子宫腺肌病患者药物治疗进展

Progress on medical treatment in the management of adenomyosis

药物治疗在缓解子宫腺肌病患者相关症状、提高手术疗效、延缓疾病进展和促进辅助生育方面具有重要的作用。非甾体抗炎药是控制子宫腺肌病相关疼痛的首选药物,是近期有生育要求患者的唯一选择;甾体激素、促性腺激素释放激素激动剂和米非司酮等药物可有效减轻疼痛和控制子宫出血,其中以口服避孕药、左炔诺孕酮宫内节育系统(曼月乐)和地诺孕素等甾体激素的疗效更确切。目前尚无用于子宫腺肌病的特效药物,应根据患者的年龄、症状、子宫大小、生育要求和经济条件等情况选择性应用,但停药后症状易复发。因此,子宫腺肌病患者药物长期应用有待进一步研究。

Drug therapy plays an important role in alleviating the symptoms related to adenomyosis, improving the curative effect of surgery, delaying the progress of disease and promoting assisted reproduction. Non-steroidal anti-inflammatory drugs(NSAIDs) are the first choice to control pain associated with adenomyosis, and are the only choice for patients with recent fertility requirements;steroid hormones, gonadotropin releasing hormone agonists and mifepristone can effectively relieve pain and control uterine bleeding, among which oral contraceptives, levonorgestrel-releasing intranterine system(Mirena) and dienogest are more effective and commonly used in clinic. Drug selection should be based on patient’s age, symptoms, uterine size, fertility requirements and economical conditions. At present, there is no specific drug for adenomyosis, and symptoms are easy to recur after drug withdrawal, so the long-term drug use needs further study.