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Endometriosis Surgery: Who Needs It?

The treatment methods are mainly divided into two categories: surgery and drugs, which are comprehensively considered according to the patient's age, the severity of the disease, and whether there is a fertility requirement. The treatment should vary from person to person. At present, laparoscopic diagnosis, surgery, and drugs are considered as the standard treatment for endometriosis. So which people need surgery? How to choose?
 
 
1. Fertility preserving surgery
 
It will remove or destroy all visible endometriosis lesions, separate adhesion parts, restore the normal anatomical structure, but retain uterus, one or both ovaries, at least part of ovarian tissue. It is suitable for the patients with unresponsive symptoms, aggravation of local lesions, or no recovery of reproductive function after drug treatment.
 
Patients with large ovarian endometriosis cysts should choose surgical treatment. The recurrence rate is about 40%, so pregnancy or medication should be used as early as possible to reduce recurrence.
 
2. Operation to preserve ovarian function
 
It will remove the focus and uterus in the pelvic cavity and reserve at least one side or part of the ovary. It is suitable for patients of stage III and IV, patients under 45 years old with obvious symptoms, and no fertility requirements.

3. Radical operation
 
This operation will remove all ectopic endometrial lesions in the uterus, double appendages, and pelvis. It is suitable for severe patients over 45 years old without estrogen supplements after surgery.
 
 
The recurrence rate of endometriosis after treatment depends on the size of the focus, the scope of the focus, the nature of the focus, and whether there are other concomitant diseases. Therefore, long-term management is needed.

The need for long-term management of patients with endometriosis:
 
1. The etiology is unknown, among which meridians countercurrent is very common, which can reach 70% - 90%. Even if the lesion can be removed completely in the operation of endometriosis, it is inevitable for the patient to suffer from adverse blood flow before menopause or after the operation without using drugs to inhibit the ovarian function.
 
It is only a matter of time before new endometrial implants lead to the recurrence of endometriosis. Therefore, it will be a long-term task to delay or prevent the recurrence of endometriosis by using drugs to inhibit ovarian function or reduce menstrual blood volume.
 
2. Endometriosis infiltrates and grows around like malignant tumors, even invades the intestine, vagina, ureter, and bladder, which are difficult to be completely removed.
 
 
3. The annual recurrence rate of endometriosis is 10%, and the recurrence rate of 5 years can reach 50%. Therefore, we can actively take herbal medicine Fuyan Pill after the operation to help inhibit the proliferation of residual lesions and avoid recurrence.
 
Fuyan Pill has the effect of promoting blood circulation and removing blood stasis, which has a good effect on relieving the pain and discomfort of patients. In addition, its functions of clearing away heat and detoxification, strengthening the spleen and removing dampness have a certain effect on preventing postoperative adhesions, inhibiting the proliferation of residual lesions and reducing postoperative adhesions.
 
4. Endometriosis may cause canceration and endanger the life of patients. The patients with postmenopausal recurrence, change of pain rhythm, aggravation and persistence of dysmenorrhea, solid or papillary structure or rich blood flow around the focus, and significantly increased serum CA125 should be wary of malignant change.
 
Endometriosis also increases the incidence of breast cancer and skin melanoma. Therefore, in the treatment of endometriosis, long-term treatment should also pay attention to monitoring the relevant indicators.
 
 
Tips: Patients with endometriosis who have had one operation to remove the ectopic focus and relapse after the operation are not recommended to have another operation. This is because two consecutive surgical treatments are hard to estimate the harm to the body. It is better to take consolidated treatment in time after the first operation, which can achieve twice the result with half the effort.
 
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