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Håndtering af endometriomer hos kvinder uden aktuelt graviditetsønske

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.

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Håndtering af endometriomer hos kvinder uden aktuelt graviditetsønske

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  1. Håndtering af endometriomer hos kvinder uden aktuelt graviditetsønske

  2. Omformuleret klinisk spørgsmål • Kirurgisk håndtering af symptomgivende endometriomer uden aktuelt graviditetsønske

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

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

  5. 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.

  6. 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 0.18-0.93), reduced requirement for further surgery (OR 0.21 CI 0.05-0.79), reduced recurrence rate of the symptoms of dysmenorrhoea (OR 0.15 CI 0.06-0.38), dyspareunia OR 0.08 CI 0.01-0.51) and non-menstrual pelvic pain (OR 0.10 CI 0.02-0.56). It was also associated with a subsequent increased rate of spontaneous pregnancy in women who had documented prior sub-fertility (OR 5.21 CI 2.04-13.29).

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

  8. Artikelvalg • Højeste evidensgrad • Aktualitet • Matcher bedst problemformulering

  9. 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

  10. Evidensgrad/styrke • Ia • A

  11. Rekommandationer • Excision af endometriomer som Guldstandard

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