[子宫内膜异位症疼痛的新医学治疗方法：法国妇产科医师与妇科学家国家联盟-法国卫生总署子宫内膜异位症指南]
[New medical treatments for painful endometriosis: CNGOF-HAS Endometriosis Guidelines].
作者信息
Legendre G, Delbos L, Hudon E, Chabbert-Buffet N, Geoffron S, Sauvan M, Fernandez H, Bouet P-E, Descamps P
机构信息
Service de gynécologie-obstétrique, CHU Angers, 4, rue Larrey, 49033 Angers cedex 01, France; CESP-Inserm, U1018, équipe 7, genre, santé sexuelle et reproductive, UVSQ, université Paris-Saclay, université Paris Sud, 94807 Villejuif, France.
Service de gynécologie-obstétrique, CHU Angers, 4, rue Larrey, 49033 Angers cedex 01, France.
出版信息
Gynecol Obstet Fertil Senol. 2018 Mar;46(3):256-263. doi: 10.1016/j.gofs.2018.02.009. Epub 2018 Mar 9.
OBJECTIVE
The objective of this work is to evaluate the place of new treatments in the management of endometriosis outside the context of infertility.
METHODS
A review of the literature was conducted by consulting Medline data until July 2017.
RESULTS
Dienogest is effective compared to placebo in short term (NP2) and long term (NP4) for the treatment of painful endometriosis. In comparison with GnRH agonists, dienogest is also effective in terms of decreased pain and improved quality of life in non-operated patients (NP2) as well as for recurrence of lesions and symptomatology postoperatively (NP2). Data on GnRH antagonists, selective progesterone receptor modulators as well as selective inhibitors (anti-TNF-α, matrix metalloprotease inhibitors, angiogenesis growth factor inhibitors) are insufficient to provide evidence of interest in clinical practice for the management of painful endometriosis (NP3).
CONCLUSION
Dienogest is recommended as second-line therapy for the management of painful endometriosis (Grade B). Because of lack of evidence, aromatase inhibitors, elagolix, SERM, SPRM and anti-TNF-α are not recommended for the management of painful endometriosis (Grade C).
目的
本研究旨在评估在非不孕症背景下，新疗法在子宫内膜异位症管理中的地位。
方法
通过查阅截至2017年7月的Medline数据进行文献综述。
结果
与安慰剂相比，地诺孕素在短期（NP2）和长期（NP4）治疗疼痛性子宫内膜异位症方面均有效。与GnRH激动剂相比，地诺孕素在未接受手术的患者中（NP2），在减轻疼痛和改善生活质量方面有效，在术后病变复发和症状方面（NP2）也有效。关于GnRH拮抗剂、选择性孕激素受体调节剂以及选择性抑制剂（抗TNF-α、基质金属蛋白酶抑制剂、血管生成生长因子抑制剂）的数据不足以证明其在临床实践中对疼痛性子宫内膜异位症管理的有效性（NP3）。
结论
地诺孕素被推荐作为疼痛性子宫内膜异位症管理的二线治疗药物（B级）。由于缺乏证据，不推荐芳香化酶抑制剂、艾拉戈利、SERM、SPRM和抗TNF-α用于疼痛性子宫内膜异位症的管理（C级）。
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