地诺孕素对子宫内膜异位症病灶体积的影响

doi:10.12280/gjfckx.20230960

摘要/Abstract

摘要：

子宫内膜异位症（endometriosis，EMs）是导致女性痛经、慢性盆腔痛和不孕症的主要原因之一，EMs的长期管理应最大程度地发挥药物治疗的作用。孕激素类药物是EMs治疗的一线用药，其中地诺孕素（Dienogest）目前已成为EMs长期管理的首选药物。地诺孕素不仅能有效缓解EMs相关疼痛症状和预防术后复发，近年来还被观察到具有一定程度的缩小EMs病灶体积的作用。对于暂未生育的年轻卵巢子宫内膜异位囊肿患者、复发型卵巢子宫内膜异位囊肿患者和疼痛明显的深部浸润型EMs患者，地诺孕素可缩小病灶体积，延缓甚至避免手术。概述地诺孕素对卵巢型EMs和深部浸润型EMs病灶体积的影响，以期为EMs的个体化非手术治疗提供依据。

关键词: 子宫内膜异位症, 卵巢囊肿, 孕激素类, 卵巢子宫内膜异位囊肿, 深部浸润型子宫内膜异位症, 地诺孕素

Abstract:

Endometriosis (EMs) is one of the leading causes of dysmenorrhea, chronic pelvic pain and infertility in women, and the long-term management of EMs should maximize the role of drug therapy. Progestogens are the first-line drugs for the treatment of EMs, among which dienogest has now been taken as the first choice of drug for long-term management of EMs. Dienogest not only effectively relieves EMs-associated pain and prevents postoperative recurrence, but also has been observed to reduced EMs lesion volume to some extent. For young patients with ovarian endometriotic cysts who have not yet given birth, patients with recurrent ovarian endometriotic cysts, and patients with deep-infiltrating endometriosis (DIE) who experience significant pain, dienogest can reduce the volume of lesions, delay or even avoid surgery. In this review, we provide an overview of dienogest′s impact on the volume of ovarian EMs and DIE, aiming to provide a basis for individualized nonsurgical treatment of EMs.

Key words: Endometriosis, Ovarian cysts, Progestins, Ovarian endometrioma, Deep-infiltrating endometriosis, Dienogest

孙佳凡, 徐炜, 朱姝, 王秀丽. 地诺孕素对子宫内膜异位症病灶体积的影响[J]. 国际妇产科学杂志, 2024, 51(3): 284-289.

SUN Jia-fan, XU Wei, ZHU Shu, WANG Xiu-li. Effect of Dienogest on the Volume of Endometriosis Lesions[J]. Journal of International Obstetrics and Gynecology, 2024, 51(3): 284-289.

图/表 1

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项目	0分	1分	2分
直径（cm）	<3	3~5	>5（如果>10为3分）
生长速度	每6个月生长≤1.0 cm	每6个月生长>1.0 cm	/
疼痛	无/轻度	/	中度/重度^a
不孕^c	无	/	存在^b
超声表现	典型	/	非典型不规则（如果有血流，为3分）
癌症史阳性^d	无	家族性	个人的
复发型OMA	否	是	/
年龄（岁）	≤40	>40	/

项目	0分	1分	2分
直径（cm）	<3	3~5	>5（如果>10为3分）
生长速度	每6个月生长≤1.0 cm	每6个月生长>1.0 cm	/
疼痛	无/轻度	/	中度/重度^a
不孕^c	无	/	存在^b
超声表现	典型	/	非典型不规则（如果有血流，为3分）
癌症史阳性^d	无	家族性	个人的
复发型OMA	否	是	/
年龄（岁）	≤40	>40	/