多模式治疗症状性子宫内膜异位症:一种临床管理的建议算法。

IF 2.6 3区 医学 Q2 OBSTETRICS & GYNECOLOGY Reproductive Sciences Pub Date : 2025-01-07 DOI:10.1007/s43032-024-01763-w
Giulia Emily Cetera, Camilla Erminia Maria Merli, Paolo Vercellini
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引用次数: 0

摘要

最近的研究已经证明,外周(PS)和中枢敏化(CS)、心理健康和肌筋膜功能障碍都与伤害感觉一起在子宫内膜异位症症状的发生和持续中发挥作用。然而,在临床实践中,这些疼痛的组成部分在很大程度上仍然被忽视,尽管不考虑这些因素可能会对妇女的健康造成严重后果,包括选择不必要的手术和不治疗疼痛的真正原因。目前,我们面临着一个悖论,25-40%的接受腹腔镜手术治疗盆腔疼痛的女性没有明显的诊断,而子宫内膜异位症女性有CS症状、抑郁或焦虑障碍或盆腔肌肉张力增加的比例分别为41-55%、15-88%和28-73%。从被广泛接受的子宫内膜异位症治疗的分步方法开始,包括最初的低剂量联合口服避孕药(COCs)或黄体酮单药治疗,然后是GnRH类似物,最后是手术,当COCs和黄体酮被证明无效或不能耐受或禁忌时,我们提出了一种整合这种模型,考虑到所有疼痛因素的识别和同时治疗。我们的目标是鼓励医生认识到需要多学科、多模式的方法来治疗子宫内膜异位症相关的疼痛,并最终促进减少不必要的手术次数。
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A Multimodal Approach to Symptomatic Endometriosis: A Proposed Algorithm for Clinical Management.

Recent research has proven that peripheral (PS) and central sensitization (CS), mental health, and myofascial dysfunction all play a role, alongside nociception, in the genesis and in the perpetuation of endometriosis' symptoms. However, such components of pain are still largely ignored in clinical practice, although not considering such contributors may entail serious consequences on women's health, including the choice of unnecessary surgery and leaving the real causes of pain untreated. At the present time, we are facing a paradox by which 25-40% of women who undergo laparoscopic surgery for pelvic pain do not have an obvious diagnosis, while the percentage of women with endometriosis who have signs of CS, of depressive or anxiety disorders, or who have an increased pelvic muscle tone ammounts to 41-55%, 15-88% and 28-73%, respectively. Moving from the widely-accepted stepwise approach suggested for endometriosis management, which consists in the initial prescription of low-dose combined oral contraceptives (COCs) or of a progestin monotherapy, followed by GnRH analogues and, ultimately, by surgery, when COCs and progestins have proven ineffective or are not tolerated or contraindicated, we propose an integration of such model which takes into account the identification and the simultaneous treatment of all pain contributors. Our objective is to encourage physicians' awareness of the need of a multidisciplinary, multimodal approach to endometriosis-related pain, and ultimately to promote a reduction in the number of unnecessary surgeries.

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来源期刊
Reproductive Sciences
Reproductive Sciences 医学-妇产科学
CiteScore
5.50
自引率
3.40%
发文量
322
审稿时长
4-8 weeks
期刊介绍: Reproductive Sciences (RS) is a peer-reviewed, monthly journal publishing original research and reviews in obstetrics and gynecology. RS is multi-disciplinary and includes research in basic reproductive biology and medicine, maternal-fetal medicine, obstetrics, gynecology, reproductive endocrinology, urogynecology, fertility/infertility, embryology, gynecologic/reproductive oncology, developmental biology, stem cell research, molecular/cellular biology and other related fields.
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