Brosens I A
Department of Obstetrics and Gynecology, University Hospital Gasthuisberg, Leuven, Belgium.
Acta Obstet Gynecol Scand Suppl. 1994;159:18-21.
The current management of endometriosis includes expectant, medical, surgical and combined therapies and the selection is based on the staging of the disease proposed by the American Fertility Society (AFS). This approach, however, has proven to be inadequate for the selection of medical treatment. Peritoneal endometriosis represents a range of lesions of different activity and stage of evolution. Surgical resection carries a risk of adhesion formation. Two to three months of medical therapy can induce inactivation and regression of active lesions. These factors should be taken into account in the selection of therapy. Ovarian endometrial cysts are indications for reconstructive surgery. The extent of adhesions and fibrosis, rather than the size of the cyst, determine the surgical outcome. The invaginated cortex explains the frequent association with lutein cysts. Large cysts can be conservatively treated at laparoscopy in a three-step procedure with a 3-month medical therapy between the first and second laparoscopy. Deep nodular endometriosis presents different lesions varying from fibrosis to adenomyosis. The effect of a therapeutic medical trial can be evaluated within 2 months. Different modalities are available for long-term medical therapy. Surgical resection is the treatment of choice for the adenomyosis type.
目前子宫内膜异位症的治疗方法包括期待治疗、药物治疗、手术治疗及综合治疗，治疗方法的选择基于美国生育协会（AFS）提出的疾病分期。然而，事实证明这种方法在选择药物治疗时并不充分。腹膜子宫内膜异位症表现为一系列不同活动度和演变阶段的病变。手术切除有形成粘连的风险。两到三个月的药物治疗可使活跃病变失活并消退。在选择治疗方法时应考虑这些因素。卵巢子宫内膜囊肿是重建手术的指征。粘连和纤维化的程度而非囊肿大小决定手术效果。内陷的皮质解释了其与黄体囊肿的常见关联。大囊肿可在腹腔镜下采用三步法进行保守治疗，在第一次和第二次腹腔镜检查之间进行3个月的药物治疗。深部结节性子宫内膜异位症表现为从纤维化到子宫腺肌病的不同病变。可在2个月内评估治疗性试验的效果。长期药物治疗有多种方式可供选择。手术切除是子宫腺肌病类型的首选治疗方法。
