Endometriosis is nicknamed “super cancer”, but it is not fatal, but the trauma it causes to women sometimes exceeds that of real cancer. At present, the treatment of this disease also has such and such problems, based on personal long-term practice, to put forward some advice, the following content only represents personal views, can not represent the industry’s general statements and norms, do not advocate the use of reference!
A. Clinicopathological characteristics of endometriosis.
1, a multifactorial disease in women of childbearing age, mainly causing pain (dysmenorrhea p chronic pelvic pain p painful intercourse) and infertility, prolonged periods, etc. There is also a significant proportion of women without any discomfort except infertility.
2, similar to malignant tumor, clinically divided into 4 stages, but the symptoms are disproportionate to the signs and the severity of the disease, especially for infertility, in fact, it is not the higher the stage the more difficult it is to get pregnant.
3. Extensive lesions with various morphologies
4, extremely invasive, forming extensive and severe adhesions, although almost benign (individual will be malignant), but with more stubborn behavior than malignant tumors.
5. Laparoscopy is an accurate method of diagnosis, and any diagnosis without surgery is only a suspected diagnosis.
B. Surgical treatment of endometriosis
1. basic considerations for treatment: the main factors to be considered in treatment: 1. age; 2. fertility requirements; 3. severity of symptoms; 4. history of previous treatment; 5. extent of lesions; 6. patient’s wishes. Treatment measures are individualized, and treatment of pelvic pain p infertility as well as pelvic masses should be treated separately.
2. The aims of surgical treatment: to reduce and eliminate lesions, to alleviate and eliminate pain, to improve and promote fertility, and to reduce and avoid recurrence.
3, surgery is the first choice, especially laparoscopic surgery should be preferred, while postoperative Chinese medicine treatment should be the second choice. Other western medicine treatment such as endocrine therapy should be strictly used, otherwise it may bring more serious problems!
4, before the surgery should be the doctor and patient to communicate, full understanding p cognitive and informed consent p risk of surgery p surgical injury, especially the possibility of urinary tract and intestinal injury, and the possibility of laparoscopic surgery to open surgery.
5, surgical results vary depending on the level of the doctor, surgical experience, etc. Only the doctor in charge of the operation can be clear about how the lesion is, the extent of the operation finally achieved, so it is recommended that the doctor in charge should be found back for follow-up, rather than surgery a doctor and postoperative treatment is a doctor.
6, the surgeon is willing to take risks, and once some serious complications occur, whether the patient can understand, these are related to the results of surgery, because in many cases, the location of the lesion is just on the surface of some important organs, such as ureter, bladder, large intestine, etc., do not deal with the impact of fertility, deal with it, may cause trauma to these organs. Therefore, it is very important for doctors and patients to communicate with each other before surgery.
C. Indications for laparoscopy of endometriosis: patients at high risk for ectopic disease
1 Infertility
2 ineffective medication for dysmenorrhea
3 Painful sexual intercourse
4 unexplained adnexal mass
5 Chronic pelvic inflammatory disease that has not been treated for a long time
6 Gynecological examination with suspected signs of endometriosis
D. Western medicine treatment for endometriosis
1. The purpose of treatment: to inhibit ovarian function, to stop the growth of endometriosis, to reduce the activity of endometriosis lesions and to reduce the formation of adhesions. This is the goal that every doctor and patient is looking forward to.
2. One thing is that no matter how good the surgery is or how much money is spent on medication, there is no guarantee that endometriosis will not recur, it may be effective during the medication period, but once the medication is stopped, some patients may even have a faster and more serious recurrence.
3, but sometimes really need drug treatment, although doctors prescribe drugs may not have the bottom of the heart, but after all, there are such drugs on the market can treat such a disease! So will prescribe drugs to patients.
4, if you want to prescribe drugs, it is recommended in accordance with the following principles: 1 should be used in basic diagnosed cases, not advocate long-term “experimental treatment”; 2 there is no standardized program; 3 various programs have basically the same efficacy, all have side effects, but the side effects are different, so the choice of drugs to consider the side effects of drugs; 4 the patient’s wishes and financial ability. 5 The most important point is what treatment purpose is the treatment given to the patient based on?
E. For the treatment purpose of infertility, it is recommended that
1.A significant proportion of the postoperative period will have a chance of fertility. Unless there is a very necessary reason, it is recommended not to supplement the treatment with Western medicine, which will not only fail to control recurrence, but also will not increase the chance of fertility, but may lose the time of fertility.
2. Unless ovulation disorder has been clearly identified before the operation, the use of ovulation promotion after the operation is just a good wish in mind, which will not increase the chance of fertility, but will cause the original normal endocrine function to become dysfunctional, and such dysfunction is difficult to adjust with drugs.
3. IVF for endohetero: At present, the mechanism of endohetero affecting fertility is still vague, and even if embryo transfer is carried out, the success rate of the same is very low, so IVF is not the first choice for endohetero to solve the fertility problem, and it is also a final method that has no way out.
4. In addition to the necessary treatment, mindfulness, diet and proper exercise are sometimes useful for those who are infertile with endometriosis, just like other infertile people.
F. For those who do not consider fertility but aim to treat pain
1.As soon as possible after the surgery, regardless of how it is done, supplemental treatment with western medicine becomes necessary.
2.Oral and injection may have the same effect, but the side effects are not the same, and the course of treatment is not the same, based on the intraoperative situation and economic ability, doctor’s advice, etc. choice.
G. Chinese medicine treatment
1.People who don’t know or pay attention to Chinese medicine will say that Chinese medicine is ineffective in treating internal heterogeneity, or people who prescribe Chinese medicine casually will also say that it is ineffective, because they don’t know!
2, for endometriosis, the efficacy of Chinese medicine is very satisfactory, to avoid the drawbacks of Western medicine, to improve the pregnancy rate, reduce dysmenorrhea is an objective fact, but the same is not possible to significantly reduce recurrence.
3.Once pregnant, a high percentage of miscarriages will occur in endoheterosexuality. Chinese medicine treatment can reduce the rate of miscarriage brought about and improve the success rate of pregnancy.
4. The only shortcoming is that it requires a relatively long course of treatment, and drinking the medicine is not an easy task.