Alvi Farah A, Glaser Laura M, Chaudhari Angela, Tsai Susan, Milad Magdy P
Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
Curr Opin Obstet Gynecol. 2017 Aug;29(4):240-248. doi: 10.1097/GCO.0000000000000371.
Adenomyosis is commonly diagnosed in women of reproductive age. Interest in conservative interventions has grown as more women desire fertility preservation or avoidance of hysterectomy. This review discusses surgical and interventional methods for treatment of symptomatic adenomyosis. The technique, evidence, and utility of each method are described.
Hysteroscopic ablative techniques are associated with lower morbidity than with hysterectomy but may result in an unacceptable risk of treatment failure. Surgical adenomyomectomy may provide good symptomatic improvement, especially when combined with preoperative gonadotropin-releasing hormone agonist treatment. Laparoscopic myometrial coagulation is associated with high rates of future pregnancy complications. Uterine artery ligation has limited value as an isolated approach but, coupled with other techniques, provides adequate therapeutic control. Bilateral uterine artery embolization may improve symptoms, without significantly compromising fertility. Focused ultrasonic surgical methods also show promise in alleviating symptoms without compromising reproductive outcomes.
A multitude of surgical and interventional options are available for young women with symptomatic adenomyosis. These treatment methods have unique associated risks and benefits, and may have varying impacts on long-term symptom control, fertility, and reproductive outcomes.
子宫腺肌病常见于育龄女性。随着越来越多的女性希望保留生育能力或避免子宫切除，对保守治疗的兴趣日益增加。本综述讨论了有症状子宫腺肌病的手术和介入治疗方法。描述了每种方法的技术、证据和实用性。
宫腔镜消融技术与子宫切除相比，发病率较低，但可能导致治疗失败的风险不可接受。手术腺肌病切除术可显著改善症状，尤其是术前联合促性腺激素释放激素激动剂治疗时。腹腔镜子宫肌层凝固术与未来妊娠并发症的高发生率相关。子宫动脉结扎术作为一种单独的方法价值有限，但与其他技术联合使用可提供充分的治疗控制。双侧子宫动脉栓塞术可改善症状，且对生育能力无明显损害。聚焦超声手术方法在缓解症状的同时不影响生殖结局方面也显示出前景。
对于有症状子宫腺肌病的年轻女性，有多种手术和介入选择。这些治疗方法具有独特的相关风险和益处，可能对长期症状控制、生育能力和生殖结局产生不同影响。
