Fauconnier A, Borghese B, Huchon C, Thomassin-Naggara I, Philip C-A, Gauthier T, Bourdel N, Denouel A, Torre A, Collinet P, Canis M, Fritel X
Service de gynécologie-obstétrique, CHI Poissy-St-Germain, 10, rue du Champ-Gaillard, 78303 Poissy, France; EA 7285 risques cliniques et sécurité en santé des femmes, université Versailles-Saint-Quentin-en-Yvelines, 2, avenue de la Source-de-la-Bièvre, 78180 Montigny-le-Bretonneux, France.
Service de chirurgie gynécologie obstétrique 2 et médecine de la reproduction, CHU Cochin, AP-HP, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France; Équipe génomique, épigénétique et physiopathologie de la reproduction, département développement, reproduction, Cancer, Inserm U1016, université Paris Descartes, Sorbonne Paris Cité, 12, rue de l'École-de-Médecine, 75270 Paris cedex 06, France.
Gynecol Obstet Fertil Senol. 2018 Mar;46(3):223-230. doi: 10.1016/j.gofs.2018.02.012. Epub 2018 Mar 13.
Based on the best evidence available, we have provided guidelines for clinical practice to target the nature of endometriosis as a disease, the consequences of its natural history on management, and the clinical and imaging evaluation of the disease according to the level of care (primary care, specialized or referral). The frequency of endometriosis is unknown in the general population; endometriosis requires management when it causes symptoms (pain, infertility) or when it affect the function of an organ. In the absence of symptom, there is no need for follow-up or screening of the disease. Endometriosis may be responsible for various pain symptoms such as severe dysmenorrhea, deep dyspareunia, painful bowel movements or low urinary tract signs increasing with menstruation, or infertility. A careful evaluation of the symptoms and their impact on the quality of life should be made. The first-line examinations for the diagnosis of endometriosis are: digital examination and pelvic ultrasound. The second-line examinations are: the pelvic exam by an expert clinician, the pelvic MRI and/or the transvaginal ultrasound by an expert. MRI and ultrasound carrying different and complementary information. Other examinations may be considered as part of the pre-therapeutic assessment of the disease in case of specialized care. Diagnostic laparoscopy may be suggested in case of clinical suspicion of endometriosis whereas preoperative examinations have not proved the disease, it must be part of a management plan of endometriosis-related pain or infertility. During management, it is recommended to give comprehensive information on the different therapeutic alternatives, the benefits and risks expected from each treatment, the risk of recurrence, fertility, especially before surgery. The information must be personalized and take into account the expectations and preferences of the patient, and accompanied by an information notice given to the patient.
基于现有最佳证据，我们制定了临床实践指南，旨在针对子宫内膜异位症这一疾病的本质、其自然病史对治疗的影响以及根据医疗级别（初级保健、专科或转诊）对该疾病进行临床和影像学评估。一般人群中子宫内膜异位症的发病率尚不清楚；当子宫内膜异位症引起症状（疼痛、不孕）或影响器官功能时，需要进行治疗。无症状时，无需对该疾病进行随访或筛查。子宫内膜异位症可能导致各种疼痛症状，如严重痛经、深部性交痛、排便疼痛或随月经加重的下尿路症状，或不孕。应仔细评估症状及其对生活质量的影响。诊断子宫内膜异位症的一线检查是：直肠指检和盆腔超声。二线检查是：由专家临床医生进行的盆腔检查以及盆腔MRI和/或由专家进行的经阴道超声检查。MRI和超声提供不同且互补的信息。在专科护理情况下，其他检查可被视为该疾病治疗前评估的一部分。临床怀疑子宫内膜异位症但术前检查未证实该疾病时，可能建议进行诊断性腹腔镜检查，它必须是子宫内膜异位症相关疼痛或不孕管理计划的一部分。在治疗过程中，建议就不同的治疗选择、每种治疗预期的益处和风险、复发风险、生育能力等提供全面信息，尤其是在手术前。这些信息必须个性化，并考虑患者的期望和偏好，同时应向患者提供一份信息通知。
