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A terapêutica do endometrioma em contexto de infertilidade
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A endometriose é uma doença inflamatória crónica de etiologia multifactorial, cuja fisiopatologia não é, ainda, totalmente compreendida e que surge, muitas vezes, associada a infertilidade.! O endometrioma, quisto ovárico com características particulares endometriais, é uma das manifestações da doença em causa e constitui uma agressão ao ovário, tendo o seu tratamento sido, ao longo dos anos, empiricamente cirúrgico.! No que diz respeito à infertilidade, surgiu a preocupação com a possibilidade destas cirurgias serem deletérias para o ovário e, consequentemente, para os tratamentos de fertilidade a que estas mulheres são sujeitas.! Efectuou-se uma revisão da literatura mais recente, tendo-se concluído que o tratamento cirúrgico por excisão do endometrioma pode ser prejudicial para o ovário, podendo mesmo levar a falência do órgão. No entanto, observou-se um efeito positivo na concepção espontânea e não se verificou um impacto significativo nos resultados de PMA, sendo importante uma abordagem personalizada das doentes.
Endometriosis is an inflammatory chronic disease with a multifactorial etiology, which pathophysiology is not quite understood yet, and that is commonly associated with infertility.! Endometriomas, ovarian cysts with particular endometrial characteristics, are one of the manifestations of this disease. They are, per se, a cause of damage to the ovary and its treatment has been empirically surgical. ! As far as infertility is concerned, the preoccupation has arisen that these surgeries might be deleterious to the ovary and, consequently, to the fertility treatments to which these women are submitted.! A revision of the recent literature on the subject has been made, concluding that the surgical treatment of the endometrioma by excision may be prejudicial to the ovary and might lead even to organ failure. However, it has been observed a positive effect on the spontaneous conception and also, a significative impact on the assisted reproductive technology results has not been verified. ! The most important posture concerning the approach to the patient is to personalize the treatment.
Endometriosis is an inflammatory chronic disease with a multifactorial etiology, which pathophysiology is not quite understood yet, and that is commonly associated with infertility.! Endometriomas, ovarian cysts with particular endometrial characteristics, are one of the manifestations of this disease. They are, per se, a cause of damage to the ovary and its treatment has been empirically surgical. ! As far as infertility is concerned, the preoccupation has arisen that these surgeries might be deleterious to the ovary and, consequently, to the fertility treatments to which these women are submitted.! A revision of the recent literature on the subject has been made, concluding that the surgical treatment of the endometrioma by excision may be prejudicial to the ovary and might lead even to organ failure. However, it has been observed a positive effect on the spontaneous conception and also, a significative impact on the assisted reproductive technology results has not been verified. ! The most important posture concerning the approach to the patient is to personalize the treatment.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2017
Palavras-chave
Endometrioma Infertilidade Tratamento Cirurgia Expectante Obstetrícia