Introduction: Endometriosis is a common chronic gynecological disease, the most direct harm of which is causing female infertility. This is undoubtedly a major obstacle for women who are planning to become pregnant. So, how is the disease best treated?
1. Surgical treatment
Surgical treatment is the main method for endometriosis, because the scope and nature of the lesions can be basically clear under direct vision, which can relieve pain and promote The fertility function effect is better, and the treatment course is short, especially for severe cases, where there is a lot of fibrosis and tight adhesions, so the drugs are not easy to be effective. For large ovarian endometrioid cysts, medical treatment is ineffective, and surgery may still preserve effective ovarian tissue. Surgery can be divided into three types: conservative surgery, semi-radical surgery and radical surgery.
1. Conservative surgery: mainly used for young people who want to have children. The uterus and appendages are preserved (try to preserve both sides), and only the lesions are removed, adhesions are separated, the ovaries are reconstructed, and the tissues are repaired. In recent years, microsurgery has been applied to remove ectopic lesions, carefully suture the wound, reconstruct the pelvic peritoneum, carefully stop bleeding, and thoroughly flush, so as to improve the surgical effect, improve the success rate of post-operative pregnancy, and reduce the recurrence rate.
2. Semi-radical surgery: For those who have no requirement for childbirth, have serious lesions, and are younger (<45 years old), the uterus and lesions can be completely removed, but normal ovarian tissue on one side should be retained as much as possible. Avoid premature menopausal symptoms. It is generally believed that the recurrence rate after semi-radical surgery is low and there are few sequelae. Removing the uterus removes the source of viable endometrial cell seeding, thereby reducing the chance of recurrence. However, recurrence is still possible because the ovaries are preserved.
3. Radical surgery: Those who are close to menopause, especially those who are seriously ill and have had recurrences, should undergo total hysterectomy and bilateral appendectomy. Try to avoid rupture of endometrial cysts during surgery. When the cyst fluid flows out, it should be sucked up and flushed as soon as possible. For those who experience menopausal syndrome after surgery, sedatives and nilestriol can be used.
2. Hormone treatment
1. Danazol: It is a derivative of the synthetic steroid 17α-ethynyltestosterone. Its main function is to inhibit the production of gnrh in the hypothalamus, thereby reducing the synthesis and release of fsh and lh, resulting in the suppression of ovarian function. It can also directly inhibit the synthesis of ovarian steroid hormones or competitively bind to estrogen and progesterone receptors, leading to ectopic endometrial atrophy, anovulation and amenorrhea.
2. Nemestran: 3-nortestosterone (r2323) is a derivative of 19-nortestosterone. It has high anti-progesterone activity and moderate anti-estrogenic effect. The secretion of fsh and lh reduces the estrogen level in the body, causing the ectopic endometrium to atrophy and absorb.
3. Gonadotropin-releasing hormone agonist (gnrha): Meldtum and Lemay reported in 1982 that the application of lhrha in the treatment of endometriosis has achieved good results. Lhrh has biphasic effects on the pituitary gland. The continuous application of large amounts of LHRH causes the pituitary cells to show a down-regulatory reaction, that is, the pituitary cell receptors are occupied by the hormone and cannot synthesize and release FSH and LH, thus acting as a counter-regulatory effect. Side effects include hot flashes, dry penis, headache, small amount of vaginal bleeding, etc.
4. Tamoxifen (tmx): a derivative of distyrene. The dose is 10 mg × 2/d, starting on the fifth day of menstruation, and a 20-day course of treatment is used.
5. Synthetic progestins: Periodic treatment with isonandrosterone, norethindrone or medroxyprogesterone (medroxyprogesterone) can be used to degenerate the ectopic endometrium. From the sixth day to the twenty-fifth day of the menstrual cycle, take 5 to 10 mg of one of the above drugs orally daily. The course of treatment depends on the effectiveness of the treatment. This method can inhibit ovulation.
6. Testosterone: It also has a certain effect on this disease. The dosage should be determined according to the patient's tolerance. The best starting dose is 10 mg, twice a day, taken orally 2 weeks after the menstrual cycle. This dose rarely affects the menstrual cycle and produces virilizing side effects. However, to achieve the purpose of pain relief, it often needs to be taken continuously for several cycles. After that, the dose can be reduced and the treatment can be maintained for a period of time, and then the drug can be stopped for observation. If pregnancy can occur, the disease can be cured.
3. Radiotherapy
Although radiotherapy has been used for endometriosis for many years, it uses a variety of drugs and surgeries to achieve high efficacy and generally does not destroy ovarian function. , and the role of radiation therapy for endometriosis is to destroy ovarian tissue, thereby eliminating the influence of ovarian hormones and shrinking the ectopic endometrium to achieve the purpose of treatment. The damaging effect of radiation on ectopic endometrium is not obvious, but I am very interested in patients who are unable to tolerate hormone therapy and whose lesions are located in the intestines, urinary tract and extensive pelvic adhesions, especially those combined with serious diseases such as heart, lung or kidney. Individual patients who are afraid of surgery can also use external radiotherapy to destroy ovarian function to achieve the purpose of treatment. Even if individual patients receive radiotherapy, a clear diagnosis must be made first. In particular, malignant ovarian tumors must not be misdiagnosed as endometrial cysts, resulting in incorrect treatment and delay in correct treatment.