Operative Therapie der Endometriose

Zusammenfassung Die operative Therapie der Endometriose ist als die wichtigste therapeutische Maßnahme anzusehen. Die Hauptindikation für eine Operation ist der starke Schmerz, die Sterilität sowie eine progressive Veränderung der Organanatomie. Ziel ist es, die Endometriose zu inaktivieren bzw. zu beseitigen. Der Widerspruch zwischen einer vollständigen Entfernung der Endometriose und dem Wunsch nach Organerhalt erfordert individuelle Lösungen. Die Auswahl der Operation erfolgt in Abhängigkeit des Alters, der Vorgeschichte, der anatomischen Situation und des Wunsches der Patientin. Die Entscheidung operative Laparotomie oder endoskopischer Eingriff wird durch den Befund und die Erfahrung des Operateurs bestimmt. Die Adenomyosis uteri wird meist durch eine Hysterektomie therapiert, wobei auch hier konservative Operationsverfahren zur Anwendung kommen. Die Ergebnisse der operativen Therapie zeigen bei entsprechender Indikationswahl und individueller Operationsplanung eine hohe Erfolgsrate. Endoskopische Operationen scheinen der konventionellen Laparotomie überlegen zu sein. Abstract Surgery is the most important approach to endometriosis. The main indications for surgery are severe pain, sterility and progressive changes to the anatomical structures of pelvic organs. The aim is to inactivate and/or remove the endometriotic lesions. There is a tension between complete removal of all endometriotic tissue and the desire to preserve the organs, which means that individually tailored treatment strategies are necessary. The surgical procedure selected depends on the patient’s age and previous medical history, the anatomical situation and the patient’s wishes. The surgeon’s experience is the decisive factor in the decision on whether a laparotomy or laparoscopic surgery is done. Adenomyosis is genereally treated by hysterectomy in most cases; conservative surgical procedures can be successful in selected cases. The success rates after surgical treatment of endometriosis are high, providing that patients are carefully selected and the surgery is individually planned. On the whole, endoscopic surgery seems to be superior to conventional laparotomy. Similar content being viewed by others Literatur Rawson JM (1991) Prevalence of endometriosis in asymptomatic women. J Reprod Med 36: 513–515 Martin DC, Hubert GD, Vander ZR, Zeky FA el (1989) Laparoscopic appearances of peritoneal endometriosis. Fertil Steril 51: 63–67 Koninckx PR, Martin D (1994) Treatment of deeply infiltrating endometriosis. Curr Opin Obstet Gynecol 6: 231–241 Ulrich U, Hucke J, Schweppe KW (2005) Empfehlungen zur Diagnostik und Therapie der Endometriose. 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