子宫内膜异位症患者循证治疗.docVIP

子宫内膜异位症患者循证治疗 　【摘 要】 目的 借助循证医学的方法为1 例初诊子宫内膜异位症病患者确定治疗目标及治疗方案。方法 在充分评估患者情况后，提出临床问题,从Cochrane图书馆(2010 年第4 期)、Medline (1990.1-2010.12)、Embase(1990.1-2010.12)和Pubmed (1990.1-2010.12)，检索主题词为：endometriosis; treatment strategy; gonadotropin releasing hormone agonist (GnRH-a); laparotomy;laparoscopy; recur; RCT;meta-analysis; systematic review。结果 共检索出与不同问题相关的随机对照试验329篇,系统评价或Meta分析35 篇。通过对检索结果进行分析，为患者制定了合理的治疗方案。结论 采用循证治疗的方法，为初治的子宫内膜异位症患者确定合理的治疗目标和治疗方案，可有效提高治疗效果，改善患者生活质量。 【关键词】 子宫内膜异位症；循证治疗；系统评价 [Abstract] Objective Methods of evidence-based medicine were used to make an individualized treatment plan for one case of newly diagnosed patients with endometriosis. Methods After clinical problems were put forward, evidence was collected from fourth issue, 2010, Cochrane Library; Medline (1990.1 -2010.12); Embase (1990.1-2010.12); Pubmed (1990.1-2010.12). Subject words were: endometriosis; treatment strategy; gonadotropin releasing hormone agonist (GnRH-a); laparotomy; laparoscopy; recur; RCT; meta-analysis; systematic review. Results A total of 329 RCTs and 35 systematic reviews were identified. A rational treatment plan was made up on a serious evaluation of the data. Conclusion The treatment efficacy in newly diagnosed endometriosis has been improved by determining an individualized treatment plan according to evidence-based methods. The therapeutic effect and the life quality of the patient have been improved effectively. [Keywords] Endometriosis; Evidence-based treatment; Systematic review 1 临床资料 患者，女，36 岁。因“痛经5 年，进行性加重1 年”入院。患者自2005 年出现痛经，于月经开始前2 日出现，月经第1 日最剧烈以后逐渐减轻至月经期结束。疼痛部位为下腹部和腰骶部，可以忍受，偶服止痛药。最近1 年疼痛呈进行性加重，影响工作，需经常服用止痛药。伴肛门下坠感，性交痛。月经周期为28～30 d，经期为5～6 d，量多，末次月经：2010.11.2；G2P1A1。无其他特殊病史。 体格检查：T36C，P76 次/分，R18 次/分，BP122/80 mmHg，表情自然，皮肤粘膜无黄染，心肺腹体检无异常，生理反射存在，病理反射未引出。妇科检查：外阴已婚型，阴道畅，宫颈光滑。子宫稍大，宫体压痛（+），活动差。双侧附件均可扪及一鸡蛋大小囊性包块。 辅助检查：B超显示子宫7.2 cm*5.3 cm*4.6 cm，肌层回声均匀，内膜0.5 cm。左卵巢6.5 cm*5.4 cm，内可见无回声区，有散在光点；右侧附件区可见,6.4 cm*6.9 cm无回声区，内见散在光点，卵巢显示欠清。 2 评估患者情况并提出问题 根据患者继发性痛经并进