Rethinking mechanisms, diagnosis and management of endometriosis.,Nature Reviews Endocrinology

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Rethinking mechanisms, diagnosis and management of endometriosis.
Nature Reviews Endocrinology ( IF 31.0 ) Pub Date : 2019-09-05 , DOI: 10.1038/s41574-019-0245-z
Charles Chapron _{1,

2,

3} , Louis Marcellin _{1,

2,

3} , Bruno Borghese _{1,

2,

3} , Pietro Santulli _{1,

2,

3}

Affiliation

Endometriosis is a chronic inflammatory disease defined as the presence of endometrial tissue outside the uterus, which causes pelvic pain and infertility. This disease should be viewed as a public health problem with a major effect on the quality of life of women as well as being a substantial economic burden. In light of the considerable progress with diagnostic imaging (for example, transvaginal ultrasound and MRI), exploratory laparoscopy should no longer be used to diagnose endometriotic lesions. Instead, diagnosis of endometriosis should be based on a structured process involving the combination of patient interviews, clinical examination and imaging. Notably, a diagnosis of endometriosis often leads to immediate surgery. Therefore, rethinking the diagnosis and management of endometriosis is warranted. Instead of assessing endometriosis on the day of the diagnosis, gynaecologists should consider the patient's 'endometriosis life'. Medical treatment is the first-line therapeutic option for patients with pelvic pain and no desire for immediate pregnancy. In women with infertility, careful consideration should be made regarding whether to provide assisted reproductive technologies prior to performing endometriosis surgery. Modern endometriosis management should be individualized with a patient-centred, multi-modal and interdisciplinary integrated approach.

中文翻译：

重新思考子宫内膜异位症的机制，诊断和管理。

子宫内膜异位症是一种慢性炎性疾病，定义为子宫外子宫内膜组织的存在，会引起骨盆疼痛和不孕症。这种疾病应被视为公共卫生问题，对妇女的生活质量产生重大影响，并给经济造成沉重负担。鉴于诊断影像学（例如经阴道超声和MRI）取得了长足进展，探索性腹腔镜检查不应再用于诊断子宫内膜异位病变。相反，子宫内膜异位症的诊断应基于结构化的过程，包括患者访谈，临床检查和影像学的结合。值得注意的是，子宫内膜异位症的诊断通常会导致立即手术。因此，有必要对子宫内膜异位症的诊断和治疗进行重新思考。妇科医生应该考虑患者的“子宫内膜异位症寿命”，而不是在诊断当天评估子宫内膜异位症。对于骨盆疼痛且不希望立即怀孕的患者，药物治疗是一线治疗选择。对于不育症妇女，在进行子宫内膜异位手术之前应仔细考虑是否提供辅助生殖技术。现代子宫内膜异位症的治疗应以患者为中心，多模式，跨学科的综合方法进行个性化处理。在进行子宫内膜异位手术之前，应仔细考虑是否提供辅助生殖技术。现代子宫内膜异位症的治疗应以患者为中心，多模式，跨学科的综合方法进行个性化处理。在进行子宫内膜异位手术之前，应仔细考虑是否提供辅助生殖技术。现代子宫内膜异位症的治疗应以患者为中心，多模式，跨学科的综合方法进行个性化处理。

更新日期：2019-09-06

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