Stuparich Mallory A, Donnellan Nicole M, Sanfilippo Joseph S
Department of Obstetrics, Gynecology, and Reproductive Sciences, Magee-Womens Hospital, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
Semin Reprod Med. 2017 Jan;35(1):102-109. doi: 10.1055/s-0036-1597121. Epub 2016 Dec 19.
The recognition and management of endometriosis in the adolescent patient is challenging. A strong clinical suspicion for endometriosis should be maintained in the adolescent who suffers from acyclic pelvic pain as well as absenteeism from school and lack of participation in daily activities. Risk factors include the presence of an obstructive Mullerian anomaly, a family history of endometriosis, and conditions that prolong exposure to endogenous and exogenous estrogens. Empiric medical therapy with nonsteroidal anti-inflammatory drugs and combined oral contraceptive pills may be considered in most adolescents with endometriosis. Failure of empiric therapy may warrant diagnostic laparoscopy, which affords a concomitant opportunity for treatment via excision of endometriosis. Endometriotic implants in the adolescent tend to be more atypical, appearing red/flame-like, clear/polypoid, or vesicular. Endometriosis tends to recur more often in adolescents when compared with adults, and the role of postoperative medical therapy for the suppression of disease progression is not entirely clear. Current knowledge on the impact of adolescent endometriosis on future fertility is limited but overall reassuring.
识别和管理青春期患者的子宫内膜异位症具有挑战性。对于患有非周期性盆腔疼痛、缺课以及缺乏日常活动参与度的青少年，应高度怀疑子宫内膜异位症。风险因素包括存在梗阻性苗勒管异常、子宫内膜异位症家族史以及延长内源性和外源性雌激素暴露的情况。大多数患有子宫内膜异位症的青少年可考虑使用非甾体抗炎药和复方口服避孕药进行经验性药物治疗。经验性治疗失败可能需要进行诊断性腹腔镜检查，这同时提供了通过切除子宫内膜异位症进行治疗的机会。青少年的子宫内膜异位种植体往往更不典型，表现为红色/火焰状、透明/息肉样或水疱样。与成年人相比，子宫内膜异位症在青少年中更容易复发，术后药物治疗对抑制疾病进展的作用尚不完全清楚。目前关于青春期子宫内膜异位症对未来生育影响的知识有限，但总体上令人安心。
