic of BashkortostanRussian FederationГБУЗ Республики Башкортостан «Исянгуловская центральная районная больница»РоссияIsyangulovskaya Central District Hospital, Republic of BashkortostanRussian FederationГБУЗ Республики Башкортостан «Калтасинская центральная районная больница»РоссияKaltasinskaya Central District Hospital, Republic of BashkortostanRussian FederationГБУ Ростовской области «Детская городская поликлиника № 45»РоссияRostov Region Children's City Polyclinic No. 45Russian FederationФГБОУ ВО «Приволжский исследовательский медицинский университет» Министерства здравоохранения Российской ФедерацииРоссияPrivolzhsky Research Medical University, Ministry of Health of the Russian FederationRussian FederationФГБОУ ВО «Уральский государственный медицинский университет» Министерства здравоохранения Российской ФедерацииРоссияUral State Medical University, Ministry of Health of the Russian FederationRussian FederationФГБОУ ВО «Волгоградский государственный медицинский университет» Министерства здравоохранения Российской ФедерацииРоссияVolgograd State Medical University, Ministry of Health of the Russian FederationRussian FederationНезависимый исследовательРоссияIndependent ResearcherRussian Federation20261008202600Online First2907Copyright © Chinchenko M.A., Emelyanova V.O., Akkubekova A.A., Islamova E.I., Kim E.G., Romanova M.V., Kokurina E.V., Ryabtseva A.A., Vlasova A.A., Ozornina S.V., Grebenyuk A.I., Antonyan R.V., Abastova I.M., 20262026Чинченко М.А., Емельянова В.О., Аккубекова А.А., Исламова Э.И., Ким Е.Г., Романова М.В., Кокурина Е.В., Рябцева А.А., Власова А.А., Озорнина С.В., Гребенюк А.И., Антонян Р.В., Абастова И.М.Chinchenko M.A., Emelyanova V.O., Akkubekova A.A., Islamova E.I., Kim E.G., Romanova M.V., Kokurina E.V., Ryabtseva A.A., Vlasova A.A., Ozornina S.V., Grebenyuk A.I., Antonyan R.V., Abastova I.M.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.gynecology.su/jour/article/view/2907Introduction

Introduction. Endometriosis is a chronic multisystem disease associated with decreased quality of life, chronic pelvic pain, infertility, and a wide range of comorbid conditions. Despite the fact that laparoscopy has traditionally held a central place in the diagnosis and treatment of endometriosis, the current role of surgical intervention requires a differentiated assessment, taking into account disease phenotype, the severity of pain, reproductive plans, the risk of damage to ovarian reserve and the likelihood of recurrence.

Aim

Aim: to critically compare surgical, medical, and combined approaches to endometriosis treatment and to substantiate a stratified model of long-term patient management accounting for disease phenotype, pain profile, ovarian reserve, comorbidity, and reproductive plans.

Materials and Methods

Materials and Methods. A narrative literature review was performed by retieving relevant publixcxations found in PubMed/MEDLINE, Embase, Scopus, Web of Science, ScienceDirect, eLibrary.ru, CyberLeninka, and Google Scholar. The primary search window covered 2017–2025; earlier publications were included base on their methodological, historical, or clinical relevance. Eligible sources comprised systematic reviews, meta-analyses, randomized controlled trials, large cohort studies, and clinically relecant observational studies reporting surgical, medical, or combined endometriosis treatment, pain control, recurrence prevention, effects on fertility and ovarian reserve, as well as long-term therapy safety. The review was prepared in accordance to the SANRA criteria (Scale for the Assessment of Narrative Review Articles).

Results

Results. Synthesis of current evidence indicates that surgery is effective for selected indications (large or symptomatic endometriomas, deep infiltrating endometriosis with obstructive manifestations, distorted pelvic anatomy, and certain infertility phenotypes) but guarantees no durable pain control or recurrence prevention. Long-term medical therapy (progestins, combined oral contraceptives, oral gonadotropin-releasing hormone antagonists with add-back therapy, and the levonorgestrel-releasing intrauterine system) provides clinically relevant pain reduction and lowers postoperative recurrence risk; progestogen regimens are associated with a lower need for reoperation and second-line therapy. Unlike repeated ovarian surgery, medical strategies do not involve direct surgical trauma to ovarian tissue; however, their effectiveness and safety depend on disease phenotype, treatment duration, contraindications, tolerability, and reproductive goals.

Conclusion

Conclusion. Surgical treatment remains important in cases of large or symptomatic endometriomas, pelvic anatomy disorders, obstructive complications, suspected malignancy, and certain infertility forms. The most reasonable approach is not to replace surgery with drug treatment, but rather a stratified model in which the sequence and scope of interventions are determined by patient's clinical profile and long-term goals of therapy.

Введение

Введение. Эндометриоз является хроническим мультисистемным заболеванием, ассоциированным со снижением качества жизни, хронической тазовой болью, бесплодием и широким спектром коморбидных состояний. Несмотря на то что лапароскопия традиционно занимала центральное место в диагностике и лечении эндометриоза, современная роль хирургического вмешательства требует дифференцированной оценки с учетом фенотипа заболевания, выраженности болевого синдрома, репродуктивных планов, риска повреждения овариального резерва и вероятности рецидива.

Цель

Цель: критически сопоставить хирургические, медикаментозные и комбинированные подходы к лечению эндометриоза и обосновать стратифицированную модель долгосрочного ведения пациенток с учетом фенотипа заболевания, болевого профиля, овариального резерва, коморбидности и репродуктивных планов.

Материалы и методы

Материалы и методы. Выполнен нарративный обзор литературы в базах данных PubMed/MEDLINE, Embase, Scopus, Web of Science, ScienceDirect, eLibrary.ru, КиберЛенинка и Google Scholar. Основной временной интервал составил 2017–2025 гг.; более ранние публикации включались при методологической, исторической или клинической значимости. В обзор отбирались систематические обзоры, метаанализы, рандомизированные контролируемые исследования, крупные когортные и клинически значимые наблюдательные исследования, содержащие данные о хирургическом, медикаментозном и комбинированном лечении эндометриоза, контроле боли, профилактике рецидивов, влиянии на фертильность и овариальный резерв, а также о безопасности длительной терапии. Подготовка обзора учитывала критерии SANRA (англ. Scale for the Assessment of Narrative Review Articles; шкала для оценки нарративных обзорных статей).

Результаты

Результаты. Синтез современных данных показывает, что хирургическое лечение эффективно при избранных показаниях (крупные или симптомные эндометриомы, глубокий инфильтративный эндометриоз с обструктивными проявлениями, нарушение анатомии малого таза, отдельные формы бесплодия), однако не гарантирует стойкого контроля боли и профилактики рецидива. Длительная медикаментозная терапия (прогестины, комбинированные оральные контрацептивы, пероральные антагонисты гонадотропин-рилизинг-гормона в сочетании с терапией возврата, левоноргестрел-содержащая внутриматочная система) обеспечивает клинически значимое снижение боли и снижает риск рецидива после операции; прогестагенные режимы ассоциированы с меньшей потребностью в повторных вмешательствах и терапии второй линии. В отличие от повторных операций на яичниках, медикаментозные стратегии не связаны с прямой хирургической травмой овариальной ткани, однако их эффективность и безопасность определяются фенотипом заболевания, длительностью терапии, противопоказаниями, переносимостью и репродуктивными планами пациентки.

Заключение

Заключение. Хирургическое лечение сохраняет значение при крупных или симптомных эндометриомах, нарушении анатомии малого таза, обструктивных осложнениях, подозрении на злокачественный процесс и отдельных формах бесплодия. Наиболее обоснованной является не замена хирургии медикаментозным лечением, а стратифицированная модель, в которой последовательность и объем вмешательств определяются клиническим профилем пациентки и долгосрочными целями терапии.

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The authors declare that there are no conflicts of interest present.