Der Kampf mit der Hydra
Der Gynäkologe - 2017
Tóm tắt
Diagnostik und Behandlung der Endometriose ist eine Domäne der gynäkologischen Chirurgie. Hingegen bleibt die Frage nach dem Ausmaß der chirurgischen Intervention, um ein Konzeption zu ermöglichen, kontrovers. Dies gilt insbesondere für die Behandlung bei Befall von Kolon und Rektum. Als eindeutig vorteilhaft hat sich die chirurgische Eradikation von Endometrioseläsionen bei minimaler und milder Endometriose herausgestellt. Bei Ausbleiben einer Spontankonzeption nach kompletter Operation scheint die Anwendung von ART(„assisted reproduction techniques“)-Maßnahmen (In-vitro-Fertilisierung, IVF) Vorteile gegenüber einer erneuten Operation zu haben. Frauen mit großen Endometriomen oder Endometriosezysten sollten chirurgisch behandelt werden, allein um die Follikelpunktion zu erleichtern und das Risiko einer Infektion zu minimieren. Kommt es nach mehrfachen IVF-Versuchen nicht zur Schwangerschaft und besteht eine symptomlose, aber schwere und sehr ausgedehnte Endometriose, ist eine individuelle, personalisierte Behandlungsstrategie erforderlich. Eine erneute konservative radikale Operation scheint das nachfolgende IVF-Ergebnis eher zu verbessern.
Từ khóa
Tài liệu tham khảo
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