Interdisziplinäre Diagnostik und Therapie der tief infiltrierenden Endometriose

Zusammenfassung

Endometriose ist die zweithäufigste benigne Erkrankung des weiblichen Genitales nach der Leiomyomatose. In diesem Artikel wird die Therapie der tief infiltrierenden Endometriose unter dem Aspekt der Interdisziplinarität veranschaulicht. Endometriose wird definiert durch die Anwesenheit von Endometriumdrüsen und endometrialem Stroma außerhalb des inneren Epithels des Cavum uteri. Dadurch kann die Endometriose eine Reihe von ganz unterschiedlichen Symptomen verursachen. Hierzu gehören: chronische Unterbauchschmerzen, Dysmenorrhö, Dyspareunie, Subfertilität, unspezifische Unterbauchschmerzen, zyklische Darm- oder Blasensymptome (z. B. Dyschezie, Meteorismus, Obstipation, rektaler Blutabgang, Diarrhöen, Hämaturie), Blutungsstörungen oder chronische Müdigkeit. Etwa 50 % aller weiblicher Jugendlicher und bis zu 32 % aller Frauen im reproduktionsfähigen Alter, die aufgrund chronischer Unterbauchschmerzen oder Dysmenorrhö operiert werden, leiden an Endometriose. Das Zeitintervall zwischen den ersten unspezifischen Symptomen und der festen Diagnose beträgt bei der Endometriose etwa 7 Jahre. Hierfür ist nicht nur die ganz unspezifische Symptomatik verantwortlich, sondern vor allem auch die häufig fehlende Sensibilisierung der kooperierenden Fachdisziplinen, an die sich die Patientinnen im Erstkontakt wenden. Da die Pathogenese der Endometriose noch nicht eindeutig verstanden ist, ist eine kausale Therapie bisher nach wie vor nicht möglich. Die Therapieoptionen beinhalten: abwartendes Verhalten, Analgesie, hormonelle Therapie, operative Intervention und die Kombination aus Operation und medikamentöser Therapie. Die für jede individuelle Patientin richtige Therapieentscheidung setzt sich vor allem aus dem Leidensdruck und dem Kinderwunsch zusammen und sollte so radikal wie nötig und so minimal wie möglich erfolgen. Die Rezidivrate für therapierte Endometriose liegt zwischen 5 und > 60 % und ist stark abhängig von dem ganzheitlichen Management sowie der operativen Qualität der jeweiligen Klinik. Zur Optimierung der individuellen Endometriosetherapie ist folglich Interdisziplinarität in Diagnostik und Therapie wegweisend und sollte vor allem bei der tief infiltrierenden Endometriose entsprechenden Zentren vorbehalten bleiben.

Abstract

Endometriosis is the second most common benign female genital disease after uterine myoma. This review discusses the interdisciplinary approach to the treatment of deep infiltrating endometriosis. Endometriosis has been defined as the presence of endometrial glands and stroma outside the internal epithelial lining of the cavum uteri. As a consequence, endometriosis can cause a wide range of symptoms such as chronic pelvic pain, subfertility, dysmenorrhea, deep dyspareunia, cyclical bowel or bladder symptoms (e.g., dyschezia, bloating, constipation, rectal bleeding, diarrhoea and hematuria), abnormal menstrual bleeding, chronic fatigue or low back pain. Approx. 50 % of teenagers and up to 32 % of women of reproductive age, operated for chronic pelvic pain or dysmenorrhoea, suffer from endometriosis. The time interval between the first unspecific symptoms and the medical diagnosis of endometriosis is about 7 years. This is caused not only by the non-specific nature of the symptoms but also by the frequent lack of awareness on the part of the cooperating disciplines with which the patients have first contact. As the pathogenesis of endometriosis is not clearly understood, a causal treatment is still impossible. Treatment options include expectant management, analgesia, hormonal medical therapy, surgical intervention and the combination of medical treatment before and/or after surgery. The correct treatment for each patient should take into account the severity of the disease and whether the patient desires to have children. The treatment should be as radical as necessary and as minimal as possible. The recurrence rate among treated patients lies between 5 and > 60 % and is very much dependent on the integrated management and surgical skills of the respective hospital. Consequently, to optimise the individual patientʼs treatment, a high degree of interdisciplinary cooperation in diagnosis and treatment is crucial and should, especially in the case of deep infiltrating endometriosis, be undertaken in appropriate centres.

Schlüsselwörter

Endometriose - Laparoskopie - interdisziplinäre Chirurgie - Subfertilität - Unterbauchschmerzen - Dysmenorrhö

Key words

endometriosis - laparoscopy - interdisciplinary surgery - subfertility - lower abdominal pain - dysmenorrhoea

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