Luna Russo Miguel A, Chalif Julia N, Falcone Tommaso
Section of Benign Gynecology, Obstetrics and Gynecology, Women's Health Institute, Cleveland Clinic, Cleveland, OH, USA -
Obstetrics and Gynecology, Women's Health Institute, Cleveland Clinic, Cleveland, Ohio, USA.
Minerva Ginecol. 2020 Apr;72(2):106-118. doi: 10.23736/S0026-4784.20.04544-X.
Endometriosis is a disease of reproductive age women that is commonly characterized by symptoms that often negatively impact quality of life. The clinical management of endometriosis remains highly variable and mostly influenced by geographic location, practice patterns, and breadth of clinician experience. This variability in treatment has inspired a trend towards multidisciplinary and specialized care of patients suffering from this disease. Surgical sampling, followed by histologic confirmation of endometrial-like tissue, remains the standard for the definitive diagnosis of endometriosis. However, the high sensitivity and specificity of MRI and ultrasound has shed light on the path towards non-surgical diagnosis of deep infiltrating endometriosis. Molecular variability and intricacy of this disease has limited the development of biologic markers to target for non-invasive diagnosis and pharmacologic therapies. Surgical management of advanced-stage endometriosis can be difficult, mostly secondary to the invasive nature of the disease, and anatomical distortion requiring advanced surgical skills to manage. The high prevalence of chronic pelvic pain and other complex pain syndromes in patients with endometriosis also requires knowledge in the management of these types of issues in order to provide comprehensive care. Menopausal endometriosis, extrapelvic presentation, and potential malignant transformation of lesions are infrequent, requiring a high index of suspicion for timely diagnosis and treatment.
子宫内膜异位症是育龄期女性的一种疾病，其常见特征是症状往往会对生活质量产生负面影响。子宫内膜异位症的临床管理仍然高度可变，主要受地理位置、执业模式和临床医生经验的广度影响。这种治疗上的差异激发了对患有这种疾病的患者进行多学科和专科护理的趋势。手术取样，随后通过组织学确认子宫内膜样组织，仍然是子宫内膜异位症确诊的标准。然而，MRI和超声的高敏感性和特异性为深部浸润性子宫内膜异位症的非手术诊断指明了方向。这种疾病的分子变异性和复杂性限制了用于非侵入性诊断和药物治疗的生物标志物的开发。晚期子宫内膜异位症的手术管理可能很困难，主要是由于该疾病的侵袭性，以及需要先进手术技能来处理的解剖结构扭曲。子宫内膜异位症患者中慢性盆腔疼痛和其他复杂疼痛综合征的高患病率也需要掌握这些类型问题的管理知识，以便提供全面的护理。绝经后子宫内膜异位症、盆腔外表现以及病变的潜在恶性转化并不常见，需要高度怀疑才能及时诊断和治疗。
