Hirono Takae, Feng Ye, Wang Wenhui, Yu Huan
Peking University Health Science Center.
The University of Warwick, Coventry, UK.
Ann Med Surg (Lond). 2023 Dec 5;86(2):1096-1100. doi: 10.1097/MS9.0000000000001592. eCollection 2024 Feb.
Endometriosis is most commonly found in the pelvic area, ~12% of people have it in other areas or organs, which is known as extrapelvic endometriosis. Thoracic endometriosis, which is also classified as extrapelvic endometriosis, manifests with four distinct forms: catamenial pneumothorax, catamenial hemothorax, catamenial hemoptysis, or lung nodules. Catamenial pneumothorax is the most common clinical symptom of these; however, it is frequently neglected by clinicians and goes undiagnosed and untreated. As a result, it is critical to raise awareness of this medical condition among clinicians.
The authors present a case report of a 34-year-old woman of reproductive age who had recurrent episodes of spontaneous pneumothorax during menstruation and underwent treatment with thoracoscopic surgery as well as gynaecological hormonal drugs including oral progesterone and dienogest throughout this time. Based on her symptoms, a catamenial pneumothorax caused by thoracic endometriosis was suspected.
The clinical symptoms, pathogenesis, diagnosis, and treatment of Catamenial Pneumothorax are analyzed. Furthermore, the usage of gynaecological hormone medications in this condition has been discussed. The mechanisms of oral contraceptives and progestin-based medications are evaluated by comparing the patient's treatment process, highlighting their pros and cons.
Thoracoscopic surgery combined with postoperative gynaecological hormonal medications may be the most effective treatment for this issue. Several gynaecological hormonal medicines are available, each of which has its own set of pros and cons, and must be thoroughly evaluated as well as correctly tailored to the patient's specific circumstances to have a positive therapeutic outcome.
子宫内膜异位症最常见于盆腔区域，约12%的患者在其他区域或器官发生，这被称为盆腔外子宫内膜异位症。胸段子宫内膜异位症也归类为盆腔外子宫内膜异位症，表现为四种不同形式：经期气胸、经期血胸、经期咯血或肺结节。经期气胸是这些症状中最常见的临床症状；然而，它经常被临床医生忽视，未得到诊断和治疗。因此，提高临床医生对这种疾病的认识至关重要。
作者报告了一例34岁育龄女性的病例，该患者在月经期间反复出现自发性气胸，并在此期间接受了胸腔镜手术以及包括口服孕激素和地诺孕素在内的妇科激素类药物治疗。根据她的症状，怀疑是胸段子宫内膜异位症导致的经期气胸。
分析了经期气胸的临床症状、发病机制、诊断和治疗。此外，还讨论了这种情况下妇科激素药物的使用。通过比较患者的治疗过程，评估了口服避孕药和基于孕激素的药物的作用机制，突出了它们的优缺点。
胸腔镜手术联合术后妇科激素药物治疗可能是解决这个问题最有效的方法。有几种妇科激素药物可供选择，每种都有其自身的优缺点，必须进行全面评估并根据患者的具体情况进行正确调整，才能取得积极的治疗效果。
