Stratégie thérapeutique dans l’endométriose

Résumé L’endométriose est définie par la présence en situation ectopique d’épithélium endométrial et de stroma. Cette maladie bénigne, due à un tissu hormonodépendant, est le plus souvent diagnostiquée à un moment de son évolution, où se sont constituées des séquelles et/ou une réaction du tissu sur lequel l’endomètre est greffé. Ces séquelles ou cette « hypertrophie réactionnelle » du tissu hôte sont en règle hormono-indépendants ou insensibles. À ce stade, la chirurgie devient le seul recours efficace, mais il faut connaître et tenir compte de ses limites: récidives des adhérences péritonéales, non prise en compte des causes ou mécanismes de la maladie, non-traitement des lésions microscopiques. Abstract Endometriosis is defined by the presence of ectopic endometrial epithelium and stroma. This benign disease due to hormone-dependent tissue is most often diagnosed at some time during its development, made up of sequelae and/or a reaction of the tissue under the endometrium. These sequelae or this “reactional hypertrophy” of the host tissue are as a rule hormone-independent or insensitive. At this stage, surgery becomes the only effective option, but its limits should be recognised and taken into account: recurrence of peritoneal adhesions, non-consideration of the causes or mechanisms of the disease, non-treatment of microscopic lesions. Références Freud S (1985) L’analyse avec fin et l’analyse sans fin. In: Résultats, idées, problèmes, vol II, PUF, pp 231–268 Canis M (2007) L’endométriose est une maladie simple. J Gynecol Obstet Biol Reprod 36:106–107 Canis M, Mage G, Wattiez A, et al (1992) Second-look laparoscopy after laparoscopic cystectomy of large ovarian endometriomas. Fertil Steril 58:617–619 Donnez J, Nisolle M, Gillerot S, et al (1994) Ovarian endometrial cysts: the role of gonadotropin-releasing hormone agonist and/or drainage. Fertil Steril 62:63–66 Schweppe KW, Dmowski WP, Wynn RM (1981) Ultrastructural changes in endometriotic tissue during danazol treatment. Fertil Steril 36:20–26 Evers JL (1987) The second-look laparoscopy for evaluation of the result of medical treatment of endometriosis should not be performed during ovarian suppression. Fertil Steril 47:502–504 Chêne G, Jaffeux P, Lasnier C, et al (2008) Are there anatomical and clinical correlations between minimal and deep endometriosis? First results of Auvergne’s Registry of Endometriosis. Gynecol Obstet Fertil 36:17–22 Matsuzaki S, Canis M, Vaurs-Barrière C, et al (2005) DNA microarray analysis of gene expression in eutopic endometrium from patients with deep endometriosis using laser capture microdissection. Fertil Steril 84:1180–1190 Fritel X (2007) Les formes anatomocliniques de l’endométriose. J Gynecol Obstet Biol Reprod 36:113–118 Kennedy S, Bergqvist A, Chapron C, et al (2005) ESHRE guideline for the diagnosis and treatment of endometriosis. Hum Reprod 20:2698–2704 Sutton CJ, Ewen SP, Whitelaw N, Naines P (1994) Prospective, randomised, double blind, controlled trial of laser laparoscopy in the treatment of pelvic pain associated with minimal, mild and moderate endometriosis. Fertil Steril 62:696–700 Abbott J, Hawe J, Hunter D, et al (2004) Laparoscopic excision of endometriosis: a randomised, placebo-controlled trial. Fertil Steril 82:878–884 Golfier F, Sabra M (2007) Traitement chirurgical de l’endométriose. J Gynecol Obstet Biol Reprod 36:162–172 Bianchi PH, Pereira RM, Zanatta A, et al (2009) Extensive excision of deep infiltrative endometriosis before in vitro fertilization significantly improves pregnancy rates. J Minim Invasive Gynecol 16:174–180 Vercellini P, Pietropaolo G, De Giorgi O, et al (2006) Reproductive performance in infertile women with rectovaginal endometriosis: is surgery worthwhile? Am J Obstet Gynecol 195:1303–1310 Matsuzaki S, Canis M, Pouly JL, et al (2006) Relationship between delay of surgical diagnosis and severity of disease in patients with symptomatic deep infiltrating endometriosis. Fertil Steril 86:1314–1316 Bourdel N, Matsusakï S, Roman H, et al (2006) Endométriose chez l’adolescente. Gynecol Obstet Fertil 34:727–734 Hart RJ, Hickey M, Maouris P, Buckett W (2008) Excisional surgery versus ablative surgery for ovarian endometriomata. Cochrane Database Syst Rev 2: CD004992 Canis M, Pouly JL, Tamburro S, et al (2001) Ovarian response during IVF-embryo transfer cycles after laparoscopic ovarian cystectomy for endometriotic cysts of superior to 3 cm in diameter. Hum Reprod 16:2583–2586 Roman H (2007) Prise en charge d’une endométriose douloureuse. J Gynecol Obstet Biol Reprod 36:141–150 Maubon A, Bazot M (2007) Imagerie de l’endométriose. J Gynecol Obstet Biol Reprod 36:129–134 Nisolle M, Pasleau F, Foidart JM (2007) Endométriose extragénitale. J Gynecol Obstet Biol Reprod 36:173–178 Daraï E, Marpeau O, Thomassin I, et al (2005) Fertility after laparoscopic colorectal resection for endometriosis: preliminary results. Fertil Steril 84:945–950 Coronado C, Franklin RR, Lotze EC, et al (1990) Surgical treatment of symptomatic colorectal endometriosis. Fertil Steril 53:411–416 Matsuzaki S, Houlle C, Botchorishvili R, et al (2009) Excision of the posterior vaginal fornix is necessary to ensure complete resection of rectovaginal endometriotic nodules of more than 2 cm in size. Fertil Steril 91:1314–1315 Author information Authors and Affiliations Corresponding author Rights and permissions About this article Cite this article Canis, M., Jardon, K., Rabischong, B. et al. Stratégie thérapeutique dans l’endométriose. Pelv Perineol 4, 283–290 (2009). https://doi.org/10.1007/s11608-009-0268-3 Received: Accepted: Published: Issue date: DOI: https://doi.org/10.1007/s11608-009-0268-3