BackgroundDeeply infiltrating endometriosis has an estimated prevalence of 1% in women of reproductive age. Ninety percent have rectovaginal lesions but disease may also include the bowel, bladder and ureters. Current practice often favours minimally invasive surgical excision; however, there is increasing evidence that medical management can be as effective as long as obstructive uropathy and bowel stenosis are excluded. Our objective was to establish the proportion of women with deeply infiltrating endometriosis successfully managed with hormonal therapies within our tertiary endometriosis centre in West London. Secondary analysis was performed on anonymised data from the Trust’s endometriosis database.ResultsOne hundred fifty-two women with deeply infiltrating endometriosis were discussed at our endometriosis multidisciplinary meeting between January 2010 and December 2016. Seventy-five percent of women underwent a trial of medical management. Of these, 44.7% did not require any surgical intervention during the study period, and 7.9% were symptomatically content but required interventions to optimise their fertility prospects. Another 7.0% were successfully medically managed for at least 12 months, but ultimately required surgery as their symptoms deteriorated. 26.5% took combined oral contraceptives, 14.7% oral progestogens, 1.5% progestogen implant, 13.2% levonorgestrel intrauterine device, 22.1% gonadotrophin-releasing hormone analogues, and 22.1% had analogues for 3–6 months then stepped down to another hormonal contraceptive. All women who underwent serial imaging demonstrated improvement or stable disease on MRI or ultrasound.ConclusionsMedical treatments are generally safe, well tolerated and inexpensive. More than half (52.6%) of women were successfully managed with medical therapy to control their symptoms. This study supports the growing evidence supporting hormonal therapies in the management of deeply infiltrating endometriosis. The findings may be used to counsel women on the likely success rate of medical management.

中文翻译：

---

深度浸润性子宫内膜异位症的医疗管理 - 在伦敦三级子宫内膜异位症中心 7 年的经验

背景深浸润性子宫内膜异位症在育龄妇女中的患病率估计为 1%。90% 有直肠阴道病变，但疾病也可能包括肠道、膀胱和输尿管。目前的做法往往倾向于微创手术切除；然而，越来越多的证据表明，只要排除梗阻性尿路病和肠狭窄，医疗管理就可以同样有效。我们的目标是确定在我们位于伦敦西部的三级子宫内膜异位症中心内通过激素疗法成功治疗的深度浸润性子宫内膜异位症女性的比例。对来自 Trust 子宫内膜异位症数据库的匿名数据进行了二次分析。结果在 2010 年 1 月至 2016 年 12 月期间，我们的子宫内膜异位症多学科会议讨论了 152 名患有深度浸润性子宫内膜异位症的女性。 75% 的女性接受了医疗管理试验。其中，44.7% 在研究期间不需要任何手术干预，7.9% 对症状满意但需要干预以优化其生育前景。另有 7.0% 的患者成功进行了至少 12 个月的医学治疗，但最终由于症状恶化而需要进行手术。26.5% 服用复方口服避孕药，14.7% 口服孕激素，1.5% 孕激素植入剂，13.2% 左炔诺孕酮宫内节育器，22.1% 促性腺激素释放激素类似物，22.1% 服用类似物 3-6 个月，然后降服另一种避孕激素。所有接受连续成像的女性在 MRI 或超声检查中均表现出改善或疾病稳定。结论医学治疗通常是安全的、耐受性良好且价格低廉。超过一半 (52.6%) 的女性通过药物治疗成功控制了她们的症状。这项研究支持越来越多的证据支持激素疗法治疗深部浸润性子宫内膜异位症。研究结果可用于就医疗管理的可能成功率向女性提供咨询。这项研究支持越来越多的证据支持激素疗法治疗深部浸润性子宫内膜异位症。研究结果可用于就医疗管理的可能成功率向女性提供咨询。这项研究支持越来越多的证据支持激素疗法治疗深部浸润性子宫内膜异位症。研究结果可用于就医疗管理的可能成功率向女性提供咨询。