子宫腺肌病药物治疗选择及长期管理
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摘要
缓解疼痛,减少出血和促进生育是子宫腺肌病的主要治疗目标,子宫切除术或子宫病灶挖除仍然是目前主流的治疗方法。药物治疗采用的药物及用法与子宫内膜异位症治疗类似,只有地诺孕素是子宫腺肌病的专用药物。文章着重介绍子宫腺肌病缓解疼痛和减少出血的药物治疗选择及长期管理。
To relieve pain,reduce heavy menstrual flow and retain or enhance fertility are the dominant treatment target of adenomyosis of the uterus.Hysterectomy or adenomyomectomy remains the most important method of treatment for the disease up to now.The medical drugs in treatment of adenomyosis of the uterus are similar to those for endometriosis,with dienogest being the only specific drug at present. In this article,medical treatments for adenomyosis of the uterus on pain relief and menstrual flow reduction as well as the long-term management of patients are discussed.
To relieve pain,reduce heavy menstrual flow and retain or enhance fertility are the dominant treatment target of adenomyosis of the uterus.Hysterectomy or adenomyomectomy remains the most important method of treatment for the disease up to now.The medical drugs in treatment of adenomyosis of the uterus are similar to those for endometriosis,with dienogest being the only specific drug at present. In this article,medical treatments for adenomyosis of the uterus on pain relief and menstrual flow reduction as well as the long-term management of patients are discussed.
引文
[1]中华医学会妇产科学分会子宫内膜异位症协作组.子宫内膜异位症的诊治指南[J].中华妇产科杂志,2015,50(3):161-169.
[2]周应芳.全面认识子宫腺肌病[J].中华妇产科杂志,2013,48(4):291-294.
[3]徐嘉宁,周应芳.子宫腺肌病痛经相关因素的研究进展[J].中华妇产科杂志,2013,48(2):144-147.
[4]周应芳.子宫腺肌病的非手术治疗[J].中国医师杂志,2015,17(4):491-493.
[5]石一复,张信美,黄秀峰,等.子宫腺肌症[M].北京:人民卫生出版社,2018:129-142.
[6]复方口服避孕药临床应用中国专家共识专家组.复方口服避孕药临床应用中国专家共识[J].中华妇产科杂志,2015,50(2):81-91.
[7]程利南,狄文,丁岩,等.女性避孕方法临床应用的中国专家共识[J].中华妇产科杂志,2018,53(7):433-447.
[8]Andres MP,Lopes LA,Baracat EC,et al.Dienogest in the treatment of endometriosis:systematic review[J].Arch Gynecol Obstet,2015,292(3):523-529.
[9]Osuga Y,Fujimoto-Okabe H,Hagino A,et al.Evaluation of the efficacy and safety of dienogest in the treatment of painful symptoms in patients with adenomyosis:a randomized,double-blind,multicenter,placebo-controlled study[J].Fertil Steril,2017,108(4):673-678.
[10]Neriishi K,Hirata T,Fukuda S,et al.Long-term dienogest administration in patients with symptomatic adenomyosis[J].JObstet Gynaecol Res,2018,44(8):1439-1444.
[11]Conway F,Morosetti G,Camilli S,et al.Ulipristal acetate therapy increases ultrasound features of adenomyosis:a good treatment given in an erroneous diagnosis of uterine fibroids[J].Gynecologic Endocrinol,2018,18:1-4.
[12]中国医师协会妇产科医师分会子宫内膜异位症专业委员会,中华医学会妇产科学分会子宫内膜异位症协作组.子宫内膜异位症长期管理中国专家共识[J].中华妇产科杂志,2018,53(12):836-841.
[13]周应芳.子宫腺肌病术前预处理及术后药物治疗[J].妇产与遗传(电子版),2016,6(2):3-5.
[14]Takaesu Y,Nishi H,Kojima J,et al.Dienogest compared with gonadotropin-releasing hormone agonist after conservative surgery for endometriosis[J].J Obstet Gynaecol Res,2016,42(9):1152-1158.
[15]周应芳.子宫腺肌病药物治疗原则及注意事项[J].中国实用妇科与产科杂志,2017,33(1):157-160.
[2]周应芳.全面认识子宫腺肌病[J].中华妇产科杂志,2013,48(4):291-294.
[3]徐嘉宁,周应芳.子宫腺肌病痛经相关因素的研究进展[J].中华妇产科杂志,2013,48(2):144-147.
[4]周应芳.子宫腺肌病的非手术治疗[J].中国医师杂志,2015,17(4):491-493.
[5]石一复,张信美,黄秀峰,等.子宫腺肌症[M].北京:人民卫生出版社,2018:129-142.
[6]复方口服避孕药临床应用中国专家共识专家组.复方口服避孕药临床应用中国专家共识[J].中华妇产科杂志,2015,50(2):81-91.
[7]程利南,狄文,丁岩,等.女性避孕方法临床应用的中国专家共识[J].中华妇产科杂志,2018,53(7):433-447.
[8]Andres MP,Lopes LA,Baracat EC,et al.Dienogest in the treatment of endometriosis:systematic review[J].Arch Gynecol Obstet,2015,292(3):523-529.
[9]Osuga Y,Fujimoto-Okabe H,Hagino A,et al.Evaluation of the efficacy and safety of dienogest in the treatment of painful symptoms in patients with adenomyosis:a randomized,double-blind,multicenter,placebo-controlled study[J].Fertil Steril,2017,108(4):673-678.
[10]Neriishi K,Hirata T,Fukuda S,et al.Long-term dienogest administration in patients with symptomatic adenomyosis[J].JObstet Gynaecol Res,2018,44(8):1439-1444.
[11]Conway F,Morosetti G,Camilli S,et al.Ulipristal acetate therapy increases ultrasound features of adenomyosis:a good treatment given in an erroneous diagnosis of uterine fibroids[J].Gynecologic Endocrinol,2018,18:1-4.
[12]中国医师协会妇产科医师分会子宫内膜异位症专业委员会,中华医学会妇产科学分会子宫内膜异位症协作组.子宫内膜异位症长期管理中国专家共识[J].中华妇产科杂志,2018,53(12):836-841.
[13]周应芳.子宫腺肌病术前预处理及术后药物治疗[J].妇产与遗传(电子版),2016,6(2):3-5.
[14]Takaesu Y,Nishi H,Kojima J,et al.Dienogest compared with gonadotropin-releasing hormone agonist after conservative surgery for endometriosis[J].J Obstet Gynaecol Res,2016,42(9):1152-1158.
[15]周应芳.子宫腺肌病药物治疗原则及注意事项[J].中国实用妇科与产科杂志,2017,33(1):157-160.