Uterine fibroid management: from the present to the future.
Uterine fibroid management: from the present to the future.
复制标题
DOI：
10.1093/humupd/dmw023
复制
发表时间：
2016-11
影响因子：
13.3
通讯作者：
Dolmans MM
中科院分区：
文献类型：
--
作者：
Donnez J;Dolmans MM
子宫肌瘤（也称为平滑肌瘤或肌瘤）是良性子宫肿瘤中最常见的形式。临床表现包括异常出血、盆腔包块、盆腔疼痛、不孕、大块症状和产科并发症。几乎三分之一的子宫肌瘤患者会因症状而要求治疗。目前的管理策略主要涉及手术干预，但治疗的选择是由患者的年龄和愿望，以保持生育能力或避免'根治性'手术，如子宫切除术。子宫肌瘤的治疗也取决于肌瘤的数量、大小和位置。其他手术和非手术方法包括通过宫腔镜进行的肌瘤切除术、通过剖腹手术或腹腔镜进行的肌瘤切除术、子宫动脉栓塞和在放射或超声引导下进行的介入以诱导子宫肌瘤的热消融。只有少数随机试验比较了肌瘤的各种疗法。需要进一步调查，因为缺乏有效性的具体证据，以及根据症状进行正确管理的不确定领域。子宫肌瘤管理的经济影响是显着的，这是当务之急，新的治疗方法被开发，以提供替代手术干预。越来越多的证据表明，由于使用选择性孕酮受体调节剂（SPRM），如醋酸乌利司他（UPA），孕酮途径在子宫肌瘤的病理生理学中起着至关重要的作用。最近的随机对照研究证实了长期间歇使用UPA的疗效。对手术干预的替代方案的需求是非常真实的，特别是对于寻求保留生育能力的妇女。这些选择现在存在，SPRM被证明可以有效治疗纤维瘤症状。妇科医生现在有新的工具在他们的医疗设备，开辟了新的战略管理子宫肌瘤。
Uterine fibroids (also known as leiomyomas or myomas) are the most common form of benign uterine tumors. Clinical presentations include abnormal bleeding, pelvic masses, pelvic pain, infertility, bulk symptoms and obstetric complications. Almost a third of women with leiomyomas will request treatment due to symptoms. Current management strategies mainly involve surgical interventions, but the choice of treatment is guided by patient's age and desire to preserve fertility or avoid ‘radical’ surgery such as hysterectomy. The management of uterine fibroids also depends on the number, size and location of the fibroids. Other surgical and non-surgical approaches include myomectomy by hysteroscopy, myomectomy by laparotomy or laparoscopy, uterine artery embolization and interventions performed under radiologic or ultrasound guidance to induce thermal ablation of the uterine fibroids. There are only a few randomized trials comparing various therapies for fibroids. Further investigations are required as there is a lack of concrete evidence of effectiveness and areas of uncertainty surrounding correct management according to symptoms. The economic impact of uterine fibroid management is significant and it is imperative that new treatments be developed to provide alternatives to surgical intervention. There is growing evidence of the crucial role of progesterone pathways in the pathophysiology of uterine fibroids due to the use of selective progesterone receptor modulators (SPRMs) such as ulipristal acetate (UPA). The efficacy of long-term intermittent use of UPA was recently demonstrated by randomized controlled studies. The need for alternatives to surgical intervention is very real, especially for women seeking to preserve their fertility. These options now exist, with SPRMs which are proven to treat fibroid symptoms effectively. Gynecologists now have new tools in their armamentarium, opening up novel strategies for the management of uterine fibroids.
登录
查看更多内容
影响因子：
2.6
作者：
Bernardi, Tina Sybille;Radosa, Marc Philipp;Runnebaum, Ingo Bernard
通讯作者：
Runnebaum, Ingo Bernard
影响因子：
1.9
作者：
Andreotti, Rochelle F.;Fleischer, Arthur C.
通讯作者：
Fleischer, Arthur C.
影响因子：
2
作者：
Bouchard, Philippe
通讯作者：
Bouchard, Philippe
影响因子：
6.7
作者：
Carbonnel, Marie;Goetgheluck, Julie;Ayoubi, Jean Marc
通讯作者：
Ayoubi, Jean Marc
影响因子：
5.8
作者：
CARR, BR;MARSHBURN, PB;STEINKAMPF, MP
通讯作者：
STEINKAMPF, MP