Rabinovici Jaron, Stewart Elizabeth A
Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Senior Lecturer, Sackler Medical School, Tel-Aviv University, Tel Hashomer 52621, Israel.
Best Pract Res Clin Obstet Gynaecol. 2006 Aug;20(4):617-36. doi: 10.1016/j.bpobgyn.2006.02.002. Epub 2006 Aug 24.
This chapter demonstrates that new interventional techniques have been introduced over recent years in order to find an adequate non-invasive therapy for adenomyosis. There is no evidence-based medicine to guide us in the treatment of adenomyosis with minimally invasive therapy. In fact, most data regarding adenomyosis and these evolving therapies comes from the inadvertent treatment of adenomyosis in studies designed to treat uterine leiomyomas. Essentially, all data are from case reports or small case series. The problem is compounded by the fact that there is no agreed imaging definition of adenomyosis, and so therapies that do not excise the uterus have no 'gold standard' for comparison. Nonetheless, there are some reports suggesting that there may be efficacy in techniques such as medicated intrauterine devices, uterine artery embolization, and MRI-guided focused ultrasound surgery. Larger studies specifically treating adenomyosis are clearly required. As with every new approach, the widespread success of these techniques will depend on the general adoption of adequate diagnostic solutions and improvements in the technical parameters of these new regimens. Since the techniques presented in this chapter are new, they have not yet undergone the necessary thorough scientific scrutiny and discussion that is needed for their general acceptance. In the past, adenomyosis was mainly a 'post-factum' pathological diagnosis after extensive surgery. Based on the evidence presented in this chapter it seems that adenomyosis has become an entity that might be treatable by new, minimally invasive or non-invasive treatments.
本章表明，近年来已引入新的介入技术，以寻求一种适用于子宫腺肌病的非侵入性治疗方法。在子宫腺肌病的微创治疗方面，尚无循证医学来指导我们。事实上，关于子宫腺肌病和这些不断发展的治疗方法的大多数数据，来自旨在治疗子宫平滑肌瘤的研究中对子宫腺肌病的意外治疗。基本上，所有数据均来自病例报告或小型病例系列。由于对子宫腺肌病尚无公认的影像学定义，因此对于不切除子宫的治疗方法，没有“金标准”可供比较，这使问题更加复杂。尽管如此，有一些报告表明，诸如含药宫内节育器、子宫动脉栓塞和磁共振成像引导聚焦超声手术等技术可能有效。显然需要开展专门针对子宫腺肌病的更大规模研究。与每一种新方法一样，这些技术的广泛成功将取决于适当诊断方法的普遍采用以及这些新方案技术参数的改进。由于本章介绍的技术是新的，它们尚未经过普遍接受所需的必要全面科学审查和讨论。过去，子宫腺肌病主要是广泛手术后的“事后”病理诊断。根据本章提供的证据，子宫腺肌病似乎已成为一种可通过新的微创或非侵入性治疗方法进行治疗的疾病。
