患者告知书：子宫内膜异位症和不孕：手术有帮助吗？

患者告知书：子宫内膜异位症和不孕：手术有帮助吗？（美国 2008）
 

资料来源：http://www.asrm.org顺德第一人民医院妇科古伟文岳阳市第一人民医院妇产科李诚

patient fact sheet 患者告知书

 

endometriosis and infertility: can surgery help?

子宫内膜异位症和不孕：手术有帮助吗？

 

this fact sheet was developed in collaboration with the society of reproductive surgeons 这份告知书与生殖外科学会合作校订

 

when you have your period, your body is actually getting rid of the tissue called endometrium that lines your uterus (womb). normally, this tissue grows only on the inside of the uterus. but it may grow in other places: on the outside of your uterus, ovaries or tubes. it can even grow on your bladder or intestines. if it does, the condition is called endometriosis. the tissue growth can irritate the organs and other structures that it touches, causing you pain. the irritation can cause adhesions or scar tissue on these organs.

来月经时，实际上是从体内的子宫排出内膜。通常这组织只在子宫里生长。但子宫内膜也可以在其它地方生长：在子宫外，卵巢或输卵管。甚至能在膀胱和肠管生长。如果发生这种情况称为子宫内膜异位症。子宫内膜生长可激惹器官和其它接触到的结构导致疼痛。激惹可导致这些器官粘连或疤痕组织。

 

many women with endometriosis have pain in the lower abdomen or pelvis, particularly with their menstrual bleeding. other women have endometriosis without significant pain. often, the endometriosis tissue -- and the scarring that may occur -- can make it difficult or impossible to get pregnant. in fact, 30% to 50% of infertile women (women who cannot get pregnant) have endometriosis.

许多子宫内膜异位症患者特别是在月经出血时下腹或盆腔痛，也有些子宫内膜异位症患者没有明显的疼痛。子宫内膜异位组织和可能出现的疤痕组织常可导致受孕困难或不孕。事实上，30%?50%不孕症患者有子宫内膜异位症。

 

how can i tell if i have endometriosis?怎么辨别有没有子宫内膜异位症？

your doctor will want to know your symptoms, but the only way to tell for certain if you have endometriosis is through a "minimally invasive" surgical procedure called laparoscopy. in this surgery, the surgeon will look for endometriosis tissue with or without adhesions (scar tissue). sometimes, endometriosis can grow inside your ovary and form a cyst. these cysts are very common in women who have endometriosis. they usually can be seen on ultrasound, unlike other endometriosis tissue. these cysts or endometriomas may need to be surgically removed, most commonly with the laparoscope.

医生要知道有什么症状，但确诊子宫内膜异位症的唯一方法是做微创手术腹腔镜。在腹腔镜手术中，医生能看见子宫内膜异位组织有没有粘连（疤痕组织）。有时候子宫内膜异位可在卵巢里生长形成囊肿，子宫内膜异位症患者长这种囊肿很常见。通常b超下可见到囊肿。和其它子宫内膜异位组织不同，这些囊肿或子宫内膜瘤可能要手术切除，通常大部分做腹腔镜。

 

how is laparoscopy performed? 腹腔镜怎么做？

laparoscopy is called a "minimally invasive" surgery because the surgeon makes very small openings (incisions) at (or around) your belly button and lower portion of your belly. a thin telescope-like instrument (the laparoscope) is placed into one incision, which allows the doctor to look for endometriosis using a small camera attached to the laparoscope. small instruments are inserted through the incisions to remove the tissue and adhesions. because the incisions are very small, you will only have small scars on your skin after the procedure. you usually can go home the day you have your surgery and should be able to return to your usual activities.

腹腔镜称为微创手术是因为手术在脐周或下腹部的切口很小。一个小放大镜似的器械（腹腔镜）进入一个切口，让医生用连接小摄像机的腹腔镜找子宫内膜异位症。一些小器械通过另一些切口进去切除子宫内膜异位组织和粘连。因为切口非常小，手术后皮肤上只有很小的疤痕。通常手术当天就可以回家并可恢复日常活动。

 

as is the case for any surgery, there is a small risk of complications. these risks include bleeding, infection, your reaction to anesthesia, and damage to your bowel or other organs. however, these risks are unlikely.

象这些患者做任何手术一样，都有合并症的小风险。这些风险包括出血，感染，麻醉反应和肠管或其他器官损伤。但这些危险未必发生。

 

will i be able to get pregnant after the surgery? 手术后能受孕吗？

depending on the extent of endometriosis, surgery may improve your chances of getting pregnant, but doctors will not know exactly how much better your chances will be. if you do not get pregnant within a reasonable time frame after the surgery, it probably won't help to have surgery again unless there is a new problem. because a second surgery may not improve the chances of success substantially, you have to take into consideration the potential complications as well as the expense of having a second surgery compared with the expense of infertility treatment. infertility treatment can often overcome the effects of endometriosis without surgery, but it cannot make an endometrioma go away.

根据子宫内膜异位症的范围和程度，手术可改善受孕的机会。但医生不会确切知道机会有多大改善。如果手术后在合理的预计时间没有受孕，除非有新的问题，否则再次手术可能也没有帮助。因为二次手术大致上也不能改善受孕机会。必须考虑潜在的合并症和比较不孕治疗费用和二次手术费用。不孕治疗通常不手术也可以克服子宫内膜异位症的影响，但不能切除子宫内膜异位瘤。

 

the american society for reproductive medicine grants permission to photocopy this fact sheet and distribute it to patients. created 2008

美国生殖医学会批准这份告知书复印件派发患者  2008年制订