BACKGROUND Currently,the use of dienogest in clinical practice has increased significantly,and many studies have focused on its effectiveness and safety in the treatment of endometriosis and adenomyosis;however,the ef...BACKGROUND Currently,the use of dienogest in clinical practice has increased significantly,and many studies have focused on its effectiveness and safety in the treatment of endometriosis and adenomyosis;however,the effects of treatment with dienogest on uterine fibroid size in patients with endometriosis or adenomyosis have not been investigated.AIM To explore changes in fibroid size in patients with concomitant uterine fibroids undergoing dienogest treatment for endometriosis or adenomyosis and to evaluate the effectiveness and safety of the drug.METHODS The clinical data of patients with uterine fibroids treated with dienogest for endometriosis or adenomyosis at Peking University First Hospital from January 2021 to January 2023 were retrospectively analyzed.RESULTS The maximum uterine fibroid diameter and volume increased after 3 months,6 months and 1 year of dienogest treatment compared with those before treatment(P<0.01).The maximum diameter and volume of the uterine adenomyoma increased after 3 months of dienogest treatment but decreased after 6 months and 1 year of treatment compared with those before treatment,but the difference was not significant(P>0.05).Endometrial thickness and antigen 125 levels were significantly thinner and decreased,respectively,after dienogest treatment(P<0.01).Pearson's correlation analysis revealed that the increase in uterine fibroid volume after 3 months of dienogest treatment was positively correlated with the basic uterine fibroid volume(r=0.792,P<0.01).Among 64 patients with dysmenorrhea,63 experienced significant relief of dysmenorrhea after 6 months of treatment with dienogest,and all patients experienced significant relief of dysmenorrhea after 12 months.Patients were able to tolerate the drugs,with an average drug tolerance score of 8.73.CONCLUSION The use of dienogest in patients with endometriosis or adenomyosis combined with uterine fibroids can effectively relieve the patient's pain symptoms and significantly reduce the sizes of ovarian endometriotic cysts,but it cannot inhibit uterine fibroid growth.展开更多
BACKGROUND Uterine rupture is a fatal medical complication with a high mortality rate.Most cases of uterine rupture occur in late pregnancy or during labor and are mainly related to uterine scarring due to previous su...BACKGROUND Uterine rupture is a fatal medical complication with a high mortality rate.Most cases of uterine rupture occur in late pregnancy or during labor and are mainly related to uterine scarring due to previous surgical procedures.Adenomyosis is a possible risk factor for uterine rupture.However,spontaneous uterine rupture due to severe adenomyosis in a non-gravida-teenaged female has not been reported in the literature to date.CASE SUMMARY A 16-year-old girl was referred to our hospital for acute abdominal pain and hypovolemic shock with a blood pressure of 90/50 mmHg.Radiologic studies revealed a huge endometrial mass with multiple nodules in the lung,suggesting lung metastasis.The patient underwent an emergency total hysterectomy and wedge resection of the lung nodules.Histologically,the uterus showed diffuse adenomyosis with glandular and stromal dissociation.Lung nodules were endometrioma with massive hemorrhage.Immunohistochemistry demonstrated that the tumor cells were positive for PAX8,ER,and PR expression,leading to a final diagnosis of pulmonary endometriosis and uterine adenomyosis.Following surgery,the patient remains in good condition without recurrence.CONCLUSION This is the first case of spontaneous uterine rupture due to adenomyosis in a nongravida adolescent.展开更多
基金the National Key R&D Program of Reproductive Health and Women's and Children's Health Assurance Special Fund,No.2022YFC2704004.
文摘BACKGROUND Currently,the use of dienogest in clinical practice has increased significantly,and many studies have focused on its effectiveness and safety in the treatment of endometriosis and adenomyosis;however,the effects of treatment with dienogest on uterine fibroid size in patients with endometriosis or adenomyosis have not been investigated.AIM To explore changes in fibroid size in patients with concomitant uterine fibroids undergoing dienogest treatment for endometriosis or adenomyosis and to evaluate the effectiveness and safety of the drug.METHODS The clinical data of patients with uterine fibroids treated with dienogest for endometriosis or adenomyosis at Peking University First Hospital from January 2021 to January 2023 were retrospectively analyzed.RESULTS The maximum uterine fibroid diameter and volume increased after 3 months,6 months and 1 year of dienogest treatment compared with those before treatment(P<0.01).The maximum diameter and volume of the uterine adenomyoma increased after 3 months of dienogest treatment but decreased after 6 months and 1 year of treatment compared with those before treatment,but the difference was not significant(P>0.05).Endometrial thickness and antigen 125 levels were significantly thinner and decreased,respectively,after dienogest treatment(P<0.01).Pearson's correlation analysis revealed that the increase in uterine fibroid volume after 3 months of dienogest treatment was positively correlated with the basic uterine fibroid volume(r=0.792,P<0.01).Among 64 patients with dysmenorrhea,63 experienced significant relief of dysmenorrhea after 6 months of treatment with dienogest,and all patients experienced significant relief of dysmenorrhea after 12 months.Patients were able to tolerate the drugs,with an average drug tolerance score of 8.73.CONCLUSION The use of dienogest in patients with endometriosis or adenomyosis combined with uterine fibroids can effectively relieve the patient's pain symptoms and significantly reduce the sizes of ovarian endometriotic cysts,but it cannot inhibit uterine fibroid growth.
基金the Chonnam National University Hospital Biomedical Research Institute,No.BCRI22011.
文摘BACKGROUND Uterine rupture is a fatal medical complication with a high mortality rate.Most cases of uterine rupture occur in late pregnancy or during labor and are mainly related to uterine scarring due to previous surgical procedures.Adenomyosis is a possible risk factor for uterine rupture.However,spontaneous uterine rupture due to severe adenomyosis in a non-gravida-teenaged female has not been reported in the literature to date.CASE SUMMARY A 16-year-old girl was referred to our hospital for acute abdominal pain and hypovolemic shock with a blood pressure of 90/50 mmHg.Radiologic studies revealed a huge endometrial mass with multiple nodules in the lung,suggesting lung metastasis.The patient underwent an emergency total hysterectomy and wedge resection of the lung nodules.Histologically,the uterus showed diffuse adenomyosis with glandular and stromal dissociation.Lung nodules were endometrioma with massive hemorrhage.Immunohistochemistry demonstrated that the tumor cells were positive for PAX8,ER,and PR expression,leading to a final diagnosis of pulmonary endometriosis and uterine adenomyosis.Following surgery,the patient remains in good condition without recurrence.CONCLUSION This is the first case of spontaneous uterine rupture due to adenomyosis in a nongravida adolescent.
文摘目的:系统评价地诺孕素治疗子宫腺肌病的疗效及安全性,为临床用药提供循证依据。方法:计算机检索PubMed、EMbase、Cochrane Library、中国生物医学文献数据库、CNKI和万方数据库,检索时限均为建库至2023年7月30日,纳入地诺孕素(试验组)对比阳性药物或安慰剂(对照组)治疗子宫腺肌病的随机对照研究(RCT)。筛选文献、提取资料后采用Cochrane 5.1.0偏倚风险评估工具对纳入文献质量进行评价,采用Rev Man 5.3统计软件进行meta分析。结果:纳入10篇RCT研究,共820例患者。Meta分析结果显示,试验组较对照组VAS评分显著降低(SMD=-2.50,95%CI为-4.73~-0.27,P=0.03),对于子宫体积变化疗效相当(MD=0.24,95%CI为-0.87~1.36,P=0.67),试验组的临床有效率显著高于对照组(RR=1.30,95%CI为1.19~1.41,P<0.01),患者的CA125水平两者差异不大(MD=-4.25,95%CI为-13.16~4.66,P=0.35),两者的潮热副反应发生率(RR=0.72,95%CI为0.03~15.53,P=0.83)、异常子宫出血发生率(RR=2.11,95%CI为0.87~5.15,P=0.10)相当。结论:地诺孕素组的疼痛缓解较安慰剂组有明显优势,与阳性对照组相比,疗效差别不大;临床有效率显著高于阳性对照组,子宫体积变化、CA125水平与阳性对照组和安慰剂组疗效均相当;安全性方面,潮热副反应发生率与阳性对照组和安慰剂组均相当,异常子宫出血的发生率与阳性对照组相当,但显著高于安慰剂组,因此应用地诺孕素时要警惕子宫出血的风险。未来仍需大规模随机对照研究去验证。
