Donnez Jacques, Dolmans Marie-Madeleine
Professor EM, Catholic University of Louvain, Director, Société de Recherche pour l'Infertilité (SRI), 143 Avenue Grandchamp, B-1150 Brussels, Belgium
Gynecology Department, Cliniques Universitaires St-Luc, Avenue Hippocrate 10, 1200 Brussels, Belgium; Pôle de Gynécologie, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Avenue Mounier 52, bte B1.52.02, 1200 Brussels, Belgium.
Hum Reprod Update. 2016 Nov;22(6):665-686. doi: 10.1093/humupd/dmw023. Epub 2016 Jul 27.
Uterine fibroids (also known as leiomyomas or myomas) are the most common form of benign uterine tumors. Clinical presentations include abnormal bleeding, pelvic masses, pelvic pain, infertility, bulk symptoms and obstetric complications.Almost a third of women with leiomyomas will request treatment due to symptoms. Current management strategies mainly involve surgical interventions, but the choice of treatment is guided by patient's age and desire to preserve fertility or avoid 'radical' surgery such as hysterectomy. The management of uterine fibroids also depends on the number, size and location of the fibroids. Other surgical and non-surgical approaches include myomectomy by hysteroscopy, myomectomy by laparotomy or laparoscopy, uterine artery embolization and interventions performed under radiologic or ultrasound guidance to induce thermal ablation of the uterine fibroids.There are only a few randomized trials comparing various therapies for fibroids. Further investigations are required as there is a lack of concrete evidence of effectiveness and areas of uncertainty surrounding correct management according to symptoms. The economic impact of uterine fibroid management is significant and it is imperative that new treatments be developed to provide alternatives to surgical intervention.There is growing evidence of the crucial role of progesterone pathways in the pathophysiology of uterine fibroids due to the use of selective progesterone receptor modulators (SPRMs) such as ulipristal acetate (UPA). The efficacy of long-term intermittent use of UPA was recently demonstrated by randomized controlled studies.The need for alternatives to surgical intervention is very real, especially for women seeking to preserve their fertility. These options now exist, with SPRMs which are proven to treat fibroid symptoms effectively. Gynecologists now have new tools in their armamentarium, opening up novel strategies for the management of uterine fibroids.
子宫肌瘤（也称为平滑肌瘤或肌瘤）是最常见的良性子宫肿瘤形式。临床表现包括异常出血、盆腔肿块、盆腔疼痛、不孕、压迫症状和产科并发症。几乎三分之一患有肌瘤的女性会因症状而要求治疗。目前的管理策略主要涉及手术干预，但治疗方法的选择取决于患者的年龄以及保留生育能力或避免诸如子宫切除术等“根治性”手术的意愿。子宫肌瘤的管理还取决于肌瘤的数量、大小和位置。其他手术和非手术方法包括宫腔镜下肌瘤切除术、剖腹手术或腹腔镜下肌瘤切除术、子宫动脉栓塞术以及在放射或超声引导下进行的干预，以诱导子宫肌瘤的热消融。只有少数随机试验比较了各种治疗肌瘤的方法。由于缺乏有效性的确切证据以及根据症状正确管理方面存在不确定性领域，因此需要进一步研究。子宫肌瘤管理的经济影响重大，必须开发新的治疗方法以提供手术干预的替代方案。由于使用了诸如醋酸乌利司他（UPA）等选择性孕激素受体调节剂（SPRMs），越来越多的证据表明孕激素途径在子宫肌瘤病理生理学中起着关键作用。随机对照研究最近证明了长期间歇性使用UPA的疗效。对于寻求保留生育能力的女性来说，手术干预替代方案的需求非常现实。现在有了这些选择，SPRMs已被证明能有效治疗肌瘤症状。妇科医生现在有了新的工具，为子宫肌瘤的管理开辟了新的策略。
