Collinet P, Fritel X, Revel-Delhom C, Ballester M, Bolze P A, Borghese B, Bornsztein N, Boujenah J, Bourdel N, Brillac T, Chabbert-Buffet N, Chauffour C, Clary N, Cohen J, Decanter C, Denouël A, Dubernard G, Fauconnier A, Fernandez H, Gauthier T, Golfier F, Huchon C, Legendre G, Loriau J, Mathieu-d'Argent E, Merlot B, Niro J, Panel P, Paparel P, Philip C A, Ploteau S, Poncelet C, Rabischong B, Roman H, Rubod C, Santulli P, Sauvan M, Thomassin-Naggara I, Torre A, Wattier J M, Yazbeck C, Canis M
Clinique de gynécologie, hôpital Jeanne-de-Flandre, CHRU de Lille, 59000 Lille, France; Université Lille-Nord-de-France, 59000 Lille, France.
Service de gynécologie-obstétrique et médecine de la reproduction, Inserm CIC 1402, 2, rue de la Milétrie, 86000 Poitiers, France; Université de Poitiers, 86000 Poitiers, France; Inserm CIC 1402, 86000 Poitiers, France.
Gynecol Obstet Fertil Senol. 2018 Mar;46(3):144-155. doi: 10.1016/j.gofs.2018.02.027. Epub 2018 Mar 14.
First-line investigations to diagnose endometriosis are clinical examination and pelvic ultrasound. Second-line investigations include pelvic examination performed by a referent clinician, transvaginal ultrasound performed by a referent echographist, and pelvic MRI. It is recommended to treat endometriosis when it is symptomatic. First-line hormonal treatments recommended for the management of painful endometriosis are combined with hormonal contraceptives or levonorgestrel 52mg IUD. There is no evidence to recommend systematic preoperative hormonal therapy for the unique purpose of preventing the risk of surgical complications or facilitating surgery. After endometriosis surgery, combined hormonal contraceptives or levonorgestrel SIU 52mg are recommended as first-line therapy in the absence of desire of pregnancy. In case of initial treatment failure, recurrence, or multiple organ involvement by endometriosis, medico-surgical and multidisciplinary discussion is recommended. The laparoscopic approach is recommended for the surgical treatment of endometriosis. HRT may be offered in postmenopausal women operated for endometriosis. In case of infertility related to endometriosis, it is not recommended to prescribe anti-gonadotropic hormone therapy to increase the rate of spontaneous pregnancy, including postoperatively. The possibilities of fertility preservation should be discussed with the patient in case of surgery for ovarian endometrioma.
诊断子宫内膜异位症的一线检查方法是临床检查和盆腔超声。二线检查包括由专科临床医生进行的盆腔检查、由专科超声检查医生进行的经阴道超声检查以及盆腔磁共振成像。有症状的子宫内膜异位症建议进行治疗。用于治疗疼痛性子宫内膜异位症的一线激素治疗方法是联合使用激素避孕药或左炔诺孕酮52mg宫内节育器。没有证据表明为预防手术并发症风险或便于手术这一唯一目的而推荐系统性术前激素治疗。子宫内膜异位症手术后，如果没有怀孕意愿，推荐联合使用激素避孕药或左炔诺孕酮宫内节育器52mg作为一线治疗。如果初始治疗失败、复发或子宫内膜异位症累及多个器官，建议进行药物 - 手术及多学科讨论。推荐采用腹腔镜手术治疗子宫内膜异位症。接受过子宫内膜异位症手术的绝经后女性可采用激素替代疗法。对于与子宫内膜异位症相关的不孕症，不建议使用促性腺激素拮抗剂治疗以提高自然受孕率，包括术后也不建议使用。对于因卵巢子宫内膜异位囊肿进行手术的患者，应与患者讨论保留生育功能的可能性。
