ENDOMETRİYOZİS TEDAVİSİNDE GÜNCEL YAKLAŞIM

Year 2012, Volume: 75 Issue: 4, 60 - 70, 15.04.2013

Ercan Baştu , Mehmet Mutlu Hasan Serdaroğlu

Abstract

Endometriyozis, genelde kronik pelvik ağrıya ve infertiliteye yol açan kronik jinekolojik bir hastalıktır. Hastanın hayat kalitesi üzerinde olumsuz etkileri vardır. Cerrahi yaklaşımla hastalığın kesin tanısı konabilir. Yardımcı üreme teknikleri endometriyozisin tedavisinde başarılı sonuçlar sağlar. Cerrahi yaklaşım over rezervini azaltabileceğinden endometriyomaların yönetimi özellikle karmaşıktır. Endometriyozise bağlı kronik pelvik ağrının hem medikal hem cerrahi yönetimi genelde sadece kısa dönemli başarılıdır. Her iki yaklaşımda da ağrıda tekrarlama sıklıkla görülür. Hormonal kontraseptifler gibi baskılayıcı medikal tedaviler, cerrahi yaklaşım sonrası ağrı tekrarlama riskini azaltabilir. Bu derlemede amaç, endometriyozis hastalarında görülen değişik peritoneal bozuklukları irdelerken, endometriyozisin etkin ve güvenli klinik yönetiminde güncel yaklaşımlara ışık tutmaktır.

Anahtar Kelimeler: endometriyozis; medikal yönetim; cerrahi yönetim 

Keywords

endometriyozis, medikal yönetim, cerrahi yönetim

References

• Nisolle M, Donnez J. Peritoneal endometriosis, ovarian endometriosis, and adenomyotic nodules of the rectovaginal septum are three different entities. Fertil Steril 1997;68:585–96.
• Giudice LC, Kao LC. Endometriosis. Lancet ;364:1789–99.
• Rawson JM. Prevalence of endometriosis in asymptomatic women. J Reprod Med 1991;36:513–
• Balasch J, Creus M, Fabregues F, Carmona F, Ordi J, Martinez-Roman S, et al. Visible and non-visible endometriosis at laparoscopy in fertile and infertile women and in patients with chronic pelvic pain: a prospective study. Hum Reprod 1996;11:1163–5.
• Carter JE. Combined hysteroscopic and laparoscopic findings in patients with chronic pelvic pain. J Am Assoc Gynecol Laparosc 1994;2:43–7.
• Laufer MR. Current approaches to optimizing the treatment of endometriosis in adolescents. Gynecol Obstet Invest 2008;66(Suppl 1):19 –27.
• Missmer SA, Hankinson SE, Spiegelman D, Barbieri RL, Malspeis S, Willett WC, et al. Reproductive history and endometriosis among premenopausal women. Obstet Gynecol 2004;104(5 Pt 1):965–74.
• Somigliana E, Vigano` P, Abbiati A, Gentilini D, Parazzini F, Benaglia L, et al. “Here comes the sun”: pigmentary traits and sun habits in women with endometriosis. Hum Reprod 2010;25:728–33.
• Malinak LR, Buttram VC Jr, Elias S, Simpson JL. Heritage aspects of endometriosis. II. Clinical characteristics of familial endometriosis. Am J Obstet Gynecol 1980;137:332–7.
• Matalliotakis IM, Arici A, Cakmak H, Goumenou AG, Koumantakis G, Mahutte NG. Familial aggregation of endometriosis in the Yale Series. Arch Gynecol Obstet 2008;278:507–11.
• Somigliana E, Infantino M, Candiani M, Vignali M, Chiodini A, Busacca M, et al. Association rate between deep peritoneal endometriosis and other forms of the disease: pathogenetic implications. Hum Reprod 2004;19:168–71.
• Sinaii N, Plumb K, Cotton L, Lambert A, Kennedy S, Zondervan K, et al. Differences in characteristics among 1,000 women with endometriosis based on extent of disease. Fertil Steril 2008;89:538–45.
• Somigliana E, Vercellini P, Vigano P, Benaglia L, Crosignani PG, Fedele L. Non-invasive diagnosis of endometriosis: the goal or own goal? Hum Reprod ;25:1863–8.
• Management of endometriosis. ACOG Practice Bulletin No. 114. American College of Obstetricians and Gynecologists. Obstet Gynecol 2010;116:223–
• Ozkan S, Murk W, Arici A. Endometriosis and infertility: treatments. Ann N Y Acad Sci 2008;1127:92–100.
• D’Hooghe TM, Debrock S, Hill JA, Meuleman C. Endometriosis and subfertility: is the relationship resolved? Semin Reprod Med 2003;21:243–54.
• Vercellini P, Fedele L, Aimi G, De Giorgi O, Consonni D, Crosignani PG, et al. Reproductive performance, pain recurrence and disease relapse after endometriosis: the predictive value of the current classification system. Hum Reprod 2006;21:2679– surgical treatment for
• Vercellini P, Pietropaolo G, De Giorgi O, Daguati R, Pasin R, Crosignani PG, et al. Reproductive performance in infertile women with rectovaginal endometriosis: is surgery worthwhile? Am J Obstet Gynecol 2006;195:1303–10.
• Berube S, Marcoux S, Langevin M, Maheux R. Fecundity of infertile women with minimal or mild endometriosis infertility. The Canadian Collaborative Group on Endometriosis. Fertil Steril 1998;69:1034 – 41.
• Vercammen EE, D’Hooghe TM. Endometriosis and recurrent pregnancy loss. Semin Reprod Med ;18:363–8. Hughes E, Brown J, Collins JJ, Farquhar C, Fedorkow DM, Vandekerckhove P. Ovulation suppression for endometriosis. The Cochrane Database of Systematic Reviews 2007, Issue 3. Art. No: 1002/14651858.CD000155.pub2. DOI:
• Loverro G, Carriero C, Rossi AC, Putignano G, Nicolardi V, Selvaggi L. A randomized study comparing triptorelin or expectant management following conservative laparoscopic surgery for symptomatic stage III-IV endometriosis. Eur J Obstet Gynecol Reprod Biol 2008;136:194–8.
• Sallam HN, Garcia-Velasco JA, Dias S, Arici A. Long-term pituitary down-regulation before in vitro fertilization (IVF) for women with endometriosis. The Cochrane Database of Systematic Reviews , Issue 1. Art. No.: CD004635. DOI: 1002/14651858.CD004635.pub2.
• D’Hooghe TM, Denys B, Spiessens C, Meuleman C, Debrock S. Is the endometriosis recurrence rate increased after ovarian hyperstimulation? Fertil Steril 2006;86:283–90.
• Coccia ME, Rizzello F, Gianfranco S. Does controlled ovarian hyperstimulation in women with a history of endometriosis influence recurrence rate? J Womens Health 2010;19:2063–9.
• Benaglia L, Somigliana E, Vercellini P, Benedetti F, Iemmello R, Vighi V, et al. The impact of IVF procedures on endometriosis recurrence. Eur J Obstet Gynecol Reprod Biol 2010;148:49–52.
• Jacobson TZ, Duffy JM, Barlow D, Farquhar C, Koninckx PR, Olive D. Laparoscopic surgery for subfertility associated with endometriosis. The Cochrane Database of Systematic Reviews 2010, Issue 1002/14651858.CD001398.pub2. CD001398. DOI:
• Vercellini P, Somigliana E, Vigano P, Abbiati A, Barbara endometriosis-associated infertility: a pragmatic approach. Hum Reprod 2009;24:254–69. for
• Bianchi P, Pereira R, Zannata A, Alegretti JR, Motta E, Serafini P. Extensive excision of deep infiltrative endometriosis significantly improves pregnancy rates. Minim Invasive Gynecol 2009;16:174–80. fertilization
• Littman E, Giudice L, Lathi R, Berker B, Milki A, Nezhat C. Role of laparoscopic treatment of endometriosis in patients with failed in vitro fertilization cycles. Fertil Steril 2005;84:1574–8.
• Pagidas K, Falcone T, Hemmings R, Miron P. Comparison of surgical treatment of moderate (stage III) and severe (stage IV) endometriosis–related infertility with in vitro fertilization embryo transfer. Fertil Steril 1996;65:791–5.
• Beretta P, Franchi M, Ghezzi F, Busacca M, Zupi E, Bolis P. Randomized clinical trial of two laparoscopic cystectomy versus drainage and coagulation. Fertil Steril 1998;70:1176–80. of endometriyomas:
• Alborzi S, Momtahan M, Parsanezhad ME, Dehbashi S, Zolghadri J, Alborzi S. A prospective, randomized study comparing laparoscopic ovarian cystectomy versus fenestration and coagulation in patients ;82:1633–7. Fertil Steril
• Somigliana E, Infantino M, Benedetti F, Arnoldi M, Calanna G, Ragni G. The presence of ovarian endometriyomas is associated with a reduced responsiveness to gonadotropins. Fertil Steril ;86:192–6. Benschop L, Farquhar C, van der Poel N, Heineman MJ. Interventions for women with endometriyoma prior to assisted reproductive technology. The Cochrane Database of Systematic Reviews 2010, Issue 1002/14651858.CD008571.pub2. CD008571. DOI:
• Demirol A, Guven S, Baykal C, Gurgan T. Effect of endometriyoma cystectomy on IVF outcome: a prospective randomized study. Reprod Biomed Online 2006;12:639–43.
• Gupta S, Agarwal A, Agarwal R, Loret de Mola JR. Impact of ovarian endometriyoma on assisted reproduction outcomes. Reprod Biomed Online ;13:349–60. Somigliana E, Vercellini P, Vigano´ P, Ragni G, Crosignani PG. Should endometriyomas be treated before IVF-ICSI cycles? Hum Reprod Update ;12:57–64. Chang HJ, Han SH, Lee JR, Jee BC, Lee BI, Suh CS, et al. Impact of laparoscopic cystectomy on ovarian reserve: serial changes of serum anti- Mullerian hormone levels. Fertil Steril 2010;94:343–
• Almog B, Sheizaf B, Shalom-Paz E, Shehata F, Al- Talib A, Tulandi T. Effects of excision of ovarian endometriyoma on the antral follicle count and collected oocytes for in vitro fertilization. Fertil Steril 2010;94:2340–2.
• Benaglia L, Somigliana E, Vighi V, Ragni G, Vercellini P, Fedele L. Rate of severe ovarian damage following surgery for endometriyomas. Hum Reprod 2010;25:678–82.
• Horikawa T, Nakagawa K, Ohgi S, Kojima R, Nakashima A, Ito M, et al. The frequency of ovulation from the affected ovary decreases following laparoscopic cystectomy in infertile women with unilateral endometriyoma during a natural cycle. J Assist Reprod Genet 2008;25:239–
• Hart RJ, Hickey M, Maouris P, Buckett W. Excisional surgery versus ablative surgery for ovarian endometriyomata. The Cochrane Database of Systematic Reviews 2008, Issue 2. Art. No.: CD004992. 1002/14651858.CD004992.pub3. DOI:
• Muzii L, Bellati F, Bianchi A, Palaia I, Manci N, Zullo MA, et al. Laparoscopic stripping of endometriyomas: a randomized trial on different surgical techniques. Part II: pathological results. Hum Reprod 2005;20:1987–92.
• Matsuzaki S, Houlle C, Darcha C, Pouly JL, Mage G, Canis M. Analysis of risk factors for the removal of normal ovarian tissue during laparoscopic cystectomy for ovarian endometriosis. Hum Reprod ;24:1402–6.
• Donnez J, Lousse JC, Jadoul P, Donnez O, Squifflet J. Laparoscopic management of endometriyomas using (cystectomy) and ablative surgery. Fertil Steril ;94:28 –32. technique of excisional Seracchioli R, Mabrouk M, Frasca` C, Manuzzi L, Montanari G, Keramyda A, et al. Long-term cyclic and continuous oral contraceptive therapy and endometriyoma recurrence: a randomized controlled trial. Fertil Steril 2010;93:52–6.
• Kennedy S, Bergqvist A, Chapron C, D’Hooghe T, Dunselman G, Greb R, et al. ESHRE guideline for the diagnosis and treatment of endometriosis. Hum Reprod 2005;20(10):2698 –704.
• Weir E, Mustard C, Cohen M, Kung R. Endometriosis: what is the risk of hospital admission, intervention? ;12:486–93. and major surgical Gynecol J Minim Invasive Jacobson TZ, Duffy JM, Barlow D, Koninckx PR, Garry R. Laparoscopic surgery for pelvic pain associated with endometriosis. The Cochrane Database of Systematic Reviews 2009, Issue 4. Art. No.: 1002/14651858.CD001300.pub2. DOI:
• Sutton CJ, Ewen SP, Whitelaw N, Haines P. Prospective, randomized, double-blind, controlled trial of laser laparoscopy in the treatment of pelvic pain associated with minimal, mild, and moderate endomtriosis. Fertil Steril 1994;62:696–700.
• Abbott J, Hawe J, Hunter D, Holmes M, Finn P, Garry R. Laparoscopic excision of endometriosis: a randomized, placebo-controlled trial. Fertil Steril ;82:878–84. Vercellini P, Crosignani PG, Abbiati A, Somigliana E, Vigano P, Fedele L. The effect of surgery for symptomatic endometriosis: the other side of the story. Hum Reprod 2009;15:177–88.
• Abbott JA, Hawe J, Clayton RD, Garry R. The effects and effectiveness of laparoscopic excision of endometriosis: a prospective study with 2–5 year follow-up. Hum Reprod 2003;18:1922–7.
• Shakiba K, Bena JF, McGill KM, Minger J, Falcone T. Surgical treatment of endometriosis: a 7-year follow up on the requirement for further surgery. Obstet Gynecol 2008;111:1285–92.
• Vercellini P, Crosignani P, Somigliana E, Vigano` P, Frattaruolo MP, Fedele L. “Waiting for Godot”: a commonsense approach to the medical treatment of endometriosis. Hum Reprod 2011;26:3–13.
• Abou-Setta AM, Al-Inany HG, Farquhar C. Levonorgestrel-releasing intrauterine device (LNG- IUD) for symptomatic endometriosis following surgery. The Cochrane Database of Systematic Reviews 2006, Issue 4. Art. No.: CD005072. DOI: 1002/14651858.CD005072.pub2.
• Healey M, Ang WC, Cheng C. Surgical treatment of endometriosis: a prospective randomized double- blinded trial comparing excision and ablation. Fertil Steril 2010;94:2536–40.
• Latthe PM, Proctor ML, Farquhar CM, Johnson N, Kahn KS. Surgical interruption of pelvic nerve pathways in dysmenorrhea: a systematic review of effectiveness. Acta Obstet Gynecol Scand 2007;86:4 –15.
• Metwally M, Watson A, Lilford R, Vandekerckhove P. Fluid and pharmacological agents for adhesion prevention after gynaecological surgery. The Cochrane Database of Systematic Reviews 2006, Issue 1002/14651858.CD001298.pub3. CD001298. DOI:
• Brown CB, Luciano AA, Martin D, Peers E, Scrimgeour A, diZerega S. Adept adhesion reduction study group. Adept (icodextrin 4% solution) reduces adhesions after laparoscopic surgery randomized ;88:1413–26. a double Fertil Steril study.
• Mais V, Ajossa S, Marongiu D, Peiretti RF, Guerriero S, Melis GB. Reduction of adhesions reformation surgery: a randomized trial with an oxidized regenerated cellulose absorbable barrier. Obstet Gynecol 1995;86:512–5. endometriosis
• Ferrero S, Camerini G, Seracchioli R, Ragni N, Venturini PL, Biscaldi E, et al. Norethisterone acetate in the treatment of colorectal endometriosis: a pilot study. Hum Reprod 2010; 25:94 –100.
• Sowers MR, Zheng H, Jannausch ML, McConnell D, Nan B, Harlow S, et al. Amount of bone loss in relation to time around the final menstrual period and follicle-stimulating hormone staging of the transmenopause. ;95:2155–62. Endocrinol Metab
• Surrey ES, Hornstein MD. Prolonged GnRH agonist therapy and endometriosis: long-term follow-up. Obstet Gynecol ;99:709-19. for symptomatic women. Contraception Surrey ES. Add-back therapy and gonadotropin- releasing hormone agonists in the treatment of patients with endometriosis: can a consensus be reached? Add-Back Consensus Working Group. Fertil Steril 1999;71:420–4.
• Freundl G, Godtke K, Gnoth C, Godehardt E, Kienle E. Steroidal “add-back” therapy in patients treated with GnRH Agonists. Gynecol Obstet Invest ;45(Suppl 1):22–30. Vercellini P, Somigliana E, Vigano` P, Abbiati A, Barbara G, Crosignani PG. Endometriosis: current therapies and new pharmacological developments. Drugs 2009;69:649–75.
• Ferrero S, Camerini G, Seracchioli R, Ragni N, Venturini PL, Remorgida V. Letrozole combined with norethisterone acetate alone in the treatment of pain symptoms caused by endometriosis. Hum Reprod ;24:3033–41. acetate compared with
• Bohrer J, Chen C, Falcone T. Persistent bilateral ureteral obstruction secondary to endometriosis despite treatment with an aromatase inhibitor. Fertil Steril 2008;90:2004.e7–9.
• Duepree HJ, Senagore AJ, Delaney CP, Marcello PW, Brady KM, Falcone T. Laparoscopic resection of deep pelvic endometriosis with rectosigmoid involvement. J Am Coll Surg 2002;195:754–8.
• De Cicco C, Corona R, Schonman R, Mailova K, Ussia A, Koninckx P. Bowel resection for deep endometriosis: ;118:285–91. review. BJOG Darai E, Carbonnel M, Dubernard G, Lavoue V, Coutant C, Bazot M, et al. Determinant factors of fertility outcomes after laparoscopic colorectal resection for endometriosis. Eur J Obstet Gynecol Reprod Biol 2010;149:210–4.
• Mohr C, Nezhat FR, Nezhat CH, Seidman DS, Nezhat CR. Fertility considerations in laparoscopic treatment of infiltrative bowel endometriosis. JSLS ;9:16 –24. Ferrero S, Anserini P, Abbamonte LH, Ragni N, Camerini G, Remorgida V. Fertility after bowel resection ;92:41–6. Fertil Steril Roman H, Tarta O, Pura I, Opris I, Bourdel N, Marpeau L, et al. Direct proportional relationship between parenchyma cystectomy, and its implication on the management of ;25:1428–32. size and ovarian during inadvertently removed endometriyomas. Hum Reprod
• Roman H, Vassilieff M, Gourcerol G, Savoye G, Leroi AM, Marpeau L, et al. Surgical management of deep infiltrating endometriosis of the rectum: pleading for a symptom-guided approach. Hum Reprod 2011;26:274–81.
• Fedele L, Bianchi S, Montefusco S, Frontino G, Carmignani L. A gonadotropin-releasing hormone agonist versus a continuous oral contraceptive pill in the treatment of bladder endometriosis. Fertil Steril ;90:183–4. Vercellini P, Fedele L, Aimi G, Pietropaolo G, Consonni D, Crosignani PG. Association between endometriosis characteristics and severity of pelvic pain symptoms: a multivariate analysis of over 1000 patients. Hum Reprod 2007;22:266–71. lesion type, patient
• Al Kadri H, Hassan S, Al Fozan HM, Hajeer A. Hormone therapy for endometriosis and surgical menopause. The Cochrane Database of Systematic Reviews 2009, Issue 1. Art. No.: CD005997. DOI: 1002/14651858.CD005997.pub2.
• Moen MH, Rees M, Brincat M, Erel T, Gambacciani M, Lambrinoudaki I, et al. EMAS position statement: Managing the menopause in women with a ;67:94 –7. endometriosis. Maturitas Zanetta G, Webb M, Li H, Kenney G. Hyperestrogenism: A relevant risk factor for the development of cancer from endometriosis. Gynecol Oncol 2000;79:18 –22.
• Chlebowski RT, Hendrix SL, Langer RD, Stefanick ML, Gass M, Lane D, et al. Influence of estrogen plus progestin on breast cancer and mammography in healthy postmenopausal women: the Women’s Health ;289:3243–53. trial. JAMA
• Chlebowski RT, Anderson GL, Gass M, Lane DS, Aragaki AK, Kuller LH, et al. Estrogen plus progestin and breast cancer incidence and mortality in postmenopausal women. JAMA 2010;304:1684–
• Aris A. Endometriosis-associated ovarian cancer: a ten year cohort study of women living in the Estric Region of Quebec, Canada. J Ovarian Res 2010;3:2.