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J Zhejiang Univ (Med Sci)  2019, Vol. 48 Issue (2): 123-129    DOI: 10.3785/j.issn.1008-9292.2019.04.01
    
Stratified treatment and management of adenomyosis
ZHANG Xinmei(),XU Ping
Department of Gynecology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou 310006, China
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Abstract  

In recent years, surgical and non-surgical excision and drug therapy have replaced hysterectomy as the main therapeutic modalities for adenomyosis. It is suggested that the precise clinical diagnosis should be based on the reconstruction of digitized three-dimensional model with original image data of adenomyosis. Patients' age and clinical manifestations should also be considered, and the patients should be stratified according to reproductive requirements, so as to determine the best treatment. In view of the infiltration and diffuse growth of adenomyosis lesions in the myometrium of the uterus, it is suggested that long-term drug management should be adopted after surgical or non-surgical lesion resection.Gonadotropin releasing hormone agonists, levonorgestrel-releasing intrauterine system, dienogest and short-acting oral contraceptives should be recommended to consolidate the curative effect in order to delay the progress of the disease and prevent recurrence.



Key wordsAdenomyosis/pathology      Adenomyosis/diagnostic imaging      Adenomyosis/surgery      Adenomyosis/drug therapy      Combined modality therapy     
Received: 26 January 2019      Published: 24 July 2019
CLC:  R711.74  
Cite this article:

ZHANG Xinmei,XU Ping. Stratified treatment and management of adenomyosis. J Zhejiang Univ (Med Sci), 2019, 48(2): 123-129.

URL:

http://www.zjujournals.com/med/10.3785/j.issn.1008-9292.2019.04.01     OR     http://www.zjujournals.com/med/Y2019/V48/I2/123


子宫腺肌病分层治疗及管理

近年来,手术病灶切除、非手术病灶切除及药物治疗已代替子宫切除术成为子宫腺肌病的主要治疗方式。临床上建议基于子宫腺肌病影像学数据重建数字化三维模型进行临床精准诊断,综合考虑患者年龄、临床表现,以及是否有生育要求进行子宫腺肌病患者的临床分层,同时遵守个体化原则,选择最佳治疗方案。鉴于子宫腺肌病病灶在子宫肌层内呈现浸润弥漫生长,建议手术病灶切除、非手术病灶切除方法治疗后采用药物长期管理,推荐促性腺激素释放激素激动剂、左炔诺孕酮宫内节育系统、地诺孕素以及短效口服避孕药等药物巩固疗效,以延缓疾病进展,防止复发。


关键词: 子宫腺肌病/病理学,  子宫腺肌病/影像诊断,  子宫腺肌病/外科学,  子宫腺肌病/药物疗法,  综合疗法 
Fig 1 Three-dimensional reconstruction digital model of adenomyosis
Fig 2 Clinical pathway of diagnosis and treatment based on three-dimensional reconstruction digital model of adenomyosis
Fig 3 Long-term postoperative management mode of adenomyosis
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