异常子宫出血的诊断与管理方法
Approach to diagnosis and management of abnormal uterine bleeding.
作者信息
Telner Deanna E, Jakubovicz Difat
机构信息
Toronto East General Hospital and Department of Family and Community Medicine, University of Toronto, Ontario.
出版信息
Can Fam Physician. 2007 Jan;53(1):58-64.
OBJECTIVE
To present a primary care approach to evaluating and managing abnormal uterine bleeding.
SOURCES OF INFORMATION
Literature searches were conducted on MEDLINE from 1996 to November 2004, EMBASE from 1996 to January 2005, the Cochrane Database of Systematic Reviews from the 4th quarter of 2004 to the 3rd quarter of 2005, guideline advisory committee databases, the Canadian Medical Association Infobase, and Clinical Evidence. The quality of evidence ranged from level I to III.
MAIN MESSAGE
Premenopausal abnormal uterine bleeding can be ovulatory, anovulatory, or anatomic. A variety of hormonal and nonhormonal treatments are available. Patients' preferences, side effects, and physicians' comfort should be considered when making treatment decisions. One in 4 cases of endometrial carcinoma occur in premenopausal women, so it is important to investigate women with risk factors. While postmenopausal bleeding is most commonly caused by atrophic vaginitis, bleeding should be investigated to rule out endometrial and cervical carcinoma.
CONCLUSION
A primary care approach to medical management of abnormal uterine bleeding can help family physicians treat most women in the office as well as help physicians know when to refer women for specialist care.
目的
介绍一种评估和管理异常子宫出血的初级保健方法。
信息来源
于1996年至2004年11月在MEDLINE、1996年至2005年1月在EMBASE、2004年第四季度至2005年第三季度在Cochrane系统评价数据库、指南咨询委员会数据库、加拿大医学协会信息库以及临床证据中进行文献检索。证据质量从I级到III级不等。
主要信息
绝经前异常子宫出血可能是排卵性、无排卵性或解剖性的。有多种激素和非激素治疗方法可供选择。在做出治疗决策时，应考虑患者的偏好、副作用以及医生的舒适度。四分之一的子宫内膜癌病例发生在绝经前女性中，因此对有危险因素的女性进行调查很重要。虽然绝经后出血最常见的原因是萎缩性阴道炎，但仍应对出血进行调查以排除子宫内膜癌和宫颈癌。
结论
一种异常子宫出血的初级保健医疗管理方法有助于家庭医生在诊所治疗大多数女性，同时也有助于医生了解何时将女性转诊至专科治疗。
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