Doyle J O, Missmer S A, Laufer M R
Division of Gynecology, Children's Hospital Boston, Boston, Massachusetts, USA.
J Pediatr Adolesc Gynecol. 2009 Aug;22(4):257-63. doi: 10.1016/j.jpag.2008.11.003.
To evaluate the effect of combined surgical-medical treatment on endometriosis progression in adolescents as measured by disease stage.
Retrospective chart review.
Two academic medical centers.
Sequential cases of young women identified on chart review with chronic pelvic pain unresponsive to dysmenorrheal treatment who underwent initial laparoscopy for diagnosis and surgical destruction of endometriosis. All patients were then treated with standard continuous medical therapy. Patients with exacerbation of pain on anti-endometriosis medical therapy who elected a subsequent laparoscopic procedure were eligible for this study.
Retrospective chart review
Endometriosis stage and adhesions at subsequent laparoscopy as compared to the initial surgical procedure.
90 patients met inclusion criteria. Eligible patients were 12 to 24 years of age at the time of the initial laparoscopy. The median endometriosis stage at first and second laparoscopy was I. No stage change was observed in 70% of patients, 19% improved by one stage, 1% improved by two stages, and 10% worsened by one stage. Regardless of initial stage, a trend toward disease progression was not observed. There was a significant likelihood for stage improvement at second laparoscopy, with those initially diagnosed as stage II or III most likely to exhibit improvement.
Based on the concept that endometriosis can be progressive, these data suggest that combined surgical-medical management retards disease progression in adolescents and young adults.
通过疾病分期评估手术联合药物治疗对青少年子宫内膜异位症进展的影响。
回顾性病历审查。
两个学术医疗中心。
通过病历审查确定的患有慢性盆腔疼痛且痛经治疗无效的年轻女性连续病例，这些患者接受了初次腹腔镜检查以诊断和手术破坏子宫内膜异位症。所有患者随后均接受标准的持续药物治疗。因抗子宫内膜异位症药物治疗导致疼痛加重而选择后续腹腔镜手术的患者符合本研究条件。
回顾性病历审查
与初次手术相比，后续腹腔镜检查时的子宫内膜异位症分期和粘连情况。
90名患者符合纳入标准。符合条件的患者在初次腹腔镜检查时年龄为12至24岁。初次和第二次腹腔镜检查时子宫内膜异位症的中位分期均为I期。70%的患者分期无变化，19%的患者改善了一期，1%的患者改善了两期，10%的患者恶化了一期。无论初始分期如何，均未观察到疾病进展的趋势。第二次腹腔镜检查时有分期改善的显著可能性，最初诊断为II期或III期的患者最有可能出现改善。
基于子宫内膜异位症可能进展的概念，这些数据表明手术联合药物治疗可延缓青少年和年轻成年人的疾病进展。
