Endometriosis

Endometriosis is a disease in which cells similar in structure to endometrial cells appear outside the uterus – in other organs and body systems.

By its nature, this is a benign disease, which, however, has some signs (invasive growth, course of the disease) that are more characteristic of malignant tumors.

Endometriosis is a hormonally dependent disease and develops only in reproductive age.

Why does endometriosis occur?

It is called the disease of a hundred theories, however, none of them fully describes the cause of its occurrence.

The basis of the disease is the failure of apoptosis (the process in which the body destroys ‘extra’ cells). With endometriosis, this process is disrupted and endometrioid foci gradually appear.

One of the main problems in the treatment of endometriosis is its late detection. This trend can be traced in all countries, regardless of their geographical location and standard of living. According to various studies, it takes an average of 6 to 10 years from the first manifestations of endometriosis to the diagnosis!

Forms of endometriosis

There are 3 main forms of endometriosis – peritoneal (peritoneal endometriosis), endometrioid ovarian cysts and deep invasive endometriosis.

Peritoneal endometriosis is a form of the disease in which small endometrioid foci are located on the surface of the peritoneum in the form of variously shaped and sized elements. During the surgery, they are visible as characteristic bluish/brown dots or whitish spots on the peritoneum. In total, there are more than 10 manifestations that are different in appearance.

As a rule, such endometriosis is asymptomatic and is detected only during surgery, since these lesions are too thin to be visible during ultrasound diagnostics or other non-invasive diagnostic methods.

Most often, peritoneal endometriosis is detected during diagnostic laparoscopy for infertility, since foci of endometriosis can be its cause. Another form of endometriosis is ovarian endometrioid cysts (endometriomas). An endometrioma is a cyst that has a brown capsule filled with thick contents, which is why such cysts are called ‘a chocolate cyst’.

Such cysts can be both small in size – up to several centimeters, and huge ones, whose content can sometimes amount to several liters. The peculiarity of endometrioid cysts in most cases is their asymptomatic course, so they are most often detected accidentally during ultrasound or during examinations for infertility.

The most effective method of surgical treatment of endometriomas is enucleation (stripping), i.e., enucleation of the cyst capsule. With the modern equipment and the appropriate skill of a surgeon, this method allows minimizing the recurrence of cysts, while preserving the follicular apparatus and ovarian function as much as possible.

And finally, the most difficult form of this disease to treat is deep infiltrative endometriosis. From its name it is clear that such foci are located not on the surface of the peritoneum, but in the depths of the affected tissues and organs.

Most often, deep infiltrative endometriosis affects the wall of the rectum and sigmoid colon, the pelvic ureters, the wall of the bladder, nerves, blood vessels, and ligaments of the pelvis.

Infiltrative endometriosis is often manifested by pain in the pelvic area, aggravated on the eve or during menstruation, although it can also be asymptomatic for a long time. With deep damage to the organs there can be pain during urination and defecation, blood in the stool during menstruation, as well as pain during intercourse.

Surgery for deep infiltrative endometriosis is one of the most difficult operations in pelvic surgery, as it often requires the imposition of intestinal anastomoses, isolation and transplantation of the ureters, and resection of the bladder wall.

Around the world, such operations are performed in specialized centers by surgeons with extensive experience and high-quality equipment.

When is a surgery required?

The surgery is required with:

  • endometriomas or ovarian cysts are more than 3 cm in diameter;
  • deep infiltrative endometriosis with damage to neighboring organs;
  • lack of effect from drug therapy;
  • infertility caused by endometriosis.

The treatment of endometriosis is usually complex; it combines surgery and subsequent medication.

Лечение эндометриоза

  • Что такое эндометриоз?
    Эндометриоз – это заболевание, при котором клетки, подобные клеткам эндометрия (внутреннего слоя матки), появляются в других органах и системах организма.
  • Почему возникает эндометриоз?
    Причины возникновения эндометриоза до конца не изучены, но основные версии его появления связаны с нарушением процесса апоптоза (программированной гибели клеток) и с попаданием клеток эндометрия в брюшную полость через маточные трубы, что приводит к образованию эндометриоидных очагов.
  • Какие формы эндометриоза существуют?
    Существуют 3 основные формы эндометриоза: перитонеальный (эндометриоз брюшины), эндометриоидные кисты яичников и глубокий инвазивный эндометриоз.
  • Каковы признаки перитонеального эндометриоза?
    При перитонеальном эндометриозе мелкие эндометриоидные очаги образуются на поверхности брюшины. Они могут быть видны во время операции и иметь синеватый/коричневый цвет. Часто это обнаруживается во время диагностической лапароскопии при бесплодии.
  • Как лечить глубокий инфильтративный эндометриоз?
    Лечение глубокого инфильтративного эндометриоза проводится с помощью довольно сложной хирургической операции по удалению его очагов и в самых тяжелых случаях может включать даже наложение кишечных анастомозов, пересадку мочеточников и резекцию стенки мочевого пузыря. Эти операции выполняются в специализированных центрах хирургами с опытом и с использованием современного оборудования. В нашей клинике удаление глубокого инфильтративного эндометриоза является одним из приоритетных направлений и такие операции проводятся регулярно.
  • Сколько времени проходит от появления первых очагов эндометриоза до постановки диагноза?
    По статистике, даже в странах с наиболее развитыми системами здравоохранения, от первых проявлений эндометриоза до постановки диагноза проходит от 6 до 10 лет!
  • * the results of treatment are individual and depend on many factors.

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