New principles in the management of endometriosis.

I A Brosens
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Abstract

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.

子宫内膜异位症治疗的新原则。
目前子宫内膜异位症的治疗包括期待、药物、手术和联合治疗,选择是基于美国生育学会(AFS)提出的疾病分期。然而,这种方法已被证明不足以选择治疗方法。腹膜子宫内膜异位症代表了一系列不同活动和发展阶段的病变。手术切除有粘连形成的风险。两到三个月的药物治疗可导致活动性病变失活和消退。在选择治疗方法时应考虑到这些因素。卵巢子宫内膜囊肿是指重建手术。决定手术结果的是粘连和纤维化的程度,而不是囊肿的大小。内陷的皮质解释了与叶黄素囊肿的频繁联系。大囊肿可以在腹腔镜下保守治疗,分三步进行,第一次和第二次腹腔镜之间需要3个月的药物治疗。深结节性子宫内膜异位症表现为不同的病变,从纤维化到腺肌病不等。治疗性医学试验的效果可在2个月内评估。长期药物治疗可采用不同的方式。手术切除是治疗子宫腺肌病的首选方法。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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