子宫内膜异位症热点问相关诊疗策略ppt.ppt

In a prospective randomized clinical trial, after treatment of 144 infertile women in their reproductive age by laparoscopy (whose endometriosis was confirmed by prior laparoscopy), they were divided into 3 groups: GnRH agonist (triptorelin) AIs 芳香化酶抑制剂 * Rectal shaving：直肠剔除 ICSI （Intracytoplasmic sperm injection）即卵胞浆内单精子注射技术 * Among patients who tried to conceive spontaneously, the pregnancy rate was lower if bowel endometriosis was present (group A or B compared with group C). There was a strong association (P0.005) between the classification of patients into groups (A, B, C) and spontaneous fertility (Fig. 1). Among women with bowel endometriosis,the reproductive outcome was better if bowel resection was performed (P 0.03). After the first pregnancy, one patient in group A, four in group B,and eight in group C tried to conceive, and one, one and six in each group, respectively, conceived again. * Asymptomatic disease: No specific treatment is required in asymptomatic patients or when unpainful disease is discovered at infertility explorations High rate of complicance with this kind of surgery Medical treatment other surgeries can also be successful * Laparoscopic surgical removal of endometriosis (through either excision or ablation of endometriosis or both) is an effective first-line approach for treating pain related to endometriosis * Intervention(s): Subjects completed a questionnaire rating their various pains using visual analogue scales (VASs). Result(s)：There was no significant difference in reduction in overall pain VAS scores at 12 months when comparing ablation and excision. * CO2 laser laparoscopic radical excision of endometriosis with colorectal wall invasion combined with laparoscopic segmental bowel resection and reanastomosis. * 欧洲人类生殖与胚胎学会(ESHRE) * 一项前瞻性、随机、对照研究，纳入40例18-45岁腹腔镜术后严重内异症且CPP患者（r-AFS评分40，手术前已用激素治疗3个月，盆腔炎症、附件炎、不孕症、计划怀孕的患者排除）。平均分组后分别给予6个月的LNG-IUS或GnRH-a（戈舍瑞林）。分别于治疗结束后、1个月、3个月、6个月、12个月进行随访。对比两者在缓解CPP（VAS评分）及其具体症状（TESP评分）的差异。结果表明， Gn