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首页> 外文期刊>Current opinion in obstetrics & gynecology >Non-surgical management of leiomyoma: impact on fertility.
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Non-surgical management of leiomyoma: impact on fertility.

机译：平滑肌瘤的非手术治疗：对生育力的影响。

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PURPOSE OF REVIEW: This review is designed to discuss the literature, published from December 2002 to January 2004, on the non-surgical treatment of fibroid. All established and new modalities are reviewed, and all new developments in the field are discussed. The resulting impact on the treatment of infertility will also be evaluated. RECENT FINDINGS: In the past year important advances occurred in the medical treatment of uterine fibroids. It was found, in a large randomized trial, that preoperative treatment with gonadotropin-releasing hormone analogue did not improve surgical results or decrease blood loss. However, important strides were made in understanding the molecular biology of the effect of the hormone analogue on fibroids. Other medical therapies investigated include danazol, raloxifene, mifepristone, aromatase inhibitors, and the levonorgestrel-containing intrauterine device. Most promising in terms of long-term usage for reduction of size and symptoms appears to be the combination of gonadotropin-releasing hormone analogue and raloxifene, although selective progesterone receptor modulators may also achieve this aim. However, none avoid producing an anovulatory state that inhibits fertility, and none have been shown to enhance fertility following discontinuation. Uterine artery embolization is another non-surgical technique under intense investigation. The year's literature suggests that while results are comparable with hysterectomy in terms of complication rate and patient satisfaction, there may be important issues for women who wish to undergo the procedure and retain future fertility. Specifically, there is a significant rate of premature ovarian failure, as well as occasional damage to the endometrial vasculature with resulting atrophy and adhesion formation. Improvements in technique, in particular the use of larger and more spherical microspheres for embolization, may reduce these unwanted effects. However, few data exist regarding the course of pregnancy and outcome following embolization. SUMMARY: A number of non-surgical treatments exist for uterine fibroids, but none has been shown to be of value in the patient desiring future fertility. Myomectomy remains the standard of care for such women, and all other therapies should be designated experimental and limited to appropriate investigational studies.
机译：综述的目的：这篇综述旨在讨论2002年12月至2004年1月间发表的有关非手术治疗肌瘤的文献。审查所有已建立的和新的模式，并讨论该领域中的所有新发展。还将对不孕症治疗产生的影响进行评估。最近的发现：在过去的一年中，子宫肌瘤的医学治疗取得了重要进展。在一项大型随机试验中，发现用促性腺激素释放激素类似物进行术前治疗不能改善手术效果或减少失血量。然而，在了解激素类似物对肌瘤作用的分子生物学方面取得了重要进展。研究的其他医学疗法包括达那唑，雷洛昔芬，米非司酮，芳香化酶抑制剂和含左炔诺孕酮的宫内节育器。长期使用以减少体型和症状最有希望的似乎是促性腺激素释放激素类似物与雷洛昔芬的组合，尽管选择性孕激素受体调节剂也可以达到这一目的。但是，没有人避免产生抑制生育力的无排卵状态，并且也没有证据表明停药后会增强生育力。子宫动脉栓塞术是正在深入研究中的另一种非手术技术。该年度的文献表明，尽管就并发症发生率和患者满意度而言，结果与子宫切除术相当，但对于希望接受该手术并保留未来生育能力的女性而言，可能存在重要问题。具体而言，卵巢早衰的发生率很高，偶尔会损伤子宫内膜血管，导致萎缩和粘连。技术上的改进，特别是使用更大和更多球形的微球进行栓塞可减少这些不良影响。但是，很少有关于妊娠过程和栓塞后结局的数据。摘要：存在许多针对子宫肌瘤的非手术治疗方法，但尚未显示出对希望未来生育的患者有价值。肌瘤切除术仍然是这类女性的标准治疗方法，所有其他疗法均应指定为实验性疗法，并仅限于适当的研究性研究。

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