子宫腺肌病分度治疗的理论与实践  

Theory and practice of grading treatment adenomyosis

作　　者：肖雁冰[1] Xiao Yanbing(Department of Gynecology,Zunyi Maternal and Child Health Hospital,Zunyi Guizhou 563000,China)

机构地区：[1]遵义市妇幼保健院妇科,贵州遵义563000

出　　处：《遵义医科大学学报》2025年第3期213-218,共6页Journal of Zunyi Medical University

摘　　要：子宫腺肌病是妇科常见病,以继发性、进行性加重的痛经,经期延长,子宫增大和继发不孕为主要临床表现。由于缺乏根据病变程度进行分度或分期治疗的理念,导致临床上治疗不足或过度、尤其是子宫切除的现象普遍存在。子宫虽不是致命器官,但对女性生活、生命质量至关重要,不可轻易切除。基于这样的认识,团队在十余年前提出根据患者子宫肌壁或腺肌病最大直径(MD)对病变进行分度,再根据分度采用相应治疗方法的曼月乐三方案,取得了系列研究结果,为子宫腺肌病保留子宫的治疗提供了一套完整的方法体系。近年来,缘于曼月乐的某些局限性和生育力保护的大背景,团队结合前期分度治疗子宫腺肌病和中药治疗ICR小鼠子宫腺肌病模型积累的经验以及药物经济学原则,提出以丹黄祛瘀胶囊为基础,单独或分别联合米非司酮、GnRH-a类药物分度和无创治疗子宫腺肌病的丹黄三方案,经前瞻性、系统性临床研究取得了令人满意的治疗效果,为子宫腺肌病提供了一套无创治疗的概念与方法体系。团队基于分度治疗思想的曼月乐三方案和丹黄三方案为子宫腺肌病保留子宫和保护生育力的治疗提供了借鉴与参考,在临床工作中两套方案可酌情单独或结合使用,以获得最佳治疗效果。犹如妇癌的分期治疗一样,分度治疗应该成为子宫腺肌病治疗的基石并引起学界的广泛重视,藉此改变子宫腺肌病以子宫切除为主要手段的治疗局面。Objective Adenomyosis is a common gynecological disease,characterized by secondary and progressive worsening of dysmenorrhea,prolonged menstruation,uterine enlargement and secondary infertility.Due to lack of the concept of grading or staging treatment based on the degree of lesions,insufficient or excessive treatment,especially hysterectomyis commonly observed in clinical practice.Although the uterus is not a lethal organ,but it is crucial for women’s lives and quality of life,and should not be lightly removed.Based on this understanding,the team proposed the Mirena three plan more than ten years ago,which classifies the lesions based on the maximum diameter of the patient’s uterine muscle wall or adenomyosis(MD),and then uses corresponding treatment methods according to the classification.A series of research results have been obtained,providing a complete method system for the treatment and preserving the uterus in adenomyosis.In recent years,due to certain limitations of the Mirena and the background of fertility protection,the team combined the experience accumulated from the previous classification treatment of adenomyosis and traditional Chinese medicine treatment of ICR mouse adenomyosis models,as well as the principles of pharmacoeconomics,to propose Danhuang three regimens based on Danhuang Quyu capsules,which could be used alone or in combination with mifepristone,GnRH-a for classification and non-invasive treatment of adenomyosis.Through prospective and systematic clinical research,satisfactory therapeutic effects have been achieved,providing a concept and method system for non-invasive treatment of adenomyosis.The team’s Mirena three plan and Danhuang three plan,based on the concept of graded treatment,provide reference and guidance for the treatment of adenomyosis by preserving the uterus and protecting fertility.In clinical work,the two plans could be used separately or in combination as appropriate to achieve the best treatment effect.Just like the staged treatment of gynecological cancer,gr

关 键 词：子宫腺肌病 分度治疗 曼月乐三方案 丹黄三方案 治疗效果 

分 类 号：R711.74[医药卫生—妇产科学]