复发性子宫内膜异位症的研究进展

王 瑶, 金 明杨
右江民族医学院附属医院

摘要


子宫内膜异位症（EMs）是一种雌激素依赖性疾病，手术后复发率高，是临床管理中的难点。目前复发机制尚不明确，研究发现其复发可能与残留病灶、激素依赖、免疫失衡、表观遗传及干细胞等多机制相关。治疗上需结合药物、手术及介入手段，实行个体化、长期化管理。本文系统综述其复发机制与治疗进展，以期为临床实践提供参考。

关键词


子宫内膜异位症；复发；发病机制；妇科手术；治疗；预防

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参考


[1]冷金花，史精华.子宫内膜异位症复发的高危因素及其防治策略[J].中华妇产科杂志，2018，53（9）：640-643.

[2]CECCARONI M, BOUNOUS V E, CLARIZIA R, et al. Recurrent endometriosis: a battle against an unknown enemy[J]. The European journal of contraception & reproductive health care, 2019,24(6): 464-474.

[3]中国医师协会妇产科医师分会，中华医学会妇产科学分会子宫内膜异位症协作组.子宫内膜异位症诊治指南（第三版）[J].中华妇产科杂志，2021，56（12）：812-824.

[4]潘宁萍，吴婷婷，胡长长，等.复发子宫内膜异位症二次手术的临床特点[J].现代妇产科进展，2017，26（2）：129-132.

[5]GUO S, MARTIN D C. The perioperative period: a critical yet neglected time window for reducing the recurrence risk of endometriosis?[J]. Human reproduction (Oxford, England), 2019,34(10): 1858-1865.

[6]彭超，周应芳.复发性卵巢子宫内膜异位症的管理[J].中国实用妇科与产科杂志，2022，38（5）：491-495.

[7]王莱娜，张萍.子宫内膜异位症与关键核受体相关机制的研究进展[J].现代医学，2022，50（1）：130-135.

[8]郭希，魏佳，杨永秀.导致子宫内膜疾病的激素通路及调节因素[J].国际妇产科学杂志，2024，51（4）：395-400.

[9]CHANTALAT E, VALERA M, VAYSSE C, et al. Estrogen Receptors and Endometriosis[J]. International Journal of Molecular Sciences, 2020,21(8): 2815.

[10]谢书晗，杨婷婷.雌、孕激素受体在子宫内膜异位症中的表达及临床意义[J].妇儿健康导刊，2024，3（19）：29-32.

[11]SAARE M, LAWARDE A, MODHUKUR V, et al. The expression pattern of endometrial receptivity genes is desynchronized between endometrium and matched endometriomas[J]. Reproductive BioMedicine Online, 2022,45(4): 713-720.

[12]陈思凯，祝洪澜，昌晓红.雌激素微生态理论在子宫内膜异位症发病机制中的研究进展[J].中国妇产科临床杂志，2024，25（4）：367-369.

[13]DONNEZ J, DOLMANS M. Endometriosis and Medical Therapy: From Progestogens to Progesterone Resistance to GnRH Antagonists: A Review[J]. Journal of Clinical Medicine, 2021,10(5): 1085.

[14]WANG N, LIANG H, ZEN K. Molecular mechanisms that influence the macrophage m1-m2 polarization balance[J]. Frontiers in immunology, 2014,5: 614.

[15]DYMANOWSKA-DYJAK I, TERPIŁOWSKA B, MORAWSKA-MICHALSKA I, et al. Immune Dysregulation in Endometriomas: Implications for Inflammation[J]. International journal of molecular sciences, 2024,25(9): 4802.

[16]IKEDA M, NEGISHI Y, AKIRA S, et al. Inflammation related to high-mobility group box-1 in endometrial ovarian cyst[J]. Journal of Reproductive Immunology, 2021,145: 103292.

[17]MARQUARDT R M, TRAN D N, LESSEY B A, et al. Epigenetic Dysregulation in Endometriosis: Implications for Pathophysiology and Therapeutics[J]. Endocrine reviews, 2023,44(6): 1074-1095.

[18]王礼贤，李琰，康山.DNA甲基化转移酶DNMTs和甲基化结合蛋白MBDs在卵巢子宫内膜异位症中的表达及相关性研究[J].华中科技大学学报（医学版），2020，49（3）：312-317.

[19]MARIADAS H, CHEN J, CHEN K. The Molecular and Cellular Mechanisms of Endometriosis: From Basic Pathophysiology to Clinical Implications[J]. International Journal of Molecular Sciences, 2025,26(6): 2458.

[20]BJORKMAN S, TAYLOR H S. MicroRNAs in endometriosis: biological function and emerging biomarker candidates[J]. Biology of Reproduction, 2019,101(6): 1167-1178.

[21]赵蓉，毛利云，杨艳琳.长链非编码RNA、miRNA及雌激素受体在子宫内膜异位症中的研究进展[J].中国医学创新，2022，19（15）：179-183.

[22]LIU S, LI X, GU Z, et al. Single-cell and spatial transcriptomic profiling revealed niche interactions sustaining growth of endometriotic lesions[J]. Cell genomics, 2025,5(1): 100737.

[23]YOU W, WANG S, LI C, et al. Stem cell theory: A new horizon for the treatment of endometriosis by targeting mesenchymal stem cell[J]. International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics, 2025,170(2): 588-600.

[24]KONG Y, SHAO Y, REN C, et al. Endometrial stem/progenitor cells and their roles in immunity, clinical application, and endometriosis[J]. Stem cell research & therapy, 2021,12(1): 474.

[25]ASSOCIATION REPRODUCTIVE HEALTH SOCIETY OF, GYNECOLOGISTS ENDOMETRIOSIS GROUP OF CHINESE. 子宫内膜异位症疼痛管理指南（2024年实践版）[J].中国实用妇科与产科杂志，2024，40（01）：50-61.

[26]VANNUCCINI S, CLEMENZA S, ROSSI M, et al. Hormonal treatments for endometriosis: The endocrine background[J]. Reviews in endocrine & metabolic disorders, 2022,23(3): 333-355.

[27]黄春芝，刘青蓝，苏冉，等.青少年子宫内膜异位症药物治疗选择及药物治疗进展[J].中国临床药理学与治疗学，2024，29（05）：535-542.

[28]BECKER C M, BOKOR A, HEIKINHEIMO O, et al. ESHRE guideline: endometriosis[J]. Human reproduction open, 2022,2022(2): hoac9.

[29]连秀敏，刘娜，比丽克孜·艾克木.子宫内膜异位症中西医治疗研究进展[J].新疆医学，2024，54（1）：90-93.

[30]李晓燕，戴毅.育龄期女性卵巢子宫内膜异位囊肿手术相关问题[J].中国实用妇科与产科杂志，2024，40（5）：493-496.

[31]BERLANDA N, VERCELLINI P, FEDELE L. The outcomes of repeat surgery for recurrent symptomatic endometriosis[J]. Current Opinion in Obstetrics & Gynecology, 2010,22(4): 320-325.

[32]MUZII L, ACHILLI C, LECCE F, et al. Second surgery for recurrent endometriomas is more harmful to healthy ovarian tissue and ovarian reserve than first surgery[J]. Fertility and Sterility, 2015,103(3): 738-743.

[33]RAFFI F, METWALLY M, AMER S. The Impact of Excision of Ovarian Endometrioma on Ovarian Reserve: A Systematic Review and Meta-Analysis[J]. The Journal of Clinical Endocrinology & Metabolism, 2012,97(9): 3146-3154.

[34]MUZII L, MARANA R, ANGIOLI R, et al. Histologic analysis of specimens from laparoscopic endometrioma excision performed by different surgeons: does the surgeon matter?[J]. Fertility and Sterility, 2011,95(6): 2116-2119.

[35]陆安伟，周莉，殷米诺.腹腔镜卵巢子宫内膜异位囊肿剔除术质量控制[J].中国实用妇科与产科杂志，2022，38（1）：44-47.

[36]TANDOI I, SOMIGLIANA E, RIPARINI J, et al. High Rate of Endometriosis Recurrence in Young Women[J]. Journal of Pediatric and Adolescent Gynecology, 2011,24(6): 376-379.

[37]李苗，王闯，梁汝娜.超声引导下无水乙醇介入治疗卵巢子宫内膜异位囊肿疗效[J].川北医学院学报，2025，40（4）：463-466，479.

[38]孙志敏，张红娣，魏伟.腹腔镜手术与超声引导下穿刺术治疗卵巢子宫内膜异位囊肿合并不孕患者的疗效比较[J].新乡医学院学报，2025，42（6）：466-471，477.

[39]许春英.超声引导下介入治疗卵巢子宫内膜异位囊肿的效果观察[J].中国医疗器械信息，2021，27（13）：94-95.

[40]GONÇALVES F C, ANDRES M P, PASSMAN L J, et al. A systematic review of ultrasonography-guided transvaginal aspiration of recurrent ovarian endometrioma[J]. International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics, 2016,134(1): 3-7.

[41]VADUVA C C, DIRA L, CARP-VELISCU A, et al. Ovarian reserve after treatment of ovarian endometriomas by ethanolic sclerotherapy compared to surgical treatment[J]. European review for medical and pharmacological sciences, 2023,27(12): 5575-5582.

[42]张朔.卵巢子宫内膜异位囊肿的临床特点和手术方法的研究进展[J].实用妇科内分泌电子杂志，2022，9（36）：23-26.

[43]GARVEY M. Endometriosis: Future Biological Perspectives for Diagnosis and Treatment[J]. International journal of molecular sciences, 2024,25(22): 12242.

[44]黄文倩，吴绿，朱虹.子宫内膜异位症的免疫治疗及靶向治疗研究进展[J].山东医药，2023，63（11）：97-100.

[45]DUNGATE B, TUCKER D R, GOODWIN E, et al. Assessing the Utility of artificial intelligence in endometriosis: Promises and pitfalls[J]. Women's health (London, England), 2024,20: 912658809.


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