Kombinierte Therapie der Endometriose: Radikal und schonend zugleich

Subscribe to RSS DOI: 10.1055/s-0043-122175 Kombinierte Therapie der Endometriose: Radikal und schonend zugleich Combined treatment of endometriosis: radical yet gentleAuthors Publication History Publication Date: 01 February 2018 (online) Zusammenfassung Endometriose ist die zweithäufigste benigne Erkrankung des weiblichen Genitals nach der Leiomyomatose. Schwerpunkt dieser Übersicht ist die Darstellung des gynäkologischen Dilemmas zwischen medizinisch machbarem und für die individuelle Patientin sinnvollem Management. Im Vordergrund stehen die präoperative Diagnostik sowie die Planung der Operationsradikalität in Abhängigkeit des Leidensdruckes sowie des Kinderwunsches. Besonders herausgearbeitet werden die anatomischen Schnittmengenbereiche, die bei Verletzung zu (anhaltenden) Schädigungen des vorderen, mittleren und hinteren Kompartimentes führen können und damit nicht selten Ursache für urologische und urogynäkologische Folgemaßnahmen sind. Zu den typischen Symptomen der Endometriose gehören: Dysmenorrhoe, chronische Unterbauchschmerzen, Dyspareunie, Subfertilität, unspezifische Unterbauchschmerzen, zyklische Darm- oder Blasensymptome (z. B. Dyschezie, Meteorismus, Obstipation, rektaler Blutabgang, Diarrhoen, Hämaturie), Blutungsstörungen oder chronische Müdigkeit. Etwa 50 % aller weiblichen Jugendlichen und bis zu 32 % aller Frauen im reproduktionsfähigen Alter, die aufgrund chronischer Unterbauchschmerzen oder Dysmenorrhoe operiert werden; leiden an Endometriose. Das Zeitintervall zwischen den ersten unspezifischen Symptomen und der festen Diagnose beträgt bei der Endometriose etwa 7 Jahre. Hierfür ist nicht nur die ganz unspezifische Symptomatik verantwortlich, sondern v. a. auch die häufig fehlende Sensibilisierung der kooperierenden Fachdisziplinen, an die sich die Patientinnen im Erstkontakt wenden. Die Therapieoptionen beinhalten: Abwartendes Verhalten, Analgesie, hormonelle Therapie, operative Intervention und die Kombination aus Operation und medikamentöser Therapie. Die Rezidivrate für therapierte Endometriose liegt zwischen 5 % und > 60 % und ist stark abhängig von dem ganzheitlichen Management sowie der operativen Qualität. Zur Optimierung der individuellen Endometriosetherapie ist folglich Interdisziplinarität in Diagnostik und Therapie wegweisend und sollte v. a. bei der tief infiltrierenden Endometriose entsprechenden Zentren vorbehalten bleiben. Abstract Endometriosis is the second most common benign female genital disease after uterine myoma. This review discusses the management of individual patients. This should take into account the severity of the disease and whether the patient desires to have children. Particular emphasis is laid on the anatomical intersections which, when injured, can lead to persistent damage of the anterior, middle or posterior compartment and are not infrequently the cause of urological and urogynaecological follow-up measures. Typical symptoms of endometriosis include chronic pelvic pain, subfertility, dysmenorrhoea, deep dyspareunia, cyclical bowel or bladder symptoms (e. g. dyschezia, bloating, constipation, rectal bleeding, diarrhoea and haematuria), abnormal menstrual bleeding, chronic fatigue and low back pain. Approx. 50 % of all female teenagers and up to 32 % of all women of reproductive age who have been operated for chronic pelvic pain or dysmenorrhoea suffer from endometriosis. The time interval between the first unspecific symptoms and the medical diagnosis of endometriosis is about 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, causal treatment is still impossible. Treatment options include expectant management, 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 % and > 60 % and is very much dependent on integrated management and surgical skills. Consequently, to optimise the individual patient’s treatment, a high degree of interdisciplinary cooperation in diagnosis and treatment is crucial and should be reserved to appropriate centres – especially in the case of deep infiltrating endometriosis. - Literaturverzeichnis - 1 Olive DL, Schwartz LB. 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