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子宮內膜異位

很多女性在經期時都會感到痛楚。這些痛楚有小部分是由子宮內膜異位引起的。子宮內膜異位,是指部分子宮壁(子宮內膜)長於子宮外,大約有1% 至15%介乎生育年齡的婦女患有子宮內膜異位。許多患者並沒有任何病徵,但有些患者卻會劇痛難當,並有機會減低懷孕的機會。

以下容由保柏健康資訊顧問團隊提供,一切料均根可靠而有醫學證明的料而編寫並經保柏的醫學顧問考,不能取代合格的醫護員給下之人建  

在月經週期中,子宮內膜會逐漸增厚和充血,為迎接受精卵作好準備。假如卵子沒有受精,子宮內膜會分解脫落,形成月經。但有小部分子宮內膜或會在子宮外面的器官生長,形成子宮內膜異位。異位的子宮內膜和正常的子宮內膜一樣,每月都會經過上述的週期性變化;但這些子宮內膜有時會腫脹和出血,讓血液流到體腔內,令患者發炎和感到痛楚。同時,一些稱為黏連的強?疤痕組織可能會因而形成,把身體器官和組織連結在一起,影響身體器官的正常運作。

最常出現子宮內膜異位的地方是卵巢、把卵子由卵巢輸送到子宮的輸卵管,以及一些將子宮固定於適當位置上的組織。卵巢的子宮內膜異位可形成腫囊,即子宮內膜瘤。腫囊內有棕色液體,所以又叫「巧克力腫囊」。它們不會引起痛楚,因此只能在一些檢查生育能力的身體檢查中發現。萬一腫囊破裂,腫囊內的液體會流進體腔,導致劇痛和形成黏連。較罕見的子宮內膜異位可在膀胱、腸道或其他器官出現。

子宮內膜異位最常見的病徵是近似經痛的盆腔痛,而個別病徵則因人而異。有些子宮內膜異位的患者可能沒有任何病徵,而有些患者卻會感到劇痛難當,她們通常會在經期前後感到痛楚;而有些患者則會長期感到盆腔痛。痛楚可能會集中在身體其中一旁、中間或散佈在身體兩旁。有些患者在來經前或經期中性交會感到痛楚。另外,患者的經期也可能會出現變化,例如她們在經期前會有輕微出血(滴血)、月經失衡或經血過量等現象。腸道或膀胱的子宮內膜異位可引致下腹腫脹、如?時疼痛或經期時糞便帶血。可是,子宮內膜異位的病徵通會常在懷孕期間或停經後消失。對於某些婦女,患上子宮內膜異位的第一個表徵就是難於成孕。
由於子宮內膜異位沒有明顯的病徵,所以檢查腹腔的內部情況,是確定婦女是否患上子宮內膜異位的唯一方法。這項檢查需要在醫院進行,醫生會將一個名為腹腔鏡的幼金屬探望管,經肚臍下方的皮膚插入腹腔內。這檢查一般會在全身麻醉的狀態下進行,由婦科醫生負責。在某些情況下,醫生會取出小部分異位的子宮內膜作檢驗。檢查需時約30分鐘,病人一般無需留院。

子宮內膜異位的成因至今未明,也沒有人知道為何子宮內膜異位只會在某些女性身上出現的原因。有些人相信,那是因為月經未有經由陰道流出體外,而經由輸卵管倒流至卵巢所致。

哪些女性會患上子宮內膜異位?

子宮內膜異位可在任何介乎生育年齡的婦女身上發生,也可以由家族遺傳。白種人患子宮內膜異位的機會比其他種族的人為高,而30歲後才首次生育以及不育的婦女,有更大機會患有子宮內膜異位。

治療子宮內膜異位的目的包括:

  • 減輕痛楚
  • 縮小異位的子宮內膜或減慢它們的生長
  • 清除子宮內膜異位
  • 保持或恢復患者的生育能力

治療方式主要取決於患者的年齡、病徵的嚴重程度、患者是否希望生育孩子以及病情是否嚴重等。對於大部分沒有接受治療的患者,子宮內膜異位的情況通常會維持不變或有所改善。可是,在每3個患者中,約有1個的病情會惡化。因此,患者必須與醫生商討病情,並共同尋求治療的對策。藥物對治療輕微的子宮內膜異位或有幫助;而病情較嚴重的則可能需要動手術。有時醫生可能需要把病人的子宮移除,又或移除一個甚至兩個卵巢。

減輕痛楚

止痛劑 ─ 例如撲熱息痛、抗發炎劑及可待因,都有助緩和輕微痛楚。

輔助療法 ─ 如針炙、香薰療法、草藥療法和順勢治療等,也可能有幫助。

以激素治療法縮小子宮內膜異位
子宮內膜細胞就好像正常的子宮內膜一樣,需要雌激素來維持生命和生長。因此,一些能降低體內雌激素水平的激素藥物,可幫助縮小子宮內膜異位。激素藥物有多種可供選擇,包括:

  • 混合口服避孕藥
  • 黃體酮
  • danazol
  • gestrinone
  • 促性腺激素釋出因子GnRH的類似物

以上所有激素性藥物的作用大致相同,但各有不同的副作用。醫生可能會建議病人試服數種藥物,以找出那一種最為有效以及帶給患者最少副作用。

當服用激素藥物時(口服避孕藥除外),病人應同時採用阻礙性避孕法(如使用避孕套),因為藥物可損害發育中的胎兒。

使用藥物不可治癒子宮內膜異位,病徵通常在停服藥物後再出現。在每5個女性中,約有2個在停用藥物的12個月後會再感到痛楚,約有一半則會在5年後再次出現疼痛的情況。

手術

手術旨在盡量清除異位的子宮內膜,同時不損女性的生育能力。如有以下情況,病人便應接受手術:

  • 子宮內膜異位的面積大於4厘米至5厘米(1.5吋至2吋)
  • 有大量黏連,或體內器官(如腸道)的正常運作受黏連影響
  • 子宮內膜異位阻塞輸卵管,導致不育
  • 出現止痛劑或激素不能控制的劇痛。子宮內膜異位可能會被切除,或以電力儀器或激光所發出的熱力消除。通常手術會透過使用腹腔鏡在腹部上的小切口進行(鎖眼切口手術),也有可能需要進行剖腹手術

每 5個子宮內膜異位的患者中,約有1人會在接受手術5年後病情復發。醫生通常會在手術後為病人開處激素藥物,以延遲病情復發。可是,現時唯一能夠完全阻止子宮內膜異位復發的方法,是切除病者的卵巢。病情嚴重的患者在不得已的情況下才會考慮這個辦法。而切除卵巢的手術也可用於不打算生育的婦女。

可作的檢驗

超聲波、X光和磁力共振造影均可觀察子宮內膜異位對治療的反應。

Some complications of endometriosis are listed below:

 

  • Scar tissue can attach to organs in your pelvis and abdomen (tummy). These scars are known as adhesions and can cause pain. They may also cause your bowel to become blocked.
  • You may have difficulty getting pregnant (reduced fertility). This may affect up to a half of those women who have endometriosis.
  • Endometriosis increases your risk of getting  ovarian cysts. These can rupture and cause pain and reduced fertility.
  • You may have a slightly increased risk of ovarian cancer if you have endometriosis.

Speak to your GP or doctor if you have any questions about the complications of endometriosis.

子宮內膜異位有機會使女性不育。嚴重的子宮內膜異位可能是由輸卵管受阻塞引致,但輕微的子宮內膜異位也可減低生育能力。治療子宮內膜異位的藥物不會改善婦女的生殖能力,但如果因為子宮內膜異位損害子宮和卵巢的正常運作而需接受手術,這便可改善生殖能力。患有子宮內膜異位的女性如希望生育,可能需要接受生育治療。

1. Can treatment for endometriosis help me get pregnant?

The good news is that around seven out of 10 women with endometriosis will eventually get pregnant without medical help. However, some women with endometriosis do have problems with reduced fertility.

Having hormonal treatment for endometriosis can help ease your pain symptoms (see our treatment section above). However, doctors don’t think it increases your chance of getting pregnant.

There are treatments that can help improve your chance of getting pregnant if you have endometriosis. However, there isn’t yet one, agreed ‘best option’. This is something you should discuss with your gynaecologist. What treatment you may have will depend upon several factors including the type and severity of endometriosis and your preferences.

Having laparoscopic surgery to remove or destroy patches of endometriosis may improve your fertility. This is more likely to help if you have mild endometriosis, rather than moderate to severe disease.

After discussion with your gynaecologist, you may decide to opt for one of the forms of medically-assisted reproduction (assisted conception, fertility treatments). These include intrauterine insemination and in vitro fertilisation (IVF). See our topic on female infertility for more information.

2. I have endometriosis – am I more likely to get cancer?

Endometriosis is a benign condition, which means it isn’t a type of cancer.

However, having endometriosis does seem to slightly increase your chance of getting some types of ovarian cancer. Doctors aren’t sure why this is. So there’s lots of research going on to try and find out more about the link between endometriosis and ovarian cancer.

If you’re concerned about your risk of ovarian cancer, talk to your GP or gynaecologist.

3. Will a hysterectomy cure my endometriosis?

If other treatments haven’t worked, and you’re sure that you don’t want to become pregnant in the future, then a hysterectomy may be an option. This is an operation to remove your uterus (womb).

Your gynaecologist may recommend you have your ovaries removed at the same time, as this gives you a better chance of your symptoms ending. Removing your ovaries removes the hormones they produce. It’s these hormones which cause the areas of endometriosis to swell and bleed.

Having your womb and ovaries removed, along with areas of endometriosis, may make your symptoms go away for good. It doesn’t always work though – some women still have symptoms of endometriosis after the operation.

If you have your ovaries removed, this may cause you to have symptoms similar to the menopause, such as hot flushes and mood changes. Your doctor may recommend that you take hormone replacement therapy (HRT) to deal with these. They’ll discuss with you how soon after your hysterectomy you can start HRT.

For more information about your treatment options, or if you have any questions, speak to your doctor. They’ll explain the options available to you, as well as their benefits and risks.

This information was published by Bupa Group's Health Content Team and has been reviewed by appropriate medical or clinical professionals. To the best of their knowledge the information is current and based on reputable sources of medical evidence, however Bupa (Asia) Limited makes no representation or warranty as to the completeness or accuracy of the Content.

The information on this page, and any information on third party websites referred to on this page, is provided as a guide only.  It should not be relied upon as a substitute for professional medical advice, nor is it intended to be used for medical diagnosis or treatment. Bupa (Asia) Limited is not liable for any loss or damage you suffer arising out of the use of, or reliance on, the information.

Third party websites are not owned or controlled by Bupa and any individual may be able to access and post messages on them. Bupa is not responsible for the content or availability of these third party websites.

 

 

The National Endometriosis Society (UK) 
http://www.endo.org.uk

Website written by a patient:
http://www.endometriosis.org.uk

Website written by a doctor:
http://www.womens-health.co.uk

National Womens Health Information Center (US)
http://www.4woman.gov/faq/endomet.htm

Endometriosis Association
http://www.endometriosisassn.org/

Endometriosis Research Center
http://www.endocenter.org/

The Endometrosis Association (Victoria)
http://www.endometriosis.org.au

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