Endokrine operative Therapie der Adenomyosis

Zusammenfassung Die Adenomyosis ist eine Erkrankung, die zu einer Struktur- und Funktionsänderung des Uterus führt. Die Genese ist bisher nicht eindeutig geklärt. Hauptsymptome sind die Dysmenorrhö, Blutungsstörungen und die ungewollte Kinderlosigkeit. Die endgültige Diagnose kann nur am histologischen Präparat gestellt werden. Dazu stehen die transabdominale oder transvaginale Stanzbiopsie und die transzervikale Resektion zur Verfügung. Als hormonelle Therapie hat sich die kontinuierliche Gabe eines Ovulationshemmers oder die Einlage einer Hormonspirale (mit Levonorgestrel oder Danazol beladen) bewährt. Bei Kinderwunsch, aber auch als Vorbereitung für einen operativen Eingriff oder für IVF, ICSI ist die Applikation von GnRH-Agonisten effektiv. Eine umschriebene fokale Adenomyosis kann organerhaltend reseziert werden. Oberflächliche Adenomyosisherde lassen sich mit einer transzervikalen hysteroskopischen Schlingenresektion entfernen. Die Hysterektomie gilt als Therapie der Wahl bei ausgedehnten Befunden. Abstract Adenomyosis represents a pathologic change of uterine architecture which may result in uterine dysfunction. There are various theories on its pathogenesis. The main symptoms are dysmenorrhea, bleeding disorders, and infertility. Vaginal ultrasound and MRI show specific signs for adenomyosis. The definite diagnosis is made on histologic specimens retrieved from transabdominal or transvaginal punch biopsy or transcervical loop resection. Hormonal treatment includes continuous application of contraceptives or insertion of an intrauterine device loaded with desogestrel or danazol. GnRH analogues increase the pregnancy rate without surgery or improve the results of surgery and IVF or ICSI. With partial resection of adenomyotic nodules or transcervical loop resection, hysterectomy, which represents the classic surgical treatment of choice, can be avoided. 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J Am Assoc Gynecol Laparosc 9:293–296 Wood C, Maher P, Hill D (1993) Biopsy diagnosis and conservative surgical treatment of adenomyosis. Aust N Z J Obstet Gynaecol 33:319–321 Interessenkonflikt: Der korrespondierende Autor versichert, dass keine Verbindungen mit einer Firma, deren Produkt in dem Artikel genannt ist, oder einer Firma, die ein Konkurrenzprodukt vertreibt, bestehen. Author information Authors and Affiliations Corresponding author Rights and permissions About this article Cite this article Keckstein, J., Ulrich, U. Endokrine operative Therapie der Adenomyosis. Gynäkologische Endokrinologie 2, 11–18 (2004). https://doi.org/10.1007/s10304-004-0049-6 Issue date: DOI: https://doi.org/10.1007/s10304-004-0049-6