Håndtering af endometriomer hos kvinder uden aktuelt graviditetsønske

Omformuleret klinisk spørgsmål Kirurgisk håndtering af symptomgivende endometriomer uden aktuelt graviditetsønske

PICO - model Endometrioma Surgery Excision vs. Ablation Painreduction; recurrency

Litteratursøgning PubMed: MeSH-term Endometrioma(s) ; Ingen term fundet. Kun ”Endometriosis” Endometriosis and surgery; Filter by: Systematic reviews 58www.tripdatabase.com Ud fra problemformulering og aktualitet findes: Excisional surgery versus ablative surgery for ovarian endometriomataExcisional surgery versus ablative surgery for ovarian endometriomata –Cochrane Database of Systematic Reviews. 2005

Authors' conclusions There is some evidence that excisional surgery for endometriomata provides for a more favourable outcome than drainage and ablation, with regard to the recurrence of the endometrioma, recurrence of symptoms and subsequent spontaneous pregnancy in women who were previously subfertile. Consequently this approach should be the favoured surgical approach. However we found no data as to the effect of either approach in women who subsequently undergo assisted reproductive techniques.

Main results No randomised studies of the management of endometriomata by laparotomy were found. Two randomised studies of the laparoscopic management of ovarian endometriomata of greater than 3cm in size were included. Laparoscopic excision of the cyst wall of the endometrioma was associated with a reduced rate of recurrence of the endometrioma (OR 0.41 CI ), reduced requirement for further surgery (OR 0.21 CI ), reduced recurrence rate of the symptoms of dysmenorrhoea (OR 0.15 CI ), dyspareunia OR 0.08 CI ) and non-menstrual pelvic pain (OR 0.10 CI ). It was also associated with a subsequent increased rate of spontaneous pregnancy in women who had documented prior sub-fertility (OR 5.21 CI ).

PubMed søgning: endometriomatas and surgery 18 hits Genfinder nævnte Cochrane review

Artikelvalg Højeste evidensgrad Aktualitet Matcher bedst problemformulering

Vores kliniske problemstilling blev besvaret Let tilpasning af PICO ang.comparision, da vi primært sigtede mod bred håndtering af endomtriomer, men i litteraturen fandt kirurgisk beh. som Gudstandard i beh. af ovarielle endometriomer. 2 kirurgiske behandlinger: Excision vs.ablation

Evidensgrad/styrke Ia A

Rekommandationer Excision af endometriomer som Guldstandard