Alkatout Ibrahim, Wedel Thilo, Maass Nicolai
Klinik für Gynäkologie und Geburtshilfe, Kiel School of Gynecological Endoscopoy, Universitätsklinikum Schleswig-Holstein.
Institut für Anatomie, Zentrum für Klinische Anatomie, Christian-Albrechts Universität zu Kiel.
Aktuelle Urol. 2018 Feb;49(1):60-72. doi: 10.1055/s-0043-122175. Epub 2018 Feb 1.
Endometriosis is the second most common benign female genital disease after uterine myoma. This review discusses the management of individual patients. This should take into account the severity of the disease and whether the patient desires to have children. Particular emphasis is laid on the anatomical intersections which, when injured, can lead to persistent damage of the anterior, middle or posterior compartment and are not infrequently the cause of urological and urogynaecological follow-up measures. Typical symptoms of endometriosis include chronic pelvic pain, subfertility, dysmenorrhoea, deep dyspareunia, cyclical bowel or bladder symptoms (e. g. dyschezia, bloating, constipation, rectal bleeding, diarrhoea and haematuria), abnormal menstrual bleeding, chronic fatigue and low back pain. Approx. 50 % of all female teenagers and up to 32 % of all women of reproductive age who have been 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, 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 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 integrated management and surgical skills. Consequently, to optimise the individual patient's treatment, a high degree of interdisciplinary cooperation in diagnosis and treatment is crucial and should be reserved to appropriate centres - especially in the case of deep infiltrating endometriosis.
子宫内膜异位症是仅次于子宫肌瘤的第二常见的女性良性生殖器疾病。本综述讨论了个体患者的管理。这应考虑到疾病的严重程度以及患者是否渴望生育。特别强调了解剖学上的交叉部位，这些部位受损时可导致前、中或后盆腔持续损伤，并且常常是泌尿外科和泌尿妇科后续治疗措施的原因。子宫内膜异位症的典型症状包括慢性盆腔疼痛、不孕、痛经、深部性交困难、周期性肠道或膀胱症状（如排便困难、腹胀、便秘、直肠出血、腹泻和血尿）、异常子宫出血、慢性疲劳和腰痛。在所有因慢性盆腔疼痛或痛经接受手术的女性青少年中，约50%患有子宫内膜异位症，在所有育龄女性中这一比例高达32%。从最初出现非特异性症状到子宫内膜异位症的医学诊断之间的时间间隔约为7年。这不仅是由于症状的非特异性，还由于患者最初接触的协作科室常常缺乏认识。由于子宫内膜异位症的发病机制尚未完全明确，因此仍然无法进行病因治疗。治疗选择包括期待管理、镇痛、激素药物治疗、手术干预以及手术前后药物治疗的联合应用。治疗应尽可能彻底且尽可能微创。接受治疗的患者的复发率在5%至>60%之间，并且很大程度上取决于综合管理和手术技巧。因此，为了优化个体患者的治疗，在诊断和治疗中高度的多学科合作至关重要，并且应保留给合适的中心——尤其是在深部浸润性子宫内膜异位症的情况下。
