Rodgers Allison K, Falcone Tommaso
Department of Obstetrics and Gynecology, The Cleveland Clinic, Department of Obstetrics and Gynecology-A81, 9500 Euclid Avenue, Cleveland, Ohio 44159, USA.
Expert Opin Pharmacother. 2008 Feb;9(2):243-55. doi: 10.1517/14656566.9.2.243.
Endometriosis is a common chronic disease that causes symptoms of pain and infertility. The pain syndrome can be quite incapacitating. The pain symptoms usually originate in the reproductive organs but can also involve the urinary or intestinal tracts if endometriosis implantation has occurred there. The presentation and physical appearance of endometriosis is extremely variable and can be characterized by a chronic intraperitoneal inflammatory process and adhesions. The only definitive diagnostic technique is laparoscopy.
To review current literature on the treatment strategies for endometriosis.
Review of Pubmed, Cochrane database and Medline for current review articles and studies regarding the current treatment strategies for endometriosis.
Initial treatment is surgical or medical. Medical therapy is often used as a first-line therapy and can also be used in conjunction with those patients who undergo surgical therapy for pain. No medical therapy has proven effective for infertility. Medical therapy consists mostly of hormonal suppressive therapy in which the medication causes a downregulation of the hypothalamus-pituitary-ovarian pathway. Non-steroidal anti-inflammatory drugs and oral contraceptives are often used as an initial approach even without a definitive diagnosis. Progestins, such as oral norethindrone and depot medroxyprogesterone, are effective while using them but have a high recurrence rate. The norgestrol intrauterine device is also quite effective at relieving pain associated with endometriosis, especially pain arising during menses as well as from lesions in the rectovaginal tissue. Gonadotropin-releasing hormone agonists induce a pseudomenopausal state and have significant side effects, such as hot flashes and genital atrophy. 'Add-back' therapy with a progestin has been shown to relieve most of these drug related symptoms. Gonadotropin-releasing hormone agonists are also very effective at relieving symptoms of pain during treatment but are also associated with a high recurrence rate. New drug therapies that are under investigation are aromatase inhibitors and immunomodulators. Furthermore, new delivery systems are being investigated that may also improve the patient response.
子宫内膜异位症是一种常见的慢性疾病，可导致疼痛和不孕症状。疼痛综合征可能会使人丧失能力。疼痛症状通常起源于生殖器官，但如果子宫内膜异位症植入发生在泌尿系统或肠道，也可能累及这些部位。子宫内膜异位症的表现和外观极具多样性，其特征可能是慢性腹膜内炎症过程和粘连。唯一确定的诊断技术是腹腔镜检查。
综述当前关于子宫内膜异位症治疗策略的文献。
检索Pubmed、Cochrane数据库和Medline，查找有关子宫内膜异位症当前治疗策略的综述文章和研究。
初始治疗为手术或药物治疗。药物治疗常被用作一线治疗，也可用于接受手术治疗疼痛的患者。尚无药物治疗对不孕有效。药物治疗主要包括激素抑制疗法，其中药物会导致下丘脑 - 垂体 - 卵巢通路的下调。即使在没有明确诊断的情况下，非甾体抗炎药和口服避孕药也常被用作初始治疗方法。孕激素，如口服炔诺酮和长效醋酸甲羟孕酮，在使用时有效，但复发率高。左炔诺孕酮宫内节育器在缓解与子宫内膜异位症相关的疼痛方面也非常有效，尤其是经期疼痛以及直肠阴道组织病变引起的疼痛。促性腺激素释放激素激动剂会诱导假绝经状态，并具有显著的副作用，如潮热和生殖器萎缩。使用孕激素进行“反向添加”疗法已被证明可缓解这些药物相关的大多数症状。促性腺激素释放激素激动剂在治疗期间缓解疼痛症状方面也非常有效，但复发率也很高。正在研究的新药疗法包括芳香化酶抑制剂和免疫调节剂。此外，正在研究新的给药系统，这也可能改善患者的反应。
