Author/Editor		Pakiž, Maja; But, Igor; Žegura, Branka
Title		Minimalno invazivno zdravljenje benignih tumorjev maternice
Type		članek
Source		In: Takač I, editor. 80 let hospitalne ginekologije in porodništva v Mariboru: mednarodni znanstveni simpozij, Univerzitetni klinični center Maribor, Maribor, 17. 10. 2008. Maribor: Univerzitetni klinični center,
Publication year		2008
Volume		str. 433-41
Language		slo
Abstract		Myomas and endometrial polyps are the most common benign uterine tumors. Endometrial polyps account for about 10 % of postmenopausal bleeding while uterine myomas are even the most common solid pelvic tumors in women, occurring in 20 % to 40 % during the reproductive years. Hysterectomy was the golden standard in the treatment of myomas for almost a century, but major changes in lifestyle and technical improvement enabled the development of minimally invasive methods for the treatment of benign uterine pathology. Dilation and curettage is being increasingly replaced by office hysteroscopy in diagnosis and treatment of abnormal uterine bleeding and endometrial pathology suspected by ultrasound examination. Office hysteroscopy is more precise in diagnosis and more effective in removal of endometrial polyps, and submucosal myomas may also be treated. Selective estrogen and progesterone receptor modulators possibly represent a new option in symptomatic treatment of uterine myomas. The levonorgesterel intrauterine system and transcervical endometrial resection are increasingly used for treatment of heavy menstrual bleeding caused by myomas. Uterine artery embolization is an effective and safe alternative to surgical treatment of myomas. It is however probably more appropriate for premenopausal women as approximately every fifth woman needs further treatment in the next five years. Laparoscopic myomectomy is preferred in women of reproductive age to desire to give birth. Its benefits include shorter hospital stay, less febrile illness and a smaller drop in preoperative hemoglobin concentration when compared to laparotomy. Hysterectomy is still the only definitive method for treating myomas, but there is a trend toward increasing subtotal hysterectomy rates and decreasing the proportion of abdominal and even vaginal hysterectomies. (Abs. trunc. at 2000 ch.)
Summary		Najpogostejši benigni tumorji maternice so miomi in polipi endometrija. Polipi endometrija so kar v približno 10 % vzrok za pomenopavzalne krvavitve iz nožnice, miomi maternice pa so celo najpogostejši benigni tumorji v mali medenici pri ženskah, pojavljajo pa se kar v 20 % do 40 % žensk v reproduktivnem obdobju. Histerektomija je bila metoda izbora zdravljenja miomov kar dobro stoletje, spremembe v načinu življenja in tehnološki razvoj pa so privedle do razvoja manj invazivnih diagnostičnih in terapevtskih metod v zdravljenju benigne patologije maternice. Frakcionirano abrazijo maternice kot metodo diagnosticiranja in zdravljenja nenormalnih krvavitev iz maternice ter ultrazvočnega suma na patologijo endometrija vedno bolj nadomešča ambulantna histeroskopija, ki omogoča natančnejšo diagnostiko in učinkovitejše zdravljenje polipov, pa tudi submukoznih miomov maternice. Nove obete v simptomatskem zdravljenju miomov predstavlja razvoj selektivnih modulatorjev estrogenskih in progesteronskih receptorjev, vedno več se uporabljata intrauterini sistem z levonorgestrelom in transcervikalna resekcija endometrija. Učinkovito in varno metodo zdravljenja miomov maternice predstavlja embolizacija arterije uterine, ki je primerna za premenopavzalne bolnice, saj je pri približno petini bolnic v petih letih po posegu potrebno še dodatno zdravljenje. Laparoskopska miomektomija je metoda izbora predvsem pri simptomatskih bolnicah, ki želijo še roditi in ima prednost pred laparotomijo v krajši hospitalizaciji, redkejših febrilnih stanjih in manjšem padcu hemoglobina po operaciji. Histerektomija je še vedno edina dokončna metoda v zdravljenju miomov maternice, se pa spreminja razmerje načinov histerektomij s padcem abdominalnih, pa tudi vaginalnih histerektomij, narašča pa število subtotalnih histerektomij. (Izvl. skrajšan na 2000 zn.)
Descriptors		ENDOMETRIAL NEOPLASMS UTERINE DISEASES MYOMA POLYPS