Liječenje endometrioze jajnika

master's thesis

• Title (english): Therapy of ovarian endometriosis
• Author: Domagoj Kabelka
• Mentor: Mario Ćorić (mentor)
• Committee member: Goran Vujić (predsjednik povjerenstva)
• Committee member: Dinka Pavičić Baldani (član povjerenstva)
• Committee member: Mario Ćorić (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Gynecology and Obstetrics); Zagreb
• Defense date and country: 2022-07-15, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Gynecology and Obstetrics

Abstract

Endometrioza je bolest karakterizirana prisutnošću epitela i strome nalik endometrijskom izvan endometrija i miometrija , često uz prateći upalni proces. Uspostava i rast endometriotičnih lezija ovisna je o estrogenu te je stoga najčešće nalazimo kod žena reproduktivne dobi. Endometriotične lezije se pojavljuju u obliku površinskih (superficijalnih) peritonealnih implantata (SI), ovarijskih endometrioma (“čokoladnih cista”, OMA) i duboko infiltrirajuće endometrioze (DIE). Endometriomi su najčešći oblik endometrioze a predstavljaju benigne ciste nastale invaginacijom kore jajnika s prethodno implantiranom endometriozom.
Kliničkom slikom dominiraju infertilnost, dismenoreja, dispareunija/postkoitalno krvarenje te abdominopelvična bol od kojih neki imaju ciklička obilježja. Nakon postavljene sumnje uzimanjem anamneze slijedi klinički pregled simptomatskih žena. Fizikalni pregled zdjelice, uključujući vaginalni pegled spekulumom te bimanualna i rektovaginalna palpacija, upotpunjuje se slikovnim metode poput transvaginalnog ultrazvuka ili MRI.
Dijagnostička laparoskopija i slikovne metode u kombinaciji s empirijskim liječenjem (hormonski kontraceptivi ili gestageni) jednakovaljani su postupci. Liječenje se provodi medikametno i kirurški a odabir terapijskog modaliteta ovisi o težini simptoma, lokaciji entometriotičnih lezija, ciljevima liječenja i želje za očuvanjem plodnosti.
Medikamento liječenje boli provodi se hormonskom terapijom (prvu liniju čine kombinirani oralni kontraceptivi i gestageni) zbog njihove učinkovitosti i sigurnosti.
Cilj svakog kirurškog zahvata je eliminacija endometriotičnih lezija i adhezioliza prisutnih priraslica kojom se uspostavljaju normalni anatomski odnosi zdjelice. Više je tehnika od kojih se cistektomija pokazala dominantom u odnosu na druge metode s obzirom na redukciju boli povezane sa endometriozom i očuvanje plodnosti.

Abstract (english)

Endometriosis is defined as a disease characterised by the presence of endometrium-like epithelium and/or stroma outside the endometrium and myometrium, usually with an associated inflammatory process. Establishment and growth of such endometriotic tissue is estrogen-dependent, thus it is mostly found in women of reproductive age. Clinically, endometriosis is subdivided into superficial (peritoneal/serosal) lesions, ovarian endometriosis cysts (endometrioma) and deep endometriosis. Endometriomas are the most common type of endometriosis, they are in fact benign cysts formed after invagination of the ovarian cortex with preexistitng superficial endometriosis.
Clinical hallmarks are infertility, dysmenorrhea , dyspareunia/postcoital bleeding and abdominopelvic pain with cyclic presentation. History taking is followed by clinical examination in symptomatic women. Clinical examination in women suspected with abdominal endometriosis includes physical examination of the pelvis and where appropriate, vaginal inspection should include a speculum as well as bimanual and rectovaginal palpation wich are complemented with transvaginal ultrasound od MRI.
Both diagnostic laparoscopy and imaging combined with empirical treatment (hormonal contraceptives or progestogens) can be considered in women suspected of endometriosis. There is no evidence of superiority of either approach.Treatment of endometriosis consists of medical therapies and surgery. When choosing between hormone treatments and surgery a shared decision-making approach taking into consideration the extent of the disease, lession location, therapy goals and the desire to preserve fertility is advised.
Hormone treatment (combined hormonal contraceptives, progestogens) for endometriosis associated pain should be prescribed as first line therapy because they are effective and safe.
Surgical treatment aims to eliminate endometriotic lesions and divide adhesions. These procedures restitute normal anatomical positions within the pelvis. More techniques are described and cystectomy has been shown to be the dominant one regarding pain and fertility preservation.

• Keywords: endometrioza; ovariji; liječenje
• Keywords (english): endometriosis; ovary; therapy
• Language: croatian
• URN:NBN: urn:nbn:hr:105:160943
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2023-01-13 08:28:23