Van Voorhis Bradley
Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Iowa Hospitals and Clinics, 200 Hawkins Rd, Iowa City, IA 52242, USA.
JAMA. 2009 Jan 7;301(1):82-93. doi: 10.1001/jama.2008.791. Epub 2008 Dec 2.
Uterine fibroids are common tumors that can cause heavy menstrual bleeding, pelvic pressure symptoms, and reproductive disorders. The incidence of fibroids peaks in the fifth decade of age and they are more common in African American women. Often, fibroids are asymptomatic and require no treatment. However, the case of Ms P, a 41-year-old woman with recurrent uterine fibroids, menorrhagia, anemia, and fatigue who wishes to retain fertility, illustrates the symptoms that require treatment. Evaluation usually begins with a pelvic examination and an ultrasound to determine both the size and location of the fibroids within the uterus. Standard treatment of symptomatic fibroids is surgical removal by myomectomy or hysterectomy, depending in part on the desire for future fertility; new treatment options include uterine artery embolization via interventional radiologic techniques as well as various medical interventions. Several new therapies show promise but are still experimental at this time. The evidence for treatment options for Ms P and symptomatic patients with fibroids in general is discussed.
子宫肌瘤是常见的肿瘤，可导致月经过多、盆腔压迫症状和生殖功能障碍。肌瘤的发病率在50岁左右达到高峰，在非裔美国女性中更为常见。通常情况下，肌瘤没有症状，无需治疗。然而，P女士的病例说明了需要治疗的症状。P女士41岁，患有复发性子宫肌瘤、月经过多、贫血和疲劳，希望保留生育能力。评估通常从盆腔检查和超声检查开始，以确定肌瘤在子宫内的大小和位置。有症状肌瘤的标准治疗方法是通过肌瘤切除术或子宫切除术进行手术切除，部分取决于对未来生育的期望；新的治疗选择包括通过介入放射技术进行子宫动脉栓塞以及各种药物干预。几种新疗法显示出前景，但目前仍处于实验阶段。本文讨论了针对P女士以及一般有症状肌瘤患者的治疗选择的证据。
