子宫切除术金标准

外科治疗的适应症

• 药物治疗失败(一线):盆腔疼痛持续。
• 重要器官的恢复解剖: 输尿管梗阻肾盂积水，肠梗阻。
• 子宫内膜腺肌瘤- 挤压效应，感染，破裂。
• 生育能力:改善或治疗 (ART治疗前输卵管积血，便于穿刺，性交困难)。

子宫保守手术

• 相关保守手术并无共识 No consensus relative to conservative  surgery
   
• 选择取决于患者是否希望保持生育能力 Choice depends on whether the patient  wishes to preserve fertility
   
• 保守手术- 深度亲润是重要的预后因素;熟练程度高;底水平数据 Conservative surgery – depth penetration  important prognostic factor; high degree of  skill; low-level data
   

腺肌瘤切除
Adenomyomectomy

• 可能用于局灶性子宫腺肌症(子宫腺肌症患者的25%)。Possible for focal adenomyosis (25% of adenomyosis pts)
   
• 对于弥漫性/广泛性疾病，切除手术(细胞减小手术)更具挑战性——证据不足 Excisional surgery (cytoreductive surgery) more challenging for diffuse/extensive disease – low evidence
   
• 使用/不使用GnRH激动剂治疗 With/without GnRH agonist therapy
   
• 子宫动脉短暂性闭塞(不是单独的技术) ± transient occlusion of uterine arteries (not a stand-alone  technique)
   
• 完全切除:痛经减少82%，月经过多控制69%，怀孕率61%;活产率83.1%;复发率  9% Complete excision: dysmenorrhea reduction 82%,  menorrhagia control 69%, and pregnancy rates 61%;  delivery rate 83.1%; recurrence 9%
   
• 部分切除:痛经减少82%，月经过多控制50%，怀孕率47%;活产率73%;复发率  19% Partial excision: dysmenorrhea reduction 82%,  menorrhagia control 50%, and pregnancy rates 47%;  delivery rate 73%; recurrence 19%
   
• 自然流产、早产、胎盘增生和子宫破裂的风险较高(46%) Higher risk (46%) of spontaneous abortion, preterm labor,  placenta accreta and uterine rupture
   

宫腔镜切除和消融

子宫肌层电凝

• 腹腔镜手术 Laparoscopic procedure
   
• 证据有限，需要进一步研究验证 Limited evidence – needs further studies for validation
   
• 保留给已完成生育的妇女:继发于子宫肌层强度减弱的子宫破裂的风险是显著的 Reserved for women who have completed child-bearing:  risk of uterine rupture secondary to the diminished  strength of the myometrium is significant
   
• 缺点: