Surgical Management of Endometriosis in Patients with Chronic Pelvic Pain
Surgical Management of Endometriosis in Patients with Chronic Pelvic Pain
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DOI：
10.1055/s-0036-1597306
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发表时间：
2017-01-01
影响因子：
2.7
通讯作者：
Falcone, Tommaso
中科院分区：
文献类型：
--
作者：
Flyckt, Rebecca;Kim, Suejin;Falcone, Tommaso
患有慢性盆腔疼痛的子宫内膜异位症患者的手术方法是多模式的，需要个体化。当通过切除或消融/电灼病灶保守治疗子宫内膜异位症时，腹腔镜手术优于剖腹手术。现有数据支持子宫内膜异位囊肿切除术优于开窗术或电灼术；然而，子宫内膜异位症治疗可能会导致卵巢储备功能下降。骶前神经切除术可能对中线疼痛患者有用，而 LUNA 对于治疗与子宫内膜异位症相关的盆腔疼痛无效。尽管还需要更多的研究，但在手术时可以考虑阑尾切除术来预防盆腔疼痛。对于深部浸润性子宫内膜异位症，必须权衡积极肠道手术的风险与明显减轻疼痛的益处。强烈建议术后进行药物抑制治疗，以延长这种慢性疾病的无症状间隔期。作为确定性治疗，子宫切除术可能会有所帮助，尤其是与子宫内膜异位症切除术相结合时。进行子宫切除术时，应仔细考虑双侧卵巢切除术，因为该手术会导致过早的手术绝经，并且可能不会降低 30 至 39 岁患有慢性疼痛的患者再次手术和症状持续的可能性。
Surgical approaches to endometriosis patients with chronic pelvic pain are multimodal and require individualization. Laparoscopic approaches are preferred over laparotomy when conservatively treating endometriosis via excision or ablation/fulguration of lesions. The available data support cystectomy over fenestration or fulguration for endometriomas; however, there may be associated decreases in ovarian reserve with endometrioma treatment. Presacral neurectomy may be useful in patients with midline pain and LUNA is not effective for the treatment of pelvic pain related to endometriosis. Appendectomy may be considered prophylactically at the time of the surgery for pelvic pain, although more studies are needed. For deep infiltrating endometriosis, the risks of aggressive bowel surgery must be weighed against the benefits of clear pain reduction. Postoperative medical suppressive therapy is strongly recommended to prolong symptom-free intervals of this chronic disease. As definitive therapy, hysterectomy can be helpful especially when combined with endometriosis excision. When performing hysterectomy, bilateral oophorectomy should be given careful consideration, as this procedure leads to premature surgical menopause and may not decrease the possibility of reoperation and persistence of symptoms in patients aged 30 to 39 years with chronic pain.