子宫肌瘤的个性化治疗原则.pptVIP

Individualizedtreatmentforuterinemyoma子宫肌瘤的个性化治疗原则

子宫平滑肌瘤是最常见的妇科良性肿瘤，发病率占育龄期妇女20%-40%。BackgroundUterinemyomasarethemostcommonbenignuterinetumors,presentin20%–40%ofwomenatreproductiveage.

Hysterectomyhasbeenthemostcommontreatmentmodalityforsymptomaticfibroidsinthepast.Background过去，子宫切除的有症状的子宫肌瘤的最主要治疗方式。Basedondatafrom1990to1997,thepresenceofuterinefibroidsformedthemainindicationforhysterectomyintheUnitedStates.资料显示，从1990年至1997年，子宫肌瘤在美国是子宫切除术的主要适应症。

Despitethefrequencywithwhichfibroidsarediagnosedandtreated,thereremainsconsiderableuncertaintyandcontroversyamongcliniciansandwomenregardingthebestwaytomanagethem.Myomectomy,theremovaloffibroidssurgicallywithouthysterectomy,isthesecondmostcommonsurgicalprocedureforthiscondition.子宫肌瘤剔除术，即只切除肌瘤而保留子宫的手术，是子宫肌瘤第二主要的手术治疗方式关于子宫肌瘤的最佳治疗方式，临床医生及患者仍存在相当的争议。Background

factorsaffectingthechoiceoftherapeuticapproachage（年龄）parity（产次）childbearingaspirations（生育要求）extentandseverityofsymptoms（症状的程度）size,numberandlocationofmyomas(大小、数目、位置)associatedmedicalconditions（相关适应症）theriskofmalignancy（恶性的风险）proximitytomenopause（距绝经的时间）thedesireforuterinepreservation（保子宫的愿望）Hence,thetreatmentshouldbeindividualized.Background（影响治疗方式的因素）因此，应当采取个性化的治疗。

Treatment1.Expectantmanagement（期待治疗）Asymptomaticwomenwithleiomyomaoftheuterusoflessthan12weekssize,especiallythoseapproachingmenopause.小于12周大小的无症状子宫肌瘤患者，特别是接近绝经期。

follow-upevery3–6monthsTreatmentcarriyoutadetailedhistoryclinicalexaminationtonotetheuterinesizerateofgrowthofthetumor

2.Medicaltherapy（药物治疗）Treatment2.1Antifibrinolytics（抗纤维蛋白溶解药）Tranexamicacid（氨甲环酸）Fist-linenonhormonaltherapyforheavybleedingassociatedwithuterinefibroidsanddysfunctionaluterinebleeding.作为一线非激素药物，用于治疗子宫肌瘤及功能失调性子宫出血所致的大量出血。

Prolongedtreatmentmaytheoreticallyincreasetheriskofdeepveinthromb