Massachusetts General Hospital, Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Boston MA, USA.
Curr Opin Obstet Gynecol. 2023 Aug 1;35(4):383-388. doi: 10.1097/GCO.0000000000000884. Epub 2023 Jun 12.
Endometriosis is a common and often debilitating condition, with multiple theories of pathogenesis. Despite the prevalence of endometriosis, the optimal surgical management remains unclear.
Laparoscopy is the gold standard for the diagnosis of endometriosis, with biopsy confirmation more accurate than visual diagnosis alone. It is not clear from the existing data whether excision of endometriosis is superior to ablation. Improvement in pain has been documented following peritonectomy, however, controlled trials are lacking. It is not clear whether concomitant hysterectomy improves pain associated with endometriosis, although hysterectomy may reduce reoperation rate. Bilateral oophorectomy performed for the treatment of endometriosis may not be curative without simultaneous excision of all visible lesions, and the risks of surgical menopause should be considered. The rate of appendiceal endometriosis is higher than previously suspected, and may not correlate with intraoperative visual findings, suggesting appendectomy should be considered during surgical treatment of endometriosis.
Despite the prevalence of endometriosis, there is a paucity of data to guide optimal surgical management. More high-quality studies are needed.
子宫内膜异位症是一种常见且常使人衰弱的疾病，其发病机制有多种理论。尽管子宫内膜异位症很常见，但最佳的手术治疗方法仍不清楚。
腹腔镜检查是诊断子宫内膜异位症的金标准，活检证实比单纯的肉眼诊断更准确。现有的数据尚不清楚子宫内膜异位症的切除是否优于消融。虽然缺乏对照试验，但全子宫切除术联合腹膜切除术可改善疼痛。虽然子宫切除术可能会降低再次手术的几率，但同时切除所有可见病变可能会改善与子宫内膜异位症相关的疼痛，而子宫切除术是否会改善疼痛尚不清楚。为治疗子宫内膜异位症而进行的双侧卵巢切除术，如果不同时切除所有可见病变，则可能无法治愈，且应考虑手术绝经的风险。阑尾子宫内膜异位症的发生率高于先前的估计，且可能与术中肉眼观察结果无关，这表明在子宫内膜异位症的手术治疗中应考虑阑尾切除术。
尽管子宫内膜异位症很常见，但指导最佳手术治疗的相关数据却很少。需要更多高质量的研究。
