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Ditulis oleh Ovan Taufik
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Selasa, 22 April 2008 22:16 |
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Hysterectomy is currently considered by most the only effective treatment for symptomatic adenomyosis. In recent years I have successfully treated many patients with adenomyosis by removing only the part of the uterus containing the bulk of the disease (as carefully defined by transvaginal ultrasound) followed by reconstruction of a close-to-normal size uterus.
This results in resolution of the pain and in normal to light periods. Unfortunately, the uterus after such surgery is unlikely to sustain a pregnancy. Nonetheless patient satisfaction has been high because this more limited operation avoids most of the drawbacks of hysterectomy. The story of such a patient is described in an article in the New York Times (February 18, 1997, Science Section, by Natalie Angier). Recently there have been several reports from Australia and Europe of a similar surgical treatment of adenomyosis and even of successful pregnancies following resection of small areas of myometrium affected with adenomyosis. Endometrial ablation or resection for the treatment of adenomyosis-related pain and abnormal bleedingis effective only in the relatively infrequent cases where the adenomyosis is very superficial, penetrating less than 2mm into the myometrium. When the penetration is deeper than 2mm endometrial ablation or resection fails to improve the pain or bleeding. It is therefore very important in cases of "Dysfunctional uterine bleeding" to rule out adenomyosis before attempting endometrial ablation.
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