본문 바로가기
KERD
논문KCI 등재

수술 후 자궁내막증의 재발방지를 위한 치료법

Medical therapy of endometriosis to reducethe risk of recurrence

신정호|강애라
대한산부인과학회 (Korean Soceity of Obstetrics and Gynecology)|2009.11|Obstetrics & Gynecology Science|제52권 제11호|pp. 1093-1101

0

조회

0

다운로드

2

인용

0

참고문헌

키워드

재발RecurrenceEndometriosis자궁내막증
주제분류산부인과학

초록

자궁내막증은 흔하고 만성적인 부인과적인 양성질환이다. 자궁내막증은 에스트로겐의 영향을 받으며 골반통, 생리통, 불임의 원인이 된다. 재발이 매우 흔하므로 가능한 한 완전한 병소의 수술적 제거가 원칙이며, 바로 임신을 원하는 경우가 아니라면, 재발을 억제하기 위해 수술 후 약물치료가 필요한 경우가 많다. 생식샘자극호르몬분비호르몬 작용제, 다나졸, 프로게스토겐, 경구피임제들이 전통적으로 자궁내막증의 약물치료로 사용되어 왔다. 그러나 이들 약제의 전신적인 부작용으로 장기간의 치료에 한계가 있어, 최근에는 자궁내막증의 병태생리에 기초한 다양한 다른 약제들이 자궁내막증의 수술 후 재발방지 목적으로의 사용이 시도되고 있다. Levonorgestrel 분비 자궁내장치, 방향화 효소 억제제 (aromatase inhibitor), 선택적 프로게스테론수용체 조절제 (SPRM), COX-2 억제제 등이 새롭게 자궁내막증의 약물적 치료로 이용되고 있으며, 앞으로 자궁내막증에 대한 분자 생물학적인 이해가 깊어질 수록, 더욱 선택적이고 효과적인 약물의 개발이 가능해 질 것이다.

Abstract

Endometriosis is a common, benign and chronic gynecologic disorder. It is an estrogen dependent disease that can cause pelvic pain, dysmenorrhea and infertility. Because of its high rate of recurrence, medication after surgery is inevitable. GnRH agonist, Danazol, progestogen and oral contraceptive have been conventionally used for the medical treatment of endometriosis. However, systemic side effects of those agents restrict their usage as long-term management. Increasing knowledge about the pathogenesis of endometriosis has introduced new agents which were more targeted and specified for the prevention of recurrence of endometriosis.

참고문헌 (54)

  1. Farquhar CM, "Extracts from the "clinical evidence". Endometriosis", BMJ, 320, pp.1449~1452 (2000)
  2. Garry R, "The effectiveness of laparoscopic excision of endometriosis", Curr Opin Obstet Gynecol, 16, pp.299~303 (2004)
  3. Cheong Y, "Laparoscopic surgery for endometriosis: How often do we need to re-operate?", J Obstet Gynaecol, 28, pp.82~85 (2008)
  4. Busacca M, "Determinants of long-term clinically detected recurrence rates of deep, ovarian, and pelvic endometriosis", Am J Obstet Gynecol, 195, pp.426~432 (2006)
  5. Beretta P, "Randomized clinical trial of two laparoscopic treatments of endometriomas: cystectomy versus drainage and coagulation", Fertil Steril, 70, pp.1176~1180 (1998)
  6. Alborzi S, "A prospective, randomized study comparing laparoscopic ovarian cystectomy versus fenestration and coagulation in patients with endometriomas", Fertil Steril, 82, pp.1633~1637 (2004)
  7. Donnez J, "Ovarian endometrial cysts: the role of gonadotropin-releasing hormone agonist and", or drainage, 1994, pp.62, 63~66
  8. Audebert A, "Pre or post-operatIVe medical treatment with nafarelin in stage Ⅲ-Ⅳ endometriosis: a French multicenter study", Eur J Obstet Gynecol Reprod Biol, 79, pp.145~148 (1998)
  9. Bianchi S, "Effects of 3 month therapy with danazol after laparoscopic surgery for stage Ⅲ", Ⅳ endometriosis: a randomized study, 1999, pp.14, 1335~1337
  10. Vercellini P, "A gonadotrophin-releasing hormone agonist compared with expectant management after conservative surgery for symptomatic endometriosis", Br J Obstet Gynaecol, 106, pp.672~677 (1999)
  11. Muzii L, "Postoperative administration of monophasic combined oral contraceptives after laparoscopic treatment of ovarian endometriomas: a prospective, randomized trial", Am J Obstet Gynecol, 183, pp.588~592 (2000)
  12. BusaccaM, "Post-operative GnRH analogue treatment after conservative surgery for symptomatic endometriosis stage Ⅲ-Ⅳ: a randomized controlled trial", Hum Reprod, 16, pp.2399~2402 (2001)
  13. Loverro G, "A randomized study comparing triptorelin or expectant management following conservative laparoscopic surgery for symptomatic stage Ⅲ-Ⅳ endometriosis", Eur J Obstet Gynecol Reprod Biol, 136, pp.194~198 (2008)
  14. Yap C, "Pre and post operative medical therapy for endometriosis surgery", Cochrane Database Syst Rev, pp.CD003678~ (2004)
  15. Sagsveen M, "Gonadotrophin-releasing hormone analogues for endometriosis: bone mineral density", Cochrane Database Syst Rev, pp.CD001297~ (2003)
  16. Jee BC, "Impact of GnRH agonist treatment on recurrence of ovarian endometriomas after conservative laparoscopic surgery", Fertil Steril, 91, pp.40~45 (2009)
  17. Barbieri RL, "Endometriosis and the estrogen threshold theory. Relation to surgical and medical treatment", J Reprod Med, 43(3), pp.287~292 (1998)
  18. Zupi E, "Add-back therapy in the treatment of endometriosis-associated pain", Fertil Steril, 82, pp.1303~1308 (2004)
  19. Olive DL, "Medical therapy of endometriosis", Semin Reprod Med, 21, pp.209~222 (2003)
  20. Morgante G, "Low-dose danazol after combined surgical and medical therapy reduces the incidence of pelvic pain in women with moderate and severe endometriosis", Hum Reprod, 14, pp.2371~2374 (1999)
  21. Mizutani T, "Danazol concentrations in ovary, uterus, and serum and theireffect on the hypothalamic-pituitary-ovarian axis during vaginal administration of a danazol suppository", Fertil Steril, 63, pp.1184~1189 (1995)
  22. Igarashi M, "Novel vaginal danazol ring therapy for pelvic endometriosis, in particular deeply infiltrating endometriosis", Hum Reprod, 13, pp.1952~1956 (1998)
  23. Cobellis L, "A danazol-loaded intrauterine device decreases dysmenorrhea, pelvic pain, and dyspareunia associated with endometriosis", Fertil Steril, 82, pp.239~240 (2004)
  24. Vercellini P, "Cyproterone acetate versus a continuous monophasic oral contraceptive in the treatment of recurrent pelvic pain after conservative surgery for symptomatic endometriosis", Fertil Steril, 77, pp.52~61 (2002)
  25. Seracchioli R, "Long-term cyclic and continuous oral contraceptive therapy and endometrioma recurrence: a randomized controlled trial", Fertil Steril (2008)
  26. Vercellini P, "Postoperative oral contraceptive exposure and risk of endometrioma recurrence", Am J Obstet Gynecol, 199, pp.504.e1~504.e5 (2008)
  27. Park HJ, "Postoperative long-term maintenance therapy with oral contraceptives after gonadotropin-releasing hormone analog treatment in women with ovarian endometrioma", J Minim Invasive Gynecol, 16, pp.34~39 (2009)
  28. Seracchioli R, "Long-term oral contraceptive pills and postoperative pain management after laparoscopic excision of ovarian endometrioma: a randomized controlled trial", Fertil Steril (2009)
  29. Muneyyirci-Delale O, "Effect of norethindrone acetate in the treatment of symptomatic endometriosis", Int J Fertil Womens Med, 43, pp.24~27 (1998)
  30. Kamiński K, "Treatment of endometriosis with dienogest: preliminary report", Ginekol Pol, 72, pp.299~304 (2001)
  31. Cundy T, "Bone density in women receiving depot medroxyprogesterone acetate for contraception", BMJ, 303, pp.13~16 (1991)
  32. Scholes D, "Injectable hormone contraception and bone density: results from a prospective study", Epidemiology, 13, pp.581~587 (2002)
  33. Clark MK, "Bone mineral density changes over two years in first-time users of depot medroxyprogesterone acetate", Fertil Steril, 82, pp.1580~1586 (2004)
  34. Shaarawy M, "Effects of the long-term use of depot medroxyprogesterone acetate as hormonal contraceptive on bone mineral density and biochemical markers of bone remodeling", Contraception, 74, pp.297~302 (2006)
  35. Prentice A, "Progestagens and anti-progestagens for pain associated with endometriosis", Cochrane Database Syst Rev, pp.CD002122~ (2000)
  36. Fedele L, "Gestrinone versus danazol in the treatment of endometriosis", Fertil Steril, 51, pp.781~785 (1989)
  37. Surrey ES, "Prolonged GnRH agonist and add-back therapy for symptomatic endometriosis: long-term follow-up", Obstet Gynecol, 99(5), pp.709~719 (2002)
  38. Vercellini P, "Comparison of a levonorgestrel-releasing intrauterine device versus expectant management after conservative surgery for symptomatic endometriosis: a pilot study", Fertil Steril, 80, pp.305~309 (2003)
  39. Simpson ER, "Aromatase cytochrome P450, the enzyme responsible for estrogen biosynthesis", Endocr Rev, 15, pp.342~355 (1994)
  40. Velasco I, "Aromatase expression in endometriotic tissues and cell cultures of patients with endometriosis", Mol Hum Reprod, 12, pp.377~381 (2006)
  41. Buzdar A, "Advances in aromatase inhibition: clinical efficacy and tolerability in the treatment of breast cancer", Clin Cancer Res, 7, pp.2620~2635 (2001)
  42. Buzdar AU, "An overview of the pharmacology and pharmacokinetics of the newer generation aromatase inhibitors anastrozole, letrozole, and exemestane", Cancer, 95, pp.2006~2016 (2002)
  43. Goss PE, "Aromatase inhibitors in the treatment and prevention of breast cancer", J Clin Oncol, 19, pp.881~894 (2001)
  44. Santen RJ, "Use of aromatase inhibitors in breast carcinoma", Endocr Relat Cancer, 6, pp.75~92 (1999)
  45. Ailawadi RK, "Treatment of endometriosis and chronic pelvic pain with letrozole and norethindrone acetate: a pilot study", Fertil Steril, 81, pp.290~296 (2004)
  46. Soysal S, "The effects of post-surgical administration of goserelin plus anastrozole compared to goserelin alone in patients with severe endometriosis: a prospective randomized trial", Hum Reprod, 19, pp.160~167 (2004)
  47. Attar E, "Aromatase inhibitors: the next generation of therapeutics for endometriosis?", Fertil Steril, 85, pp.1307~1318 (2006)
  48. Elger W, "Endocrine pharmacological characterization of progesterone antagonists and progesterone receptor modulators with respect to PR-agonistic and antagonistic activity", Steroids, 65, pp.713~723 (2000)
  49. Chwalisz K, "Selective progesterone receptor modulators (SPRMs): a novel therapeutic concept in endometriosis", Ann N Y Acad Sci, 955, pp.373~388 (2002)
  50. Chwalisz K, "Therapeutic potential for the selective progesterone receptor modulator asoprisnil in the treatment of leiomyomata", Semin Reprod Med, 22, pp.113~119 (2004)
  51. Chwalisz K, "Selective progesterone receptor modulator development and use in the treatment of leiomyomata and endometriosis", Endocr Rev, 26, pp.423~438 (2005)
  52. Bruner KL, "Suppression of matrix metalloproteinases inhibits establishment of ectopic lesions by human endometrium in nude mice", J Clin Invest, 99, pp.2851~2857 (1997)
  53. Huang HY, "Interleukin-18 system messenger RNA and protein expression in human endometrium during the menstrualcycle", Fertil Steril, 86, pp.905~913 (2006)
  54. Chabbert-Buffet N, "Selective progesterone receptor modulators and progesterone antagonists: mechanisms of action and clinical applications", Hum Reprod Update, 11, pp.293~307 (2005)

관련 논문AI추천

자궁내막증의 임상진료지침김미란, 김성훈, 신정호, 이병석, 이사라, 이정렬, 조시현, 최영식대한산부인과학회 · Obstetrics & Gynecology Science2011 · 제54권 제08호자궁내막증에 의한 통증에 대한 GnRH agonist와 levonorgestrel 함유 자궁내장치 (Mirena？) 병합 치료의 유용성에 관한 고찰김철홍, 오성택, 조문경, 조혜연대한산부인과학회 · Obstetrics & Gynecology Science2008 · 제51권 제3호자궁내막증 환자의 자궁내막과 난소 자궁내막종에서 gonadotropin-releasing hormone agonist 치료 후 aromatase와 cyclooxygenase-2의 감소김미란, 김영아, 김지연, 안상태, 이응수, 이재훈, 황경주대한산부인과학회 · Obstetrics & Gynecology Science2007 · 제50권 제2호자궁내막종 적출술후 GnRH analogue의통증 치료 효과에 관한 고찰오성택, 오윤상대한산부인과학회 · Obstetrics & Gynecology Science2004 · 제47권 제5호자궁내막증의 호르몬요법 이후 재발된 환자의 한의학적 치료에 대한 증례보고정명주대한한방부인과학회 · 대한한방부인과학회지2015 · 제28권 제3호자궁절제술을 시행 받고 16년이 지난 폐경 여성에서 발견된 자궁내막증 1예이백, 박정화, 서식교, 윤보현, 이병석, 임경진, 전영은, 조시현, 최영식대한폐경학회 · 대한폐경학회지2011 · 제17권 제1호

이 간행물의 다른 논문 (9건)

모성보호에 대한 의료법리적 이해김향미pp. 1085-1092임신 중 우울증상에 대한 임상연구신종철, 안세영, 최세경, 장동규pp. 1102-1108임신 중 비타민 C와 비타민 E 투여 후 임신부 정맥혈장과 제대정맥혈장내 지질과산화물, 항산화능 및 항산화 비타민 농도김석모, 김철홍, 안봉환, 양성렬, 조혜연, 조문경, 강우대, 김윤하, 송태복, 김종운pp. 1117-1126자궁에서의 혈관내피 산화질소 합성효소의 발현김세련, 이상엽, 서형진, 김종욱pp. 1144-1151모야모야질환을 동반한 산모 9예의 임상적 고찰차경희, 현민경, 심재윤, 박선경, 원혜성, 김암, 이필량pp. 1152-1158
원문 보기