Zhang Xinmei, Xu Ping
Department of Gynecology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou 310006, China.
Zhejiang Da Xue Xue Bao Yi Xue Ban. 2019 Apr 25;48(2):123-129. doi: 10.3785/j.issn.1008-9292.2019.04.01.
In recent years, surgical and non-surgical excision and drug therapy have replaced hysterectomy as the main therapeutic modalities for adenomyosis. It is suggested that the precise clinical diagnosis should be based on the reconstruction of digitized three-dimensional model with original image data of adenomyosis. Patients' age and clinical manifestations should also be considered, and the patients should be stratified according to reproductive requirements, so as to determine the best treatment. In view of the infiltration and diffuse growth of adenomyosis lesions in the myometrium of the uterus, it is suggested that long-term drug management should be adopted after surgical or non-surgical lesion resection.Gonadotropin releasing hormone agonists, levonorgestrel-releasing intrauterine system, dienogest and short-acting oral contraceptives should be recommended to consolidate the curative effect in order to delay the progress of the disease and prevent recurrence.
近年来，手术切除、非手术切除及药物治疗已取代子宫切除术，成为子宫腺肌病的主要治疗方式。建议利用子宫腺肌病原始图像数据重建数字化三维模型，在此基础上进行精准的临床诊断。同时，应考虑患者年龄及临床表现，并根据生育需求对患者进行分层，以确定最佳治疗方案。鉴于子宫腺肌病病灶在子宫肌层呈浸润性、弥漫性生长，建议在手术或非手术切除病灶后采取长期药物管理。推荐使用促性腺激素释放激素激动剂、左炔诺孕酮宫内缓释系统、地诺孕素及短效口服避孕药巩固疗效，以延缓疾病进展，预防复发。
