子宫内膜异位症的复发管理
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术后复发临床数据
•88.7% recurrence involves treated ovary •Endometrium ablation+Lap •Recurrent symptoms still occur in about 10% of women with Hysterectomy
Exacoustos C, Zupi E, et al. J Minim Invasive Gynecol 2006;13:281–288. Bulletti C, DeZiegler D et al. Hum Reprod 2001;16:2676–2679. Namnoum AB, Hickman TN, et al. Fertil Steril 1995;64:898–902.
术后药物治疗
•LNG-IUD •OCP •GnRHa
Vercellini P, Frontino G, et al. Fertil Steril 2003;80:305–309. Vercellini P, Somigliana E, et al. Am J Obstet Gynecol2008;198:504.e1–5. Yap C, Furness S, Farquhar C. Cochrane Database Syst Rev 2004; CD003678.
子宫内膜异位症的复发管理
内异症复发
• Rates of recurrence (or persistence) of endometriosis after ablation are approximately 20% to 50% in 2 years
• Whereas approaching 50% by 5 years
感谢聆听 欢迎指正
Human Reproduction Update,Vol.15, No.4 pp. 441–461, 2009
Baidu Nhomakorabea
保护因素
•Number of pregnancy •Post-operative progestin •OCP usage •Completeness of first surgery
Human Reproduction Update,Vol.15, No.4 pp. 441–461, 2009
复发的生物标记
•NF-kB •PR-B
Shen FH, Wang Y et al. Am J Obstet Gynecol 2008;199:486.e1–486.e10.
复发的思考
1. 对于完成生育任务的妇女是否可 以做输卵管结扎？
2. 对于PR-B下调，对于孕激素不敏 感的患者，如何预防复发？
Sutton CJ, Ewen SP, Whitelaw N, et al. Fertil Steril 1994;62:696–700. Winkel CA. Obstet Gynecol 2003;102:397–408. Guo SWHum Reprod Update 2009;15:441–61.
危险因素
•rAFS score •Younger age •Bilateral disease •Previous treatment(surgery or medicine) •Painful nodule of cul-de-sac •Ovarian preservation •Size of endometrioma