子宫内膜异位症患者生育力保护

Fertility preservation in the patients with endometriosis

子宫内膜异位症(简称内异症)是导致育龄期女性不孕的一种常见慢性病,虽是良性病变却具备恶性行为,进行性的病情变化对患者生育力造成持续性破坏。隐匿性的临床特征常导致诊断困难。因其为雌激素依赖性,药物治疗多通过抑制卵巢功能防止病情发展或复发,但对于改善生育力作用有限。手术治疗是缓解慢性疼痛的有效手段,但不恰当的手术操作可能对盆腔环境、卵巢储备功能造成破坏,导致生育力下降。发生恶变的内异症患者进行放化疗时可对生育力造成不可逆的损伤。尽管药物、手术、辅助生殖技术(ART)能够帮助一些合并不孕的患者获得妊娠,但妊娠后可能并发产科不良结局。寻找早期诊断方法,避免过度治疗,规范手术操作,综合卵巢储备功能和疾病严重程度制定个体化治疗方案是保护患者生育力的关键。

Endometriosis（EMT） is a common chronic disease that causes female infertility in their reproductive age.Although it is a benign disease,it has malignant behavior.The progressive changes of the patient＇s condition cause continuous damage to the fertility.The occult clinical characteristics often lead to difficult diagnosis.Because of its estrogen-dependent,drug treatments are mostly by inhibiting ovarian function to prevent disease progression or recurrence,therefore the effects on preserving fertility are limited.Although surgery is an effective method to resolve chronic pain,but inappropriate surgical procedure may cause damage to the pelvic environment and ovarian reserve functions,resulting in diminished fertility.Radiotherapy and chemotherapy cause irreversible damage to fertility of patients with malignant endometriosis.Although drugs,surgery,and assisted reproductive technology（ART）can help some infertile patients to get pregnancy,adverse pregnancy outcomes may coincide with obstetric outcomes.Looking for early diagnosis methods,avoiding over-treatment,standardizing surgical procedure,integrating ovarian reserve function and disease severity to develop individualized treatment regimen are the key to protecting the fertility of patients.