{"id":10618,"date":"2020-07-07T13:14:50","date_gmt":"2020-07-07T13:14:50","guid":{"rendered":"https:\/\/jurmed.ro\/medici\/?p=10618"},"modified":"2020-07-07T13:14:50","modified_gmt":"2020-07-07T13:14:50","slug":"endometrioza-intestinala","status":"publish","type":"post","link":"https:\/\/jurmed.ro\/medici\/endometrioza-intestinala\/","title":{"rendered":"Endometrioza intestinal\u0103"},"content":{"rendered":"
\"\"<\/a>
Autor: Dr. Costin Gabriel Mitroi, Medic Primar Obstetric\u0103-Ginecologie Centrul Medical Provita<\/figcaption><\/figure>\n

Endometrioza reprezint\u0103 o afec\u0163iune genetic\u0103, ce poate fi agravat\u0103 de o serie de factori externi: mediul hormonal, imunologic, alimenta\u0163ie, sarcin\u0103 etc.<\/p>\n

Ea reprezint\u0103, de cele mai multe ori, o afec\u0163iune dureroas\u0103 a femeii tinere, \u00een perioada fertil\u0103. De multe ori \u00eens\u0103, am \u00eent\u00e2lnit aceast\u0103 patologie \u015fi la v\u00e2rste mai \u00eenaintate sau chiar la pubertate.<\/p>\n

Endometrioza reprezint\u0103 o patologie frecvent \u00eent\u00e2lnit\u0103 \u00een popula\u021bia t\u00e2n\u0103r\u0103 (25-40 de ani), afect\u00e2nd 10% din popula\u021bia feminin\u0103 (procentul variaz\u0103 \u00een func\u021bie de statistici). Endometrioza este o boal\u0103 mult subdiagnosticat\u0103 peste tot \u00een lume, datorit\u0103 multiplelor forme clinice sub care apare. De multe ori semnele clinice lipsesc, singurul lucru care poate atrage aten\u021bia asupra bolii, fiind durerea \u00een timpul menstrua\u021biei.<\/p>\n

Endometrioza intestinal\u0103 reprezint\u0103, cu siguran\u021b\u0103, cea mai frecvent\u0103 form\u0103 extragenital\u0103 a bolii \u0219i este patologia ginecologic\u0103 de care m-am ocupat cel mai mult \u00een ultimii ani.<\/p>\n

Cea mai frecvent\u0103 localizare a endometriozei intestinale este reprezentat\u0103 de rect \u0219i jonc\u021biunea recto-sigmoidian\u0103 (aprox. 90%). Afectarea intestinului sub\u021bire, a regiunii ileo-cecale \u0219i a apendicelui vermiform sunt \u00eentalnite mult mai rar.<\/p>\n

Ca \u0219i simptomatologie, endometrioza intestinal\u0103 se manifest\u0103 cel mai frecvent prin tulbur\u0103ri ale tranzitului intestinal, agravate \u00een timpul menstrua\u021biei sau al ovula\u021biei. De asemenea aceste tulbur\u0103ri sunt \u00eenso\u021bite, cel mai frecvent, de dureri intense. Nu sunt rare \u00eens\u0103 cazurile \u00een care pacientele se prezint\u0103 la noi pentru modificari minore al tranzitului intestinal, dureri minore \u00een timpul menstruatiei sau sunt asimptomatice, iar examenul clinic relev\u0103 \u201cnoduli endometriozici\u201d de mari dimensiuni la nivelul spatiului recto-vaginal.<\/p>\n

Uneori pacientele cu endometrioz\u0103 intestinal\u0103 ajung \u00een cadrul centrului nostru datorit\u0103 infertilit\u0103\u021bii de cauz\u0103 necunoscut\u0103.<\/p>\n

Orice pacient\u0103 care se prezint\u0103 la medicul specialist ginecolog (sau la oricare alt\u0103 specialitate) cu dureri pelvine cronice, dureri \u00een timpul menstrua\u021biei trebuie suspicionat\u0103 de endometrioz\u0103. Acest diagnostic ar trebui s\u0103 fie suspicionat primul, \u0219i nu ultimul, a\u0219a cum se \u00eent\u00e2mpl\u0103 de multe ori; astfel, diagnosticul este \u00eent\u00e2rziat, iar boala evolueaz\u0103 c\u0103tre forme severe, cu infiltrarea organelor pelvine, cel mai frecvent la nivelul compartimentului posterior – rect, jonc\u021biune recto-sigmoidian\u0103.<\/p>\n

Diagnosticul endometriozei profunde intestinale este, \u00een primul r\u00e2nd, unul clinic<\/em><\/strong>, atunci c\u00e2nd medicul specialist pune \u00een eviden\u021b\u0103 prezen\u021ba forma\u021biunilor \u2018nodulare\u2019 – nodulii endometriozici – la nivelul peretelui posterior vaginal. Uneori, atunci c\u00e2nd leziunile endometriozice sunt localizate superior (colon sigmoid, jonctiune recto-sigmoidiana) ele nu pot fi palpate \u00een timpul consultului ginecologic.<\/p>\n

Suspiciunea clinic\u0103 impune o evaluare suplimentar\u0103 a extensiei bolii. Acest lucru poate fi realizat cel mai bine prin examinarea RMN <\/em><\/strong>efectuat\u0103 de un radiolog specializat \u00een diagnosticul endometriozei pelvine. Aceasta arat\u0103 localizarea leziunilor, gradul de infiltrare al peretelui intestinal afectat (poate ajuta \u00een planificarea tipului de interven\u021bie). De asemenea, examinarea RMN poate pune\u00ee eviden\u021b\u0103 \u0219i alte leziuni concomitente: leziuni de endometrioz\u0103 cu alte localiz\u0103ri – vezical\u0103, leziuni parametriale adiacente ureterelor pelvine, dilata\u021bii ureterale, adenomioz\u0103 etc.<\/p>\n

Rareori (depinde de experien\u021ba imagistului), examinarea RMN poate fi completat\u0103 de Hidro-colono-CT<\/em><\/strong> care arat\u0103 gradul de stenoz\u0103 a tubului digestiv, lucru important \u00een planificarea tipului de interven\u021bie chirurgical\u0103: rezec\u021bie intestinal\u0103, excizie discal\u0103, shaving rectal.<\/p>\n

Examenul ecografic pelvin, efectuat de medici cu experien\u021b\u0103 \u00een diagnosticul acestei boli, poate fi de mare ajutor \u00een evaluarea gradului de extensie a endometriozei profunde rectale. Ea are limite importante \u00een leziunile cu localizare \u00eenalt\u0103 – sigmoid, jonc\u021biune recto-sigmoidian\u0103.<\/p>\n

Tratamentul endometriozei profunde intestinale este, prin excelen\u021b\u0103, unul chirurgical – excizia leziunilor endometriozice efectuate \u00een echipe chirurgicale complexe. Acesta \u00ee\u0219i propune refacerea anatomiei pelvine, reducerea riscului de complica\u021bii ce pot ap\u0103rea din cauza bolii \u0219i, mai ales, reducerea\/dispari\u021bia simptomatologiei (durere, tulbur\u0103ri ale tranzitului intestinal).<\/p>\n

Un alt lucru important pe care \u00eel face chirurgia excizional\u0103 corect\u0103 a acestei boli, \u0219i pe care multi dintre medicii ginecologi speciali\u0219ti ART\/FIV \u00eel ignor\u0103, este cre\u0219terea fertilit\u0103\u021bii. Le explic de fiecare dat\u0103 pacientelor noastre modalit\u0103\u021bile prin care excizia leziunilor de endometrioz\u0103 pelvin\u0103 profund\u0103 (intestinal\u0103) cre\u0219te \u0219ansa de a procrea.<\/p>\n

Chirurgia endometriozei profunde intestinale reprezint\u0103 o chirurgie minim-invaziv\u0103 foarte dificil\u0103. Aceasta se datoreaz\u0103 at\u00e2t modific\u0103rilor anatomice pe care boala le creeaz\u0103, precum \u0219i pentru faptul c\u0103 majoritatea pacientelor pe care le oper\u0103m nu sunt la prima interven\u021bie chirurgical\u0103. De cele mai multe ori aceste paciente au suferit mai multe interven\u021bii \u201cincomplete\u201d asupra bolii, unele dintre acestea fiind pe cale abdominal\u0103 \u201cclasic\u0103\u201d, ceea ce face ca interven\u021bia noastr\u0103 radical\u0103 s\u0103 fie mult \u00eengreunat\u0103 \u0219i grevat\u0103 de eventuale complica\u021bii.<\/p>\n

Tratamentul conservator (antiinflamator, antispastic, hormonal, DIU, etc.) este rezervat pacientelor care refuz\u0103 sau au contraindica\u021bii pentru opera\u021bie. El nu are rol curativ, ci doar de ameliora simptomatologia. Din p\u0103cate, tratamentele hormonale (unele dintre ele foarte agresive) sunt grevate de efecte adverse importante: tulbur\u0103ri digestive (gastrite, ulcere gastrice, intestinale – \u00een cazul antiinflamatoarelor), afect\u0103ri neuro-endocrine (tratamentele hormonale).<\/p>\n

De asemenea, interven\u021biile chirurgicale pentru endometrioza profund\u0103 intestinal\u0103 pot fi grevate de o serie de complica\u021bii:<\/p>\n

    \n
  • \u00a0s\u00e2nger\u0103ri intra \u0219i postoperatorii<\/li>\n
  • \u00a0leziuni intraoperatorii ale unor organe adiacente leziunilor endometriozice (uretere, vezic\u0103 urinar\u0103, structuri ale tubului digestiv, structuri vasculare)<\/li>\n
  • leziuni nervoase (plexuri hipogastrice, nervi hipogastrici, r\u0103d\u0103cinile sacrate, nervul sciatic)<\/li>\n
  • fistulele digestive \u2013 cea mai de temut complica\u021bie!!!<\/li>\n
  • fistulele urinare<\/li>\n<\/ul>\n

    *Riscul de apari\u021bie a complica\u021biilor precum \u0219i rata de recidiv\u0103 a bolii (implicit a simptomatologiei), sunt reduse atunci c\u00e2nd interven\u021biile chirurgicale sunt efectuate \u00een centre de referin\u021b\u0103.<\/p>\n

    \n","protected":false},"excerpt":{"rendered":"

    Endometrioza reprezint\u0103 o afec\u0163iune genetic\u0103, ce poate fi agravat\u0103 de o serie de factori externi: mediul hormonal, imunologic, alimenta\u0163ie, sarcin\u0103 etc. Ea reprezint\u0103, de cele mai multe ori, o afec\u0163iune […]<\/p>\n","protected":false},"author":4,"featured_media":10620,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_exactmetrics_skip_tracking":false,"_exactmetrics_sitenote_active":false,"_exactmetrics_sitenote_note":"","_exactmetrics_sitenote_category":0,"footnotes":""},"categories":[429],"tags":[],"class_list":["post-10618","post","type-post","status-publish","format-standard","has-post-thumbnail","category-ginecologie"],"yoast_head":"\nEndometrioza intestinal\u0103 - Jurmed - Medici<\/title>\n<meta name=\"description\" content=\"Endometrioza intestinal\u0103 reprezint\u0103, cu siguran\u021b\u0103, cea mai frecvent\u0103 form\u0103 extragenital\u0103 a bolii \u0219i este patologia ginecologic\u0103\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/jurmed.ro\/medici\/endometrioza-intestinala\/\" \/>\n<meta property=\"og:locale\" content=\"ro_RO\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Endometrioza intestinal\u0103 - 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