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Frauenheilkunde up2date 2012; 6(4): 205-220
DOI: 10.1055/s-0032-1315007
Allgemeine Gynäkologie und gynäkologische Onkologie
Georg Thieme Verlag KG Stuttgart · New York

Die operative Therapie der Endometriose

J. Hackl
,
J. Lermann
,
S. Burghaus
,
P. Klingsiek
,
C. Schulze
,
A. Boosz
,
T. Hildebrandt
,
M. W. Beckmann
,
S. P. Renner
Further Information

Publication History

Publication Date:
30 August 2012 (online)

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Kernaussagen

Zur Behandlung der Endometriose stehen verschiedene Maßnahmen zur Verfügung wie die endokrine, die symptomatische und die operative Therapie einzeln oder in Kombination. Die individuelle Situation der Patientin gilt es immer zu berücksichtigen. Vor Planung einer operativen Sanierung steht eine umfassende Diagnostik, um eine mögliche Untertherapie oder Übertherapie der zu Rezidiven neigenden Erkrankung zu vermeiden und um das Ausmaß der Endometriose vor den häufig komplexen Eingriffen zu erfassen.

Bei Verdacht auf Endometriose sollte zur Diagnosesicherung die diagnostische Laparoskopie durchgeführt werden (Goldstandard) und gegebenenfalls zur sanierenden Operation erweitert werden. Ziel ist die Resektion in sano, die auch in fortgeschrittenen Stadien und bei tief infiltrierender Endometriose unter Einbeziehung anderer Fachrichtungen (Urologie, Chirurgie) sehr häufig laparoskopisch möglich ist. Für die unterschiedlich eingesetzten Techniken bei tief infiltrierender Endometriose liegen keine belastbaren Evidenzen vor. Neben der Operation spielt die medikamentöse Therapie eine nicht minder wichtige Rolle zur Vermeidung von Rezidiven und zur Symptomkontrolle.

 

  • Literatur

  • 1 Knapp VJ. How old is endometriosis? Late 17th and 18th century European descriptions of the disease. Fertil Steril 1999; 72: 10-14
    CrossrefGoogle Scholar
  • 2 Mahmood TA, Templeton A. Prevalence and genesis of endometriosis. Hum Reprod 1991; 6: 544-549
    CrossrefGoogle Scholar
  • 3 Moen MH, Schei B. Epidemiology of endometriosis in a Norwegian county. Acta Obstet Gynecol Scand 1997; 76: 559-562
    CrossrefPubMedGoogle Scholar
  • 4 Vigano P et al. Endometriosis: epidemiology and aetiological factors. Best Pract Res Clin Obstet Gynaecol 2004; 18: 177-200
    CrossrefPubMedGoogle Scholar
  • 5 Witz CA, Burns WN. Endometriosis and infertility: is there a cause and effect relationship?. Gynecol Obstet Invest 2002; 53 (Suppl. 01) 2-11
    CrossrefGoogle Scholar
  • 6 Sampson J. Peritoneal endometriosis due to menstrual dissemination of endometrial tissue into the peritoneal cavity. Am J Obst Gynecol 1927; 14: 442-469
    Google Scholar
  • 7 Meyer R. Über den Stand der Frage der Adenomyositis, Adenomyome im Allgemeinen und insbesondere über Adenomyositis seroepithelialis und Adenomyometritis sarcomatosa. Zentralbl Gynakol 1919; 36: 745-750
    Google Scholar
  • 8 Schindler A. Epidemiologie, Pathogenese und Diagnostik der Endometriose. Journal für Fertilität und Reproduktion 2007; 17: 22-27
    Google Scholar
  • 9 Revised American Society for Reproductive Medicine classification of endometriosis: 1996. Fertil Steril 1997; 67: 817-821
    CrossrefGoogle Scholar
  • 10 Tuttlies F et al. [ENZIAN-score, a classification of deep infiltrating endometriosis]. Zentralbl Gynakol 2005; 127: 275-281
    Article in Thieme ConnectPubMedGoogle Scholar
  • 11 Stiftung Endometriose-Forschung SEF. SEF-Sitzung „Weissensee Treffen 2012“
    Google Scholar
  • 12 Haas D, Chvatal R, Habelsberger A et al. Comparison of revised American Fertility Society and ENZIAN staging: a critical evaluation of classifications of endometriosis on the basis of our patient population. Fertil Steril 2011; 95: 1574-1578
    CrossrefGoogle Scholar
  • 13 Pritts EA, Taylor RN. An evidence-based evaluation of endometriosis-associated infertility. Endocrinol Metab Clin North Am 2003; 32: 653-667
    CrossrefGoogle Scholar
  • 14 Ebert A. Endometriose. Berlin: De Gruyter; 2003
    Google Scholar
  • 15 Schweppe K. Endometriose – Eine Erkrankung ohne Lobby. Zentralbl Gynakol 2003; 125: 233
    Article in Thieme ConnectPubMedGoogle Scholar
  • 16 Schindler AE. Operative und medikamentöse Therapie der Endometriose/Adenomyose. J Gynäkol Endokrinol 2008; 18: 18-26
    Google Scholar
  • 17 Garry R. The effectiveness of laparoscopic excision of endometriosis. Curr Opin Obstet Gynecol 2004; 16: 299-303
    CrossrefGoogle Scholar
  • 18 Deutsche Gesellschaft für Gynäkologie und Geburtshilfe (DGGG). Diagnostik und Therapie der Endometriose. 2010 available from: http://www.awmf.org
    Google Scholar
  • 19 Vercellini P et al. Laparoscopic uterosacral ligament resection for dysmenorrhea associated with endometriosis: results of a randomized, controlled trial. Fertil Steril 2003; 80: 310-319
    CrossrefPubMedGoogle Scholar
  • 20 Jacobson TZ et al. Laparoscopic surgery for subfertility associated with endometriosis. Cochrane Database Syst Rev 2010; (1) CD001398
    Google Scholar
  • 21 Sutton CJ et al. Prospective, randomized, double-blind, controlled trial of laser laparoscopy in the treatment of pelvic pain associated with minimal, mild, and moderate endometriosis. Fertil Steril 1994; 62: 696-700
    CrossrefPubMedGoogle Scholar
  • 22 Shakiba K et al. Surgical treatment of endometriosis: a 7-year follow-up on the requirement for further surgery. Obstet Gynecol 2008; 111: 1285-1292
    CrossrefPubMedGoogle Scholar
  • 23 Busacca M, Fedele L, Bianchi S et al. Surgical treatment of recurrent endometriosis: laparotomy versus laparoscopy. Hum Reprod 1998; 13: 2271-2274
    CrossrefPubMedGoogle Scholar
  • 24 Hart RJ et al. Excisional surgery versus ablative surgery for ovarian endometriomata. Cochrane Database Syst Rev 2008; (2) CD004992
    Google Scholar
  • 25 Beretta P et al. Randomized clinical trial of two laparoscopic treatments of endometriomas: cystectomy versus drainage and coagulation. Fertil Steril 1998; 70: 1176-80
    CrossrefPubMedGoogle Scholar
  • 26 Chapron C, Fritel X, Dubuisson JB. Fertility after laparoscopic management of deep endometriosis infiltrating the uterosacral ligaments. Hum Reprod 1999; 14: 329-332
    CrossrefGoogle Scholar
  • 27 Donnez J et al. Large ovarian endometriomas. Hum Reprod 1996; 11: 641-646
    CrossrefGoogle Scholar
  • 28 Busacca M, Vignali M. Endometrioma excision and ovarian reserve: a dangerous relation. J Minim Invasive Gynecol 2009; 16: 142-148
    CrossrefGoogle Scholar
  • 29 Hwu YM et al. The impact of endometrioma and laparoscopic cystectomy on serum anti-Mullerian hormone levels. Reprod Biol Endocrinol 2011; 9: 80
    CrossrefGoogle Scholar
  • 30 Benaglia L et al. Rate of severe ovarian damage following surgery for endometriomas. Hum Reprod 2010; 25: 678-682
    CrossrefPubMedGoogle Scholar
  • 31 Muller A et al. Retransplantation of cryopreserved ovarian tissue: the first live birth in Germany. Dtsch Arztebl Int 2012; 109: 8-13
    Google Scholar
  • 32 Chapron C. Management of deep endometriosis. WES E-Journal 2007; 3-6
    Google Scholar
  • 33 Chopin N et al. Operative management of deeply infiltrating endometriosis: results on pelvic pain symptoms according to a surgical classification. J Minim Invasive Gynecol 2005; 12: 106-112
    Google Scholar
  • 34 Possover M et al. Laparascopically assisted vaginal resection of rectovaginal endometriosis. Obstet Gynecol 2000; 96: 304-307
    CrossrefGoogle Scholar
  • 35 Vercellini P et al. Surgery for deep endometriosis: a pathogenesis-oriented approach. Gynecol Obstet Invest 2009; 68: 88-103
    CrossrefGoogle Scholar
  • 36 Wallwiener D, Jonat W, Kreienberg R et al. Atlas der gynäkologischen Operationen. 7.. Aufl. Stuttgart: Georg Thieme Verlag; 2009
    Google Scholar
  • 37 Darai E et al. Feasibility and clinical outcome of laparoscopic colorectal resection for endometriosis. Am J Obstet Gynecol 2005; 192: 394-400
    CrossrefGoogle Scholar
  • 38 Busacca M et al. Determinants of long-term clinically detected recurrence rates of deep, ovarian, and pelvic endometriosis. Am J Obstet Gynecol 2006; 195: 426-432
    CrossrefGoogle Scholar
  • 39 Minelli L et al. Laparoscopic colorectal resection for bowel endometriosis: feasibility, complications, and clinical outcome. Arch Surg 2009; 144: 234-239 discussion 239
    CrossrefGoogle Scholar
  • 40 Keckstein J. Operative Therapie der Endometriose. Berlin: Kongress der DGGG 2006
    Google Scholar
  • 41 Keckstein J, Ulrich U, Kandolf O et al. Die laparoskopische Therapie der Darmendometriose und der Stellenwert der medikamentösen Therapie. Zentralbl Gynakol 2003; 125: 259-266
    Article in Thieme ConnectGoogle Scholar
  • 42 Köhler C, Mangler M, Loddenkemper C et al. Ein kombinierter Operationsansatz zur Therapie der rektovaginalen Endometriose auf der Basis histologischer Befunde. J Gynäkolog Endokrinol 2008; 2: 44-47
    Google Scholar
  • 43 Perez-Utrilla Perez M et al. Urinary tract endometriosis: clinical, diagnostic, and therapeutic aspects. Urol 2009; 73: 47-51
    CrossrefGoogle Scholar
  • 44 Donnez J, Squifflet J, Donnez O et al. Bladder Endometriosis. Atlas of operative Laparoscopy and Hysteroscopy. London: Informa UK Ltd.; 2007: 85-91
    Google Scholar
  • 45 Keckstein J, Ulrich U. Endokrine und operative Therapie der Adenomyose. Gynäkol Endokrinol 2004; 2: 11-18
    Google Scholar
  • 46 Hisao O, Silber S, Toshiyuki K et al. Surgical procedure to conserve the uterus for future pregnancy in patients suffering from massive adenomyosis. Reproductive BioMedicine Online 2011; 22: 94-99
    CrossrefGoogle Scholar
  • 47 Jacobson TZ, Barlow DH, Koninckx P et al. Laparoscopic surgery for subfertility associated with endometriosis. Cochrane Database Syst Rev 2002; (4) CD001398
    Google Scholar
  • 48 Bianchi PHM, Pereira RMA, Zanatta A et al. Extensive excision of deep infiltrative endometriosis before in vitro fertilization significantly improves pregnancy rates. J Minim Invasive Gynecol 2009; 16: 174-180
    CrossrefGoogle Scholar
  • 49 Chapron C, Fritel X, Dubuisson JB. Fertility after laparoscopic management of deep endometriosis infiltrating the uterosacral ligaments. Hum Reprod 1999; 14: 329-332
    CrossrefGoogle Scholar
  • 50 Renner SP et al. Preoperative pain and recurrence risk in patients with peritoneal endometriosis. Gynecol Endocrinol 2010; 26: 230-235
    CrossrefGoogle Scholar
  • 51 Renner SP, Oppelt P, Binder H, Beckmann MW. Endometriose. Geburtsh Frauenheilk 2006; R61-R88
    Article in Thieme ConnectGoogle Scholar
  • 52 Busacca M et al. Post-operative GnRH analogue treatment after conservative surgery for symptomatic endometriosis stage III–IV: a randomized controlled trial. Hum Reprod 2001; 16: 2399-2402
    CrossrefGoogle Scholar
  • 53 Hornstein MD et al. Prospective randomized double-blind trial of 3 versus 6 months of nafarelin therapy for endometriosis associated pelvic pain. Fertil Steril 1995; 63: 955-962
    CrossrefPubMedGoogle Scholar
  • 54 Vercellini P et al. A gonadotropin-releasing hormone agonist compared with expectant management after conservative surgery for symptomatic endometriosis. Br J Obstet Gynaecol 1999; 106: 672-677
    CrossrefGoogle Scholar
  • 55 Hornstein MD et al. Use of nafarelin versus placebo after reductive laparoscopic surgery for endometriosis. Fertil Steril 1997; 68: 860-864
    CrossrefGoogle Scholar
  • 56 Sallam H, Garcia-Velasco JA, Dias S, Arici A. Long-term pituitary down-regulation before in vitro fertilization (IVF) for women with endometriosis. Cochrane Database Syst 2006; (1) CD004635
    Google Scholar
  • 57 Moore J, Kennedy S, Prentice A. Modern combined oral contraceptives for pain associated with endometriosis. Cochrane Database Syst Rev 2000; (2) CD001019
    Google Scholar
  • 58 Zupi E, Marconi D, Sbracia M et al. Add-back therapy in the treatment of endometriosis-associated pain. Fertil Steril 2004; 82: 1303-1308
    CrossrefGoogle Scholar
  • 59 Fedele L, Berlanda N. Emerging drugs for endometriosis. Expert Opin Emerg Drugs 2004; 9: 167-177
    CrossrefGoogle Scholar
  • 60 Regidor PA et al. Prospective randomized study comparing the GnRH-agonist leuprorelin acetate and the gestagen lynestrenol in the treatment of severe endometriosis. Gynecol Endocrinol 2001; 15: 202-209
    CrossrefPubMedGoogle Scholar
  • 61 Telimaa S, Ronnberg L, Kauppila A. Placebo-controlled comparison of danazol and high-dose medroxyprogesterone acetate in the treatment of endometriosis after conservative surgery. Gynecol Endocrinol 1987; 1: 363-371
    CrossrefGoogle Scholar
  • 62 Dawood MY et al. Clinical, endocrine, and metabolic effects of two doses of gestrinone in treatment of pelvic endometriosis. Am J Obstet Gynecol 1997; 176: 387-394
    CrossrefGoogle Scholar
  • 63 Strowitzki T et al. Dienogest in the treatment of endometriosis-associated pelvic pain: a 12-week, randomized, double-blind, placebo-controlled study. Eur J Obstet Gynecol Reprod Biol 2010; 151: 193-198
    CrossrefPubMedGoogle Scholar
  • 64 Seitz C et al. Safety of dienogest in the long-term treatment of endometriosis: a one-year, open-label, follow-up study. Fertil Steril 2009; 92: S107
    Google Scholar
  • 65 Allen C et al. Non-steroidal anti-inflammatory drugs for pain in women with endometriosis. Cochrane Database Syst Rev 2005; (4) CD004753
    Google Scholar