子宫腺肌病的手术治疗策略

Surgical treatment strategies of adenomyosis

子宫腺肌病是育龄期女性常见激素依赖性炎症性疾病,以进行性加重的痛经、月经过多、不孕和子宫增大为主要临床表现,发病率逐年增加并呈年轻化趋势。子宫腺肌病的手术治疗往往是在药物治疗、非手术技术(包括子宫动脉栓塞术、高强度聚焦超声和射频消融等)无效或不愿意的基础上而执行的,具体术式需根据患者的年龄、临床症状、生育要求以及病灶的类型与范围等分层制定个体化手术策略。目前手术治疗主要包括子宫切除术、保守性病灶切除术、宫腔镜下囊性腺肌病灶切除术、宫腔镜下子宫内膜去除/射频消融术等术式。通过着重探讨各类术式的适用人群、手术操作要点及后续维持治疗方案等,以期个体化治疗并全程立体化管理,最大化优化疗效和提高生育力。

Adenomyosis is a common hormone-dependent and inflammatory disease in women of childbearing age,manifested with progressive dysmenorrhea,menorrhagia,infertility and uterine enlargement.The morbidity increases year by year and shows a younger trend.Surgical treatment of adenomyosis is often performed due to ineffectiveness or unwillingness of drug therapy and non-surgical techniques(including uterine artery embolization,high-intensity focused ultrasound therapy and radiofrequency ablation).Specific surgical strategy needs to be formulated individually according to the patients’age,clinical symptoms,fertility requirements and the type and scope of lesions.At present,surgical procedures include hysterectomy,conservative adenomyomectomy/cytoreductive surgery,hysteroscopic transcervical resection of endometrium/endometrial ablation,and so on.This article reviews the applicable population,key points of operation and maintenance treatment scheme of various surgical procedures,in order to ensure individualized treatment and life-long management of the disease,maximize the curative effects and improve fertility.