青春期子宫内膜异位症临床特点及诊治进展

青春期子宫内膜异位症（EMs）的发生率尚不确切，但至少2/3对口服避孕药（OCP）和非甾体类抗炎药（NSAIDs）治疗无效的痛经或慢性盆腔疼痛患者在腹腔镜检查时发现EMs。与成人EMs相比，青春期EMs具有一定的临床特征，常表现为痛经、慢性盆腔疼痛伴有消化道和泌尿系统等症状，约48%的青春期EMs患者发生心理障碍，主要表现为焦虑或抑郁等。青春期EMs的高危因素包括生殖器官畸形、月经初潮早、家族史及母亲妊娠期相关疾病等。诊断时需结合病史、临床表现、高危因素、妇科检查、盆腔超声和（或）磁共振成像（MRI）等，确诊仍需腹腔镜检查及病理检查。青春期EMs治疗方法包括药物治疗、手术治疗以及术后辅助药物治疗，治疗方法的选择需要根据患者年龄、临床表现、分期、药物的不良反应等综合考虑，制定个体化治疗方案，并应长期管理。

Clinical Characteristics,Diagnosis and Treatment of Adolescent Endometriosis

Although the true prevalence of adolescent endometriosis is unknown, at least two thirds of adolescent girls with the chronic pelvic pain or dysmenorrhea being unresponsive to oral contraceptive (OCP) and non-steroidal anti-inflammatory drugs (NSAIDs) will be diagnosed with endometriosis at the time of diagnostic laparoscopy. Compared with adult endometriosis, adolescent endometriosis has certain clinical features. The main manifestations are dysmenorrhea and chronic pelvic pain, often accompanied by gastrointestinal and urinary symptoms. About 48% of patients with adolescent endometriosis have psychological disorders, mainly manifested as anxiety or depression and so on. The risk factors of adolescent endometriosis include reproductive organ malformation, early menarche, family history, maternal pregnancy-related diseases and so on. Diagnosis should be combined with the history, clinical manifestations, high-risk factors, gynecological examination, pelvic ultrasound and/or MRI. Laparoscopy and biopsy are the standard for diagnosing definitely adolescent endometriosis. The treatment method of adolescent endometriosis should be based on the comprehensive consideration of the age, symptoms, stages and side effects of medicine, which includes drug therapy, surgery and postoperative adjuvant drug therapy. It is necessary to take the individual treatment and long-term management for those patients with adolescent endometriosis.