Adenomyosis: Epidemiology, Risk Factors, Clinical Phenotype and Surgical and Interventional Alternatives to Hysterectomy
Adenomyosis: Epidemiology, Risk Factors, Clinical Phenotype and Surgical and Interventional Alternatives to Hysterectomy
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DOI：
10.1055/s-0033-1350840
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发表时间：
2013-09-01
影响因子：
2.7
通讯作者：
Brucker, S.
中科院分区：
文献类型：
--
作者：
Taran, F. A.;Stewart, E. A.;Brucker, S.
子宫腺肌病是妇科学和医疗保健经济学中的一个重要临床挑战;在其完全发展的形式中，子宫切除术通常用于治疗绝经前和围绝经期妇女。子宫腺肌病的典型症状包括月经过多、盆腔疼痛和痛经。此外，子宫腺肌病和平滑肌瘤通常共存于同一子宫，区分每种病理过程的症状可能是有问题的。尽管它已经被认识了一个多世纪，但关于这种疾病的可靠流行病学研究仍然有限，因为过去只能进行术后诊断。微创手术技术（子宫内膜消融/切除、子宫肌层切除/缩小、子宫肌层电凝、子宫动脉结扎）在治疗子宫腺肌病方面的成功有限，这些手术的报告数据来自病例报告或随访时间较短的小病例系列。然而，较新的技术，包括子宫动脉栓塞术（UAE）和磁共振成像引导聚焦超声（MRgFUS）显示出治疗子宫腺肌病的前景。UAE的数据最强;这些研究具有最大的患者队列。然而，没有一项UAE研究是随机或对照的。因此，尽管子宫腺肌病具有临床重要性，但几乎没有证据可作为治疗决策的基础。本文旨在总结子宫切除术的流行病学、危险因素、临床表型，并评价手术和介入替代子宫切除术的经验。
Adenomyosis is an important clinical challenge in gynecology and healthcare economics; in its fully developed form, hysterectomy is often used to treat it in premenopausal and perimenopausal women. Symptoms of adenomyosis typically include menorrhagia, pelvic pain and dysmenorrhea. Moreover, adenomyosis and leiomyomas commonly coexist in the same uterus, and differentiating the symptoms for each pathological process can be problematic. Although it has been recognized for over a century, reliable epidemiological studies on this condition are limited, because only postoperative diagnoses were possible in the past. Minimally invasive surgical techniques ( endometrial ablation/resection, myometrial excision/reduction, myometrial electrocoagulation, uterine artery ligation) have had limited success in the treatment of adenomyosis, and the reported data for these procedures have been obtained from case reports or small case series with only short follow-up times. However, newer techniques including uterine artery embolization (UAE) and magnetic resonance imaging guided focused ultrasound (MRgFUS) show promise in treating adenomyosis. The data is strongest for UAE; these studies have the largest patient cohorts. However, none of the UAE studies were randomized or controlled. Thus, despite the clinical importance of adenomyosis, there is little evidence on which to base treatment decisions. The objective of this review is to summarize the epidemiology, risk factors, clinical phenotype and to evaluate the accrued experience with surgical and interventional alternatives to hysterectomy.