Cooke I D, Thomas E J
From the Department of Obstetrics and Gynecology, Jessop Hospital for Women and University of Sheffield, Sheffield, U.K. and The Department of Obstetrics and Gynecology, Newcastle General Hospital, Westgate, Newcastle upon Tyne, U.K.
Acta Obstet Gynecol Scand. 1989 Jan;68(S150):27-30. doi: 10.1111/aogs.1989.68.s150.27.
Minor degrees of endometriosis have often been regarded as being of no import and hence remain untreated, but a study of the natural history of endometriosis has demonstrated that 47% (95% confidence limits, 23-71%) of patients (n=35) given placebo in a double-blind, randomized controlled trial showed progression of the disease when assessed before and after treatment by laparoscopy. The active agent, the progestogen gestrinone, was given at a dose of 2.5 mg twice weekly and resulted in an improvement of the disease (p <0.004). Furthermore, follow-up over 12 months showed no significant difference between those patients treated with active agent or placebo, and none between those with persistent disease and those in whom it had been obliterated. These data suggest that a diagnosis of mild endometriosis should be followed by treatment to prevent progressive disease, but that the treatment does not influence subsequent fertility. They indicate that expectant treatment has no place and that even if fertility is not an immediate requirement, active treatment should be instituted, and that the new gestogen, gestrinone is efficacious. Other treatments, such as danazol or luteinizing hormone releasing hormone (LHRH) agonists, or the older contraceptive or pseudopregnancy regimens, must be set against spontaneous improvement (in 5 of 17 patients i.e. 29%) or elimination (in 4 of 17 patients i.e. 24%) in the placebo group. Infertile patients with mild endometriosis have disorders of follicular and luteal function, and in vitro fertilization suggests a reduced fertilization rate. Nevertheless, these patients require active treatment if these problems are not to be compounded by adhesions, possibly leading to ovarian enclosure, that would further reduce the untreated cumulative conception rate.
轻度子宫内膜异位症常常被认为无关紧要，因此未得到治疗。但是，一项关于子宫内膜异位症自然病史的研究表明，在一项双盲、随机对照试验中，给予安慰剂的患者（n = 35）中有47%（95%置信区间，23 - 71%）在腹腔镜检查评估治疗前后时显示疾病进展。活性药物炔诺酮，每周两次，每次剂量为2.5毫克，使病情得到改善（p < 0.004）。此外，12个月的随访显示，接受活性药物治疗或安慰剂治疗的患者之间没有显著差异，持续性疾病患者和疾病已消除患者之间也没有差异。这些数据表明，轻度子宫内膜异位症确诊后应进行治疗以预防疾病进展，但治疗并不影响后续生育能力。它们表明期待疗法没有立足之地，即使生育不是当务之急，也应进行积极治疗，新型孕激素炔诺酮是有效的。必须将其他治疗方法，如达那唑或促黄体生成素释放激素（LHRH）激动剂，或较老的避孕或假孕方案，与安慰剂组的自发改善（17例患者中有5例，即29%）或消除（17例患者中有4例，即24%）进行对比。轻度子宫内膜异位症的不孕患者存在卵泡和黄体功能障碍，体外受精表明受精率降低。然而，如果这些问题不因粘连而加重，这些患者就需要积极治疗，粘连可能导致卵巢被包裹，这将进一步降低未治疗患者的累积受孕率。
