子宫内膜异位症的诊治规范ppt课件.ppt

芳香化酶抑制剂(Ais) In premenopausal women, the ovary can overcome the estrogen blockade by reflex increments of LH and FSH, so AIs must be combined with a gonadotropin releasing hormone (GnRH) agonist to prevent the reflex LH and FSH increments. AIs have been used in infertility and can increase ovulation rate. A pilot trials showed that aromatase inhibitors could decrease pelvic pain associated with endometriosis. 芳香化酶抑制剂-临床研究 Treatment of endometriosis and chronic pelvic pain with letrozole and norethindrone acetate: a pilot study. 10 patients with endometriosis letrozole (2.5 mg, po) and norethindrone acetate (2.5 mg) for 6 months Second-look laparoscopy marked reduction of laparoscopically visible and histologically confirmed endometriosis in all 10 patients and significant pain relief in nine out of 10 patients Ailawadi,-R-K,et al. Fertil-Steril. 2004 Feb; 81(2): 290-6 环氧合酶抑制剂COX-2 specific inhibitor Animal researchs Regression of endometrial explants in rats treated with the cyclooxygenase-2 inhibitor rofecoxib. Dogan E, Fertility Sterility. 82 Suppl 3, 2004 Turkey Cyclooxygenase-2 selective inhibitor prevents implantation of eutopic endometrium to ectopic sites in rats. Matsuzaki S. Fertility Sterility. 2004 France 环氧合酶抑制剂-临床应用 STUDY DESIGN pelvic pain after conservative surgery for symptomatic endometriosis (Stage I and II) (n = 28) . a COX-2 specific inhibitors (rofecoxib, 25mg per day) (n = 16) or placebo (n = 12) was given for 6 months. RESULTS A significant improvement of both pelvic pain and dyspareunia was observed after a 6 months persisting since the end of the treatment (P 0.0001). The efficacy of rofecoxib was higher than placebo and no recurrence occurred, while in the placebo-treatment a 16% (2/12) occurred. No significant side effects have been found with the use of rofecoxib. CONCLUSIONS rofecoxib was effective, safe and low cost therapy in the management of pelvic pain associated to endometriosis and might be also proposed