Ekstragenital Endometriozis
Özet
Endometriozis, üreme çağındaki kadınların %6-10’unu etkileyen kronik inflamatuar bir hastalıktır. Çoğunlukla overler, uterin ligamentler ve pelvik periton yüzeyinde görülen bu hastalık genital organlar dışında yer aldığında ekstragenital endometriozis başlığında incelenmektedir. Ekstragenital endometriozis tüm endometriozis hastalarının %8,9’unda görülmektedir. Ekstragenital odaklar pelvik endometriozisle birlikte veya izole olarak bulunabilir. Vücutta dalak hariç her doku ve organda endometriozis tanımlanmıştır. En sık görülen ekstragenital odaklar yerleşimine göre sıklık sırasıyla gastrointestinal sistem, üriner sistem, torasik endometriozis (diyafram, plevra ve akciğer) ve batın ön duvarı (skar endometriozis, umblikal endometriozis ve inguinal endometriozis) olarak sıralanabilir. Hastalarda genital endometrioziste olduğu gibi dismenore, disparoni ve infertilite semptomlarının yanında, ekstragenital odakların yerleşimine göre farklı semptomlar da görülebilir. Semptomlar katamenial paternde veya menstrüel siklustan bağımsız dönemlerde izlenebilir. Tanı koymada fizik muayene, detaylı klinik öykü, ultrason, manyetik rezonans ve semptomlara göre başka görüntüleme yöntemlerinden faydalanılabilir. Kesin tanı lezyonun görülmesi ve histopatolojik değerlendirilmesiyle koyulmaktadır. Tedavide genital endometrioziste kullanılan medikal ajanlar tercih edilebilmektedir. Medikal tedaviye ara verilmesi yüksek rekürrens oranlarıyla ilişkilendirilmiştir. Ayrıca ekstragenital endometriotik odakların malign transformasyon riski de bulunmaktadır. Bu nedenle tedavide semptomatik hastalarda lezyonun cerrahi eksizyonu tavsiye edilmektedir. Postop rekürrensi önlemek amacıyla operasyon sonrası hormonal ajanlar kullanılabilmektedir.
Endometriosis is a chronic inflammatory disease affecting 6-10% of women of reproductive age. It is mostly seen in the ovaries, uterine ligaments and on the surface of the pelvic peritoneum. When it is located outside the genital organs, it is examined under the title of extragenital endometriosis. Extragenital endometriosis is seen in 8.9% of all endometriosis patients. Extragenital foci may be found together with pelvic endometriosis or in isolation. Endometriosis has been described in every tissue and organ in the body except the spleen. The most common extragenital foci are gastrointestinal tract, urinary tract, thoracic endometriosis (diaphragm, pleura and lung) and anterior abdominal wall (scar endometriosis, umbilical endometriosis and inguinal endometriosis). In addition to the symptoms of dysmenorrhea, dyspareunia and infertility as in genital endometriosis, patients may have different symptoms depending on the location of extragenital foci. Symptoms may be observed in a catamenial pattern or in periods independent of the menstrual cycle. Physical examination, detailed clinical history, ultrasound, magnetic resonance imaging and other imaging modalities depending on the symptoms may be used for diagnosis. Definitive diagnosis is made by visualization and histopathologic evaluation of the lesion. Medical agents used in genital endometriosis may be preferred in treatment. Interruption of medical treatment has been associated with high recurrence rates. There is also a risk of malignant transformation of extragenital endometriotic foci. Therefore, surgical excision of the lesion is recommended in symptomatic patients. Postoperative hormonal agents may be used to prevent postoperative recurrence.
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111-130
Gelecek
21 Ocak 2025
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