Operative Therapie der Endometriose: radikal und schonend zugleich

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• 作者：PD Dr. I. Alkatout M.A. (1)
  I. Meinhold-Heerlein (2)
  I. von Leffern (3)
  N. Maass (2)
  L. Mettler (1)
  
  1. Klinik f眉r Gyn盲kologie und Geburtshilfe ; Kiel School of Gynecological Endoscopoy ; Universit盲tsklinikum Schleswig-Holstein ; Campus Kiel ; Arnold-Heller-Str. 3/Haus 24 ; 24105 ; Kiel ; Deutschland
  2. Klinik f眉r Gyn盲kologie und Geburtshilfe ; Universit盲tsklinikum Aachen ; Aachen ; Deutschland
  3. Klinik f眉r Gyn盲kologie und Geburtshilfe ; Albertinen-Krankenhaus Hamburg ; Hamburg ; Deutschland
  
• 关键词：Adenomyosis uteri ; Laparoskopie ; Interdisziplin盲re Chirurgie ; Subfertilit盲t ; Dysmenorrh枚 ; Adenomyosis ; Laparoscopy ; Interdisciplinary surgery ; Subfertility ; Dysmenorrhea
• 刊名：Der Gyn?kologe
• 出版年：2015
• 出版时间：March 2015
• 年：2015
• 卷：48
• 期：3
• 页码：228-236
• 全文大小：1,167 KB
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• 刊物主题：Gynecology; Obstetrics/Perinatology; Endocrinology;
• 出版者：Springer Berlin Heidelberg
• ISSN：1433-0393

文摘

Background Endometriosis is the second most common benign female genital disease after uterine leiomyoma. Objectives This review discusses the individual management for each patient which should take into account the severity of the disease and whether the patient desires to have children. Endometriosis is defined as the presence of endometrial glands and stroma outside the internal epithelial lining of the cavity of the uterus. As a consequence, endometriosis can cause a wide range of symptoms, such as chronic pelvic pain, subfertility, dysmenorrhea, deep dyspareunia, cyclical bowel or bladder symptoms (e.g. dyschezia, bloating, constipation, rectal bleeding, diarrhea and hematuria), abnormal menstrual bleeding, chronic fatigue and low back pain. Results Approximately 50鈥? of teenage women and up to 32鈥? of women of reproductive age operated on for chronic pelvic pain or dysmenorrhea, suffer from endometriosis. The time interval between the first unspecific symptoms and the medical diagnosis of endometriosis is approximately 7 years. This is caused not only by the non-specific nature of the symptoms but also by the frequent lack of awareness on the part of the cooperating disciplines with which the patients have first contact. As the pathogenesis of endometriosis is not clearly understood, a causal treatment is still not possible. Treatment options include watchful waiting, analgesia, hormonal medical therapy, surgical intervention and the combination of medical treatment before and/or after surgery. The treatment should be as radical as necessary and as minimal as possible. The recurrence rate among treated patients lies between 5鈥? and >鈥?0鈥? and is very much dependent on the integrated management and surgical skills. Conclusion To optimize the individual patient treatment a high degree of interdisciplinary cooperation in the diagnosis and treatment is crucial and should be reserved for appropriate centres especially in the case of deep infiltrating endometriosis.