Bromham D R
Assisted Conception Unit, St James's University Hospital, Leeds, UK.
Br J Clin Pract Suppl. 1991 Autumn;72:54-8.
The role of the family doctor in the management of endometriosis is considered in three phases. With the exception of a small minority of cases in which there are superficial endometriotic lesions, it will be difficult for the general practitioner to confirm the diagnosis without referral for laparoscopy or similar gynaecological investigation. In the majority of patients, clinical diagnosis based on symptomatology and physical findings on pelvic examination is not reliable enough to be a sound basis on which to initiate medical therapy. However, the early referral of patients with a suspicious history allows prompter confirmation of endometriosis, if present, and the establishment of a treatment regime, if required. Where medical therapy is instigated, this is usually by the gynaecological team, but, for the convenience of the patient, her surveillance during treatment is conducted jointly with the referring doctor. Compliance with and continuation of therapy will largely depend on the knowledge and skill of the general practitioner in assessing the significance of side-effects of medication. A significant proportion of endometriosis sufferers experience recurrence of their symptoms, and it may be possible for the general practitioner to initiate re-treatment, with the same or alternative medication, prior to a re-evaluation by the gynaecological team.
家庭医生在子宫内膜异位症管理中的作用分三个阶段进行考量。除了极少数存在浅表性子宫内膜异位病变的病例外，全科医生若不转诊进行腹腔镜检查或类似的妇科检查，很难确诊。在大多数患者中，基于症状学和盆腔检查的体格检查结果做出的临床诊断，可靠性不足以作为启动药物治疗的坚实依据。然而，对于有可疑病史的患者尽早转诊，如果存在子宫内膜异位症，可更快确诊；如有需要，可制定治疗方案。如果启动药物治疗，通常由妇科团队进行，但为方便患者，在治疗期间由转诊医生与妇科团队共同对其进行监测。患者对治疗的依从性和持续治疗情况在很大程度上取决于全科医生评估药物副作用重要性的知识和技能。相当一部分子宫内膜异位症患者症状会复发，在妇科团队重新评估之前，全科医生有可能先用相同或替代药物启动再次治疗。
