Ball Elizabeth, Byrne Hugh, Davis Colin
The Centre for Reproductive Medicine and Surgery, Kenton and Lucas Wing, St Bartholomew's Hospital, London, UK.
Curr Opin Obstet Gynecol. 2007 Aug;19(4):303-7. doi: 10.1097/GCO.0b013e328216f642.
To appraise a new approach to laparoscopic surgery for infertility caused by advanced endometriosis.
Endometriosis is a common systemic and local disease with altered peritoneal function, which requires both systemic and local treatment. Medication alone cannot improve infertility, and laparoscopic treatment, particularly in severe endometriosis, has a high recurrence rate and is often limited by technical difficulties. Novel treatment strategies have therefore to be sought, especially in women who do not want in-vitro fertilization as a first option, either because they suffer from pain in addition to infertility or want to enhance their fertility over many cycles.
Two-step operative laparoscopy with interval pituitary suppression by means of gonadotrophin-releasing hormone analogues reduces the extent of endometriosis, as classified by the American Fertility Association, and appears to be a promising method of achieving optimal cytoreduction and facilitating complicated surgery in severe endometriosis, while protecting the ovary from unnecessary trauma. A large-scale well-designed study is needed to confirm that this treatment leads to improved pregnancy rates.
评估一种针对晚期子宫内膜异位症所致不孕症的腹腔镜手术新方法。
子宫内膜异位症是一种常见的全身性和局部性疾病，伴有腹膜功能改变，需要全身性和局部性治疗。单纯药物治疗无法改善不孕症，而腹腔镜治疗，尤其是在重度子宫内膜异位症中，复发率高且常受技术难题限制。因此，需要寻求新的治疗策略，特别是对于那些不希望将体外受精作为首选方案的女性，她们要么除不孕症外还患有疼痛，要么希望在多个周期内提高生育能力。
采用促性腺激素释放激素类似物进行间歇性垂体抑制的两步手术腹腔镜检查可降低美国生育协会分类的子宫内膜异位症程度，似乎是一种有前景的方法，可实现最佳的细胞减灭，并便于在重度子宫内膜异位症中进行复杂手术，同时保护卵巢免受不必要的创伤。需要开展大规模精心设计的研究来证实这种治疗可提高妊娠率。
