O'Callaghan David
Endosurgery Unit, Mercy Hospital for Women, Victoria.
Aust Fam Physician. 2006 Nov;35(11):864-7.
Endometriosis is one of the major causes of pelvic pain and subfertility in women.
This article discusses the diagnosis and treatment of endometriosis.
Empiric treatment in women presenting with pain symptoms suggestive of endometriosis is the usual first option. Ultrasound does not diagnose peritoneal disease but will recognise endometriomas. Laparoscopy remains the gold standard for diagnosis and surgical removal at that time should be first line treatment. Medical treatment is proven effective for superficial disease. It is most frequently used where surgical skills do not allow removal of the endometriosis or where incomplete removal is suspected in severe disease. Long term treatment after surgical removal with diet, exercise and hormones provides long term pain control and may reduce the risk of recurrence. Medical treatment has no place in infertility treatment, however surgical removal of milder disease enhances pregnancy rates. Early referral for assisted reproduction treatment is suggested with severe disease.
子宫内膜异位症是女性盆腔疼痛和生育力低下的主要原因之一。
本文讨论子宫内膜异位症的诊断和治疗。
对于出现提示子宫内膜异位症疼痛症状的女性，经验性治疗通常是首选。超声不能诊断腹膜疾病，但可识别子宫内膜瘤。腹腔镜检查仍是诊断的金标准，此时手术切除应作为一线治疗。药物治疗已被证明对浅表疾病有效。在手术技能无法切除子宫内膜异位症或怀疑严重疾病切除不完全的情况下，药物治疗最常被使用。手术切除后通过饮食、运动和激素进行长期治疗可实现长期疼痛控制，并可能降低复发风险。然而，药物治疗在不孕症治疗中没有作用，而手术切除较轻的疾病可提高妊娠率。对于严重疾病，建议尽早转诊进行辅助生殖治疗。
