Author/Editor		Vogler, Andrej; Ribič-Pucelj, Martina; Tomaževič, Tomaž
Title		Kirurško zdravljenje endometrioze pri neplodnih bolnicah
Translated title		Surgical treatment of endometriosis in infertile patients
Type		članek
Source		Zdrav Vestn
Vol. and No.		Letnik 72, št. Suppl 2
Publication year		2003
Volume		str. II-117-20
Language		slo
Abstract		Background. Endometriosis is nowadays probably the most frequent cause of infertility or subfertility and is revecaled in approximately 30-40% of infertile women. The association between fertility and minimal or mild endometriosis remains unclear and controversial. Moderate and severe forms of the disease distort anatomical relations in the minor pelvis, resulting in infertility. The goals of endometriosis treatment are relief of pain symptoms, prevention of the disease progression and fertility improvement. Treatment of stages I and II endometriosis (according to the RAFS classification) may be expectative, medical or surgical. In severely forms of the disease (stage III and IV) the method of choice is surgical treatment. Combined medical and surgical treatment is justified only in cases, in which the complete endometriotic tissue removal is not possible or recurrence of pain symptoms occur. Nowadays, laparoscopic surgical treatment is the golden standard being the diagnostic and therapeutic tool during the same procedure. The aim of this study was to evaluate the fertility rate after surgical treatment of different stages of endometriosis. Patients and methods. In prospectively designed study 100 infertile women were included. The only known cause of infertility was endometriosis. In group A there were 51 patients with stage I and ll endometriosis, whereas in group B there were 49 patients with stage III and N of the disease. Endometriosis was diagnosed and treated laparoscopically. Endometriotic implants were removed either with bipolar coagulation or CO2 laser vaporisation, whereas adhesions were sharp or blunt dissected, and endometriomas stripped out of ovaries. Pregnancy rates were calculated for both groups of patients, and statistically compared between the groups. (Abstract truncated at 2000 characters).
Summary		Izhodišča. Endometrioza je verjetno najpogostejši vzrok neplodnosti oziroma zmanjšane plodnosti pri ženskah. Pri približno 30-40% bolnic, ki imajo težave z zanositvijo, odkrijemo endometriozo. Obsežna endometrioza povzroča neplodnost predvsem zaradi anatomskih sprememb v mali medenici. Mehanizem neplodnosti pri blagih in zmernih oblikah endometrioze pa še vedno ni znan. Cilji zdravljenja endometrioze so odprava ali ublažitev simptomov, ki jih bolezen povzroča, preprečevanje napredovanja bolezni in izboljšanje plodnosti. Zdravljenje endometrioze I. in Il. stopnje po klasifikaciji RAFS je lahko ekspektativno, medikamentno ali kirurško. Pri hujših oblikah bolezni (III.. in IV. stopnja) je izbirna metoda zdravljenja kirurška. Kombinirano kirurško in medikamentno zdravljenje je na mestu le v primerih, ko endometrioze ni bilo mogoče v celoti odstraniti ali pa gre za ponovitev predvsem bolečinskih simptomov. Danes je zlati standard operativnega zdravljenja laparoskopski pristop, ki je obenem diagnostični in terapevtski postopek. Namen dela je bil ugotoviti uspešnost operativnega zdravljenja različnih stopenj endometrioze pri neplodnih bolnicah. Bolnice in metode. V prospektivno zasnovano raziskavo smo vključili 100 neplodnih bolnic z endometriozo, ki je bila edini znani vzrok neplodnosti. Preiskovanke smo razdelili v skupino A (51 bolnic s I. ali Il. stopnjo endometrioze) in skupino B (49 bolnic s lll. ali IV. stopnjo endometrioze). Endometriozo smo diagnosticirali in operirali laparoskopsko. Endometriotična žarišča smo odstranili z bipolarno koagulacijo ali vaporizirali z laserskim žarkom CO2 adhezije smo ločili topo ali ostro, endometriome smo izluščili iz ovarijev. Izračunali smo stopnjo zanositve in jo primerjali med obema skupinama bolnic. Rezultati. Povprečna starost bolnic je bila 29,25 (SD +- 4,08) leta in se med skupinama A in B ni statistično značilno razlikovala: 29,5 leta v skupini A in 29 let v skupini B. (Izvleček skrajšan pri 2000 znakih).
Descriptors		INFERTILITY, FEMALE ENDOMETRIOSIS PREGNANCY PREGNANCY OUTCOME LAPAROSCOPY