Kazakh National Medical University With S D Asfendiyarov

Kazakh National Medical University With S. D Asfendiyarov "ENDOMETRIOSIS". COMPLETED: GAYNULAEV M CHECKED: MOSHKALOVA G ALMATY 2016

Content introduction definition Classification Options endometriosis localization Etiology Clinical manifestations Diagnostics treatment Standards Treatment Forecast References

introduction Endometriosis affects women of reproductive age. The exact prevalence of endometriosis is unknown, because many women have this disease has no symptoms. Endometriosis - is one of the leading causes of pelvic pain and reasons for laparoscopic surgery in many countries. The average of patients with endometriosis 25 -30 years. Endometriosis rarely observed in postmenopausal women. A higher prevalence of endometriosis among white women than in African American and Asian women.

Endometriosis. definition Endometriosis - widespread gynecological disease in which cells of the endometrium (the inner layer of the uterus) grow beyond this layer. Because endometrial tissue has receptors for the hormones, there occur the same changes as the normal endometrium manifested monthly bleeding. These small inflammation lead to bleeding in the surrounding tissues and the main cause of disease symptoms: pain, increased organ volume, infertility. Symptoms of endometriosis depends on the location of its foci. Genital distinguish (within genital - uterus, ovaries) and extra (outside of the reproductive system - stomach, intestines, etc. . . ) Endometriosis.

Classification of endometriosis

Options for localization of endometriosis: 1 - body of the uterus; 2 - pozadisheechnoe space; 3 - sacro-uterine ligaments; 4 - vagina; 5 - crotch; 6 - fallopian tube; 7 - ovary; 8 - bladder; 9 - round ligament; 10 - rectus abdominis; 11 - the navel; 12 - sieve intestine; 13 - Rear Douglas peritoneum; 14 - cervix

The etiology of endometriosis . • metaplastic theory (the emergence of metaplasia of the epithelium of the peritoneum) (the Meyer, 1919) ; ? • violation of embryogenesis with abnormal residues (peritoneum) Müller (paramezonefralnogo) flow; ? • dizontogeneticheskie theory that links a combination of endometrioid heterotopias with congenital anomalies of the genital apparatus (R. The Kossman, 1997) ; ? • implant theory (hypothesis of retrograde menstruation and dissemination) (Sіmpson 1921) ; ? • translocation of the endometrium from the uterine cavity (peritoneum, myometrium, and other organs) during surgery (caesarean section, myomectomy) • ; ? in violation of the hormonal regulation of the hypothalamic-pituitaryovarian system - target organs (the luteal phase insufficiency (LPI), hyperprolactinemia, a violation of the steroid hormone receptor expression - estradiol, progesterone) ; ? • immune theory of endometriosis [10] ; ? • the development of endometriosis as a genetically determined disease

Clinical manifestations Pelvic pain. Pain, as a rule, are cyclical in nature (appear or are worse before menstruation), but may be permanent. Reinforcement and extension of menstrual bleeding. Pain during sexual intercourse (dyspareunia). Pain during bowel movement or bladder (when the fourth stage) Infertility. Bloody Tears (very rarely)

Diagnosis of endometriosis The analysis of complaints, clinical and gynecological examination: primary gynecological examination and "poll" for the patient experienced pain suffered by previous gynecological diseases, operations, gynecological diseases of relatives, etc. Ultrasound - diagnosis of endometrial cysts and adenomyosis. Hysterosalpingography. Laparoscopy - Laparoscopy is a minimally invasive surgical method for the evaluation of patients with suspected endometriosis, and allows you to not only correct diagnosis, to determine the extent of endometriosis, adhesions and condition of the fallopian tubes, but also to microsurgical treatment of the identified disease. The operation should be performed in a hospital under general anesthesia. Hysteroscopy - also a surgical procedure in which the inspection is made of the uterine cavity optical device, immediately after menstruation, when the background of thin mucosa visible endometrial bleeding strokes. This is one of the most accurate methods of diagnosis of adenomyosis. Biopsy - colposcopy and hysteroscopy possible to obtain material for biopsy. A biopsy and histological examination is a necessary complement to endoscopic procedures, because they help to choose an adequate method of treatment.

Laparoscopy.

Standards for the treatment of patients with endometrial disease • Surgical treatment bryushnostenochnym access (removal of endometriosis)? • Surgical treatment of laparoscopic (removal of endometriosis using a CO 2 laser, electric or thermocoagulation, argon endokoagulyatsii)? • Hormone therapy progestins, antigonadotropiny, Gn. RH agonist (a drug)? • The use of prostaglandin agonists or NSAIDs? • Drug-free methods of treatment (balneotherapy, physiotherapy, oxygen therapy, hypnosuggestive methods)

Treatment For the treatment of endometriosis using medications, surgical techniques, and a combination of techniques. Early diagnosis avoids surgery, limited to medical methods. Drug treatment of endometriosis is the assignment of hormonal preparations, in which the patient takes a long time. They normalize the ovaries work and prevent the appearance of new lesions. By resorting to surgical treatment of endometriosis, when you need to remove ovarian endometrioid cyst or when conservative treatment failed to produce results. Currently widely spread method based on laparoscopy, which allows surgery through a small incision using electrocautery or laser. However, after the operation is necessary to pass a medical course and physical therapy to normalize the menstrual cycle. In the event of a severe form of the disease and if the woman does not plan to have more children, the uterus is removed completely.

Forecast Relapses of the disease after an adequate removal of endometriotic lesions are extremely rare. The effectiveness of surgical treatment increases with complex rehabilitation treatment in the postoperative period. ? The success of surgery to restore reproductive function depends on the prevalence of endometriosis: the effectiveness of treatment at the earliest stage of the disease is 60%, while the prevalence of endometriosis - 30%. disease recurrence after 5 years after surgical treatment detected in 19% of patients. ? When conducting hormone replacement therapy Women 70 -90% otmechayumenstrualnopodobnyh bleeding t disappearance of pain and amelioration of endometriosis recurrence after one year of therapy, 15 -60% rate, pregnancy rate ranges from 20 to 70% depending on the groups of drugs.

The rehabilitation treatment includes: • Physical therapy aimed at improving blood flow and cell metabolism, enhancing phagocytosis and enzymatic activity of immune cells, stimulating the recovery of damaged tissues • vaginal normobiotsenoza Support (normal microbial composition of the vagina) • Immunomodulation -. ? Increase the protective properties of the organism • Recovery of the two-phase menstrual. ? cycle after the end of medication.

References. 1. Topical Issues of Obstetrics, Gynecology and Reproduction / Ed. EV Kohanevich. - M. : Triada Kh, 2006. 2. Adamyan LA, Kulakov VI Endometriosis. - M. : Medicine, 1998. 3. Handbook of Obstetrics and Gynecology / ed. Acad. RAMS GM Savelevoj. - M. : MIG 2006. 4. Dubossarskaya ZM New approaches to the treatment of endometriosis. - 2003.