子宮內膜病灶特徵可以導引治療選擇


  Nov. 14, 2005(芝加哥訊)-一項隨機分派控制組試驗結果顯示,內科或是外科治療子宮內膜病灶的選擇,可以根據疼痛為局部性或是廣泛性的來決定。
  
  首席研究員,義大利羅馬Tor Vergata大學的Errico Zupi醫師向Medscape表示,子宮內膜的病灶是世界各地的一個大問題,而且最佳的治療方式目前並不確定;他表示,我們可以使用內科療法、或是外科療法、甚至是合併內、外科療法來治療;我們實在不清楚這個疾病的自然史,而且我們試著去研究、更加了解這個疾病,並且將重點放在治療。
  
  不論其病理學上的病史,疼痛都是非常明顯的;婦女們使用非常強烈的形容詞來描述與子宮內膜異位有關的慢性骨盆疼痛,包括「密集的」、「燒灼的」、以及「夾痛」;手術並不一定可以治癒這樣的問題,由Buzacca於2001年發表的45個外科案例中,29%病患手術後再度發生疼痛。
  
  Zupi醫師向Medscape表示,這項試驗的目標在於界定對於廣泛性或是局部性子宮內膜異位,內科還是外科療法是最好的選擇?我們發現,對於局部子宮內膜異位,手術是比較好的選擇,而對於廣泛的子宮內膜異位,內科療法較佳。
  
  這項試驗的對象為95位接受腹腔鏡診斷子宮內膜異位、且全部都有疼痛情況的女性;他們根據病灶形式將病患分為兩組,其中46位被分類為廣泛性骨盆子宮內膜異位病灶,而另外49位被分類為局部子宮內膜異位病灶;這兩組病患都被隨機分派接受治療,廣泛性病灶的病患中,24位接受內科治療、22位接受手術;而局部病灶病患中,24位接受內科治療、25位接受外科治療。
  
  疼痛於治療前及治療後6個月以疼痛指數來評估,生活品質方面以SF36問卷評估。
  
  在6個月後,接受手術治療的局部病灶病患再發率為20%,相較於接受內科治療病患的54%(P<.01);而廣泛性病灶的病患中,則是相反的情形,接受內科治療的再發率為16.7%,相較於手術治療者則是54.4%(P<.01)。
  
  Zupi醫師與其同事的結論是,廣泛性骨盆子宮內膜異位的疼痛最好以內科方式治療,而廣泛性子宮內膜異位病灶最好以手術治療。
  
  這項試驗獨立接受贊助,Zupi醫師表示曾經接受美國醫療系統的資助。

Endometriotic Lesion Character

By Richard Hyer
Medscape Medical News

Nov. 14, 2005 (Chicago) — A randomized controlled trial suggests that the choice between medical and surgical treatment for endometriotic lesions can be made based on whether the pain is focal or diffuse.

"Endometriotic lesions are a very big problem worldwide, and treatment is not defined," lead author Errico Zupi, MD, from Universita Tor Vergata, in Rome, Italy, told Medscape. "We can use medical therapy, or surgical therapy, or a combination of medical and surgical treatment," he said. "We really don't know the real natural history of this pathology, and we are trying to do studies to better understand the disease, and focus more on treatment."

Whatever the pathology's history, the pain is very real. Women use strong adjectives to describe the chronic pelvic pain associated with endometriosis, including "intense," "burning," and "pinching." Surgery is not automatically curative: of 45 surgical cases reported by Buzacca in 2001, pain recurred in 29%.

"The aim of this study was to define whether medical or surgical therapy was the best choice in diffused or localized endometriosis," Dr. Zupi told Medscape. "We found that in local endometriosis, the surgical approach is better, and in diffused endometriosis, medical therapy is the best choice."

A study population of 95 women received laparoscopic diagnosis of endometriosis, and all reported pain. They were divided into two groups based on lesion type: 46 were determined to have diffused pelvic endometriotic lesions, and 49 to have localized endometriotic lesions. Patients in each group were randomized to treatment; among those with diffused lesions, 24 received medical treatment, and 22 received surgery. In those with localized lesions, 24 received medical therapy, and 25 received surgery.

Pain was evaluated at baseline and at six months after the intervention using the visual analog scale. Quality of life was self-reported using the SF36 questionnaire.

At six months, patients with localized lesions who received surgical treatment reported a 20% recurrence rate compared with a 54% recurrence for those who received medical treatment (P < .01). In patients with diffused lesions, the reverse was true: the recurrence rate with medical treatment was 16.7% vs 54.4% for the surgical treatment (P < .01).

From this, Dr. Zupi and colleagues concluded that the pain from diffuse pelvic endometriotic lesions was better treated medically, while that from focalized endometriotic lesions were better treated surgically.

This study was independently funded. Dr. Zupi reported that he has received support from American Medical Systems.

AAGL 34th Annual Meeting: Abstract 125. Presented Nov. 11, 2005.

Reviewed by Ursula Snyder, PhD

    
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