Therapiemöglichkeiten beim Uterus myomatosus - Neue Aspekte 2008

Zusammenfassung

Aufgrund der Häufigkeit des Uterus myomatosus sind die verschiedenen Aspekte der Therapie von großer Bedeutung. Viele Behandlungmöglichkeiten sind zwar seit Langem etabliert, aber insbesondere zur Myomembolisation, den verschiedenen Hysterektomieverfahren und der Frage der Myomenukleation der Kinderwunschpatientinnen gibt es für die tägliche Praxis wichtige neue Erkenntnisse. Prospektiv randomisierte Studien zeigen, dass Patientinnen ein Jahr nach Hysterektomie weniger Beschwerden haben, verglichen mit Frauen nach einer Myomembolisation und dass nach zwei Jahren keine Unterschiede zwischen den beiden Methoden bestehen. Zwei Jahre nach der Embolisation haben knapp 25 % der Frauen eine Hysterektomie erhalten. Die Fertilität ist nach einer Myomembolisation im Vergleich zur Kontrollgruppe, die organerhaltend operiert wurde, reduziert und die Abortrate deutlich erhöht. In randomisierten Studien konnte gezeigt werden, dass die suprazervikale Hysterektomie gegenüber der totalen Hysterektomie keinen Vorteil hinsichtlich Sexualität, Inkontinenz oder Darmfunktion hat. Die laparoskopischen Hysterektomietechniken gehen mit einem erhöhten Risiko für Verletzungen des Harntraktes einher, verringern aber die postoperative Morbidität der Patientinnen.

Abstract

Due to the high incidence of uterine leiomyomas, various aspects involved in the treatment of the condition are extremely important. Many treatment methods are already long established, but there are important new findings that are of relevance for everyday practice - particularly with regard to myoma embolization, various hysterectomy procedures, and the issue of myoma enucleation in patients wishing to have children. Prospective and randomized studies have shown that 1 year after hysterectomy, patients have fewer symptoms compared to women who undergo myoma embolization, and that after 2 years there are no differences between the two methods. Two years after embolization, 20 - 25 % of the women having received this form of treatment had also undergone a hysterectomy. After myoma embolization, fertility was found to be reduced compared to a control group undergoing organ-preserving surgery, and the rate of miscarriages was markedly increased. It has been shown in randomized studies that supracervical hysterectomy offers no advantages over total hysterectomy with regard to sexuality, incontinence, or bowel function. Laparoscopic hysterectomy techniques are associated with an increased risk of injury to the urinary tract, but reduce the postoperative morbidity for patients.

Schlüsselwörter

Myomembolisation - Kinderwunsch - Fertilität - Abort - Myomenukleation

Key words

myoma embolization - desire for children - fertility - miscarriage - myoma enucleation

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