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子宫肌瘤的当前医学治疗方法。

Current medical treatment of uterine fibroids.

作者信息

Sohn Geum Seon, Cho SiHyun, Kim Yong Man, Cho Chi-Heum, Kim Mee-Ran, Lee Sa Ra

机构信息

Department of Obstetrics and Gynecology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.

Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, Korea.

出版信息

Obstet Gynecol Sci. 2018 Mar;61(2):192-201. doi: 10.5468/ogs.2018.61.2.192. Epub 2018 Feb 13.

Abstract

Uterine fibroids (leiomyomas or myomas), benign monoclonal tumors, are the most common benign tumors in women. Heavy or prolonged menstrual bleeding, abnormal uterine bleeding, resultant anemia, pelvic pain, infertility, and/or recurrent pregnancy loss are generally associated with uterine fibroids. Although curative treatment of this tumor relies on surgical therapies, medical treatments are considered the first-line treatment to preserve fertility and avoid or delay surgery. The aim of this review is to provide available and emerging medical treatment options for symptomatic uterine fibroids. Literature review and consensus of expert opinion. Many uterine fibroids are asymptomatic and require no intervention, although it is advisable to follow-up patients to document stability in size and growth. Fibroid-associated symptoms include heavy menstrual bleeding and pain or pelvic discomfort. The association between infertility and fibroids increases with age. Treatment options for symptomatic uterine fibroids - include medical, surgical, and radiologically guided interventions. Various medical therapies are now available for women with uterine fibroids, although each therapy has its own advantages and disadvantages. Currently, gonadotrophin-releasing hormone (GnRH) agonists and selective progesterone receptor modulators (SPRMs) are the most effective medical therapies, with the most evidence to support their reduction of fibroid volume and symptomatic improvement in menstrual bleeding. The choice of treatment depends on the patient's personal treatment goals, as well as efficacy and need for repeated interventions.

摘要

子宫肌瘤(平滑肌瘤或肌瘤)是良性单克隆肿瘤,是女性最常见的良性肿瘤。月经过多或经期延长、异常子宫出血、由此导致的贫血、盆腔疼痛、不孕和/或反复流产通常与子宫肌瘤有关。尽管这种肿瘤的根治性治疗依赖于手术治疗,但药物治疗被认为是保留生育能力、避免或推迟手术的一线治疗方法。本综述的目的是为有症状的子宫肌瘤提供现有的和新出现的药物治疗选择。文献综述和专家意见共识。许多子宫肌瘤是无症状的,不需要干预,尽管建议对患者进行随访以记录肌瘤大小和生长情况的稳定性。肌瘤相关症状包括月经过多以及疼痛或盆腔不适。不孕与肌瘤之间的关联随年龄增长而增加。有症状的子宫肌瘤的治疗选择包括药物、手术和放射引导下的干预。目前有多种药物疗法可供子宫肌瘤患者使用,尽管每种疗法都有其自身的优缺点。目前,促性腺激素释放激素(GnRH)激动剂和选择性孕激素受体调节剂(SPRMs)是最有效的药物疗法,有最多的证据支持它们减少肌瘤体积并改善月经出血症状。治疗方法的选择取决于患者的个人治疗目标,以及疗效和重复干预的必要性。

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Long-term medical management of uterine fibroids with ulipristal acetate.醋酸乌利司他治疗子宫肌瘤的长期医学管理。
Fertil Steril. 2016 Jan;105(1):165-173.e4. doi: 10.1016/j.fertnstert.2015.09.032. Epub 2015 Oct 23.
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Efficacy and safety of repeated use of ulipristal acetate in uterine fibroids.醋酸乌利司他重复用于子宫肌瘤的疗效与安全性
Fertil Steril. 2015 Feb;103(2):519-27.e3. doi: 10.1016/j.fertnstert.2014.10.038. Epub 2014 Dec 24.
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Long-term treatment of uterine fibroids with ulipristal acetate ☆.醋酸乌利司他治疗子宫肌瘤的长期疗效观察。
Fertil Steril. 2014 Jun;101(6):1565-73.e1-18. doi: 10.1016/j.fertnstert.2014.02.008. Epub 2014 Mar 12.

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