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ENDOMETRIOSISENDOMETRIOSIS
Dr.dr.Nusratuddin A,SpOG(K),MARSDr.dr.Nusratuddin A,SpOG(K),MARS
DIVISI FERTILITAS DANDIVISI FERTILITAS DAN
ENDOKRINOLOGI REPRODUKSI ( FER)ENDOKRINOLOGI REPRODUKSI ( FER)
AGIAN OGIN FK UN!ASAGIAN OGIN FK UN!AS
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TU"UAN PEMELA"ARANTU"UAN PEMELA"ARAN
Ma#asis$a %&n'&ta#ui
D&*inisi &nd+%&tri+sis
Kasi*i-asi &nd+%&tri+sisEti++'iPat+'&n&sis &nd+%&tri+sis
Ga%/aran -ini- &nd+%&tri+sis
Dia'n+sis &nd+%&tri+sis
P&nan'anan &nd+%&tri+sis
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PENDA!ULUANPENDA!ULUAN
ENDOMETRIOSIS
0 T#& dis&as& +* t#&+r1
0 T#& 'r&at i%itat+r 0 T#& si&n2& in3ad&r
0 T#& %iss&d dis&as&
0 T#& pu44& dis&as&
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DefinisiDefinisi
“Presence of endometrial tissue outside
the lining of the uterine cavity”or
“Proliferation of endometrium in any
site other than the uterine mucosa”
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DEINISI !DEINISI !
0 End+%&tri+sis dit&%u-anEnd+%&tri+sis dit&%u-an 5arin'an 5arin'an
&nd+%&triu% 1an' *un'si+na diuar&nd+%&triu% 1an' *un'si+na diuar
-a3u% ut&ri.-a3u% ut&ri.
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EPIDEMIO"O#I !EPIDEMIO"O#I !
Pr&3a&nsi tida- di-&ta#ui pasti
$elom%o& %enderita Incidence
umum '()*+
Massa %elvi& ,+
Nyeri %elvi& -*+
Infertilitas .*+Dismenorea /*+
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P 0 T O # E N E S I SP 0 T O # E N E S I S
Etiologi Tida- pasti (dis&as& +* t#&+r1)1e2era%a teori diusul&an !0 M&nstruasi RETOGRAD(Teori Sam%son)0 P&n1&/aran LIMFATIK0 P&n1&/aran !EMATOGEN0 P&n1&/aran IATROGENIKLANGSUNG0 Sisa s& EMRIONIK
0 M&tapasia SELOMIK0 T&+ri INDUKSI0 T&+ri INVAGINASI
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Etiologi Tida- pasti (dis&as& +* t#&+r1)
1e2era%a teori diusul&an !0 T&+ri !ORMONAL
0 T&+ri IMUNOLOGI0 T&+ri in'-un'an
P 0 T O # E N E S I SP 0 T O # E N E S I S
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0 Teori Sam%son !
Dara# %&nstruasi %&n'air dan -&uar dari tu/a
dis&rtai s&rpi#an &nd+%&triu%, -&%udian dii-uti
+ i%pantasi dan p&rt%u/u#an dit&%pat aindi r+n''a pan''u
P0TO#ENESIS
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Teori Sampson tentang menstruasi retrograde
T# 6786. Sa%ps+n, P&i%/a#an dara# #aid
-&r+n''a p&L3i-
9:7: ; P&i%/a#an -& r+n''a p&3i-
(!a%&. O/st&t G1n&2+ 67
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0 Teori %enye2aran hematogen !
"arin'an &nd+%&tri+sis /&rasa 5arin'an
&nd+%&triu% 1an' %&%asu-i p&%/uu#
dara# -&%udian %&n1&/ar /&/&rapa
t&%pat ditu/u#
P0TO#ENESIS
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0 Teori %enye2aran limfogen ! End+%t&ri+sis /&rasa 5arin'an &nd+%&triu%
1an' %&%asu-i i%*& dari ut&rus saat
%&nstruasi -&%udian %&n1&/ar -& /a'ian
p&3i- ain.
P0TO#ENESIS
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Teori Metastasis limfati& dan vas&uler34al2an5Teori Metastasis limfati& dan vas&uler34al2an5
End+%&tri+sis dis&/ar-an dan /&r-&%/an' %&aui i%*ati- dan 3as-u&r
P0TO#ENESIS
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0 Diseminasi iatrogeni& !
p&n1&/aran an'sun' 5arin'an
&nd+%&triu% dapat t&r5adi saat +p&rasi,
%isan1a &nd+%&tri+sis 1an' t&r5adi pada
t&%pat insisi s&-si+ s&sar, #ist&r&-t+%i
dan &pisi+t+%i
P0TO#ENESIS
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0 Sisa sel em2rioni& !
S&s& dari para%&s+n&*r+s (Mu&r) %un'-in
t&rdapat disuatu t&%pat didaa% tu/u# dan
%&%/&ri-an r&sp+n t&r#adap #+r%+n +3ariu%sin''a %&n'a-ti*-an sisasisa s& ini
%&%/&ntu- &nd+%&triu% dit&%pat ain.
P0TO#ENESIS
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0 Meta%lasia selomi& !
End+%&triu% 1an' %&n1i%pan' dari
p&r-&%/an'an n+r%a t&r5adi a-i/at p&ru/a#an
p&ru/a#an di*&r&nsiasi 1an' a/n+r%a daa%&pit& '&r%ina dan /&r/a'ai /a'ian p&rit+n&u%,
r+n''a pan''u 1an' s&2ara &%/ri++'is
/&rasa dari &pit& s&+%i-.
P0TO#ENESIS
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Teori Meta%lasia selomi& 3I6anoff dan Meyer5Teori Meta%lasia selomi& 3I6anoff dan Meyer5
0 End+%&tri+sis /&r-&%/an' dari
p&rit+n&u%0 Du-tus Mu&r, &pit& +3ariu%,
p&rit+n&u% p&3is /&rasa dari
p&%/a-a &%/ri++'is 1an' sa%a
?it4 @A. @in O/st&t G1n&2+. 6777
P0TO#ENESIS
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Teori Indu&siTeori Indu&si
Endometrium yang terle%as a&an meghasil&an senya6a yang mengindu&si
7aringan %eritoneum 2er&em2ang men8adi endometriosis
P0TO#ENESIS
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Teori Invaginasi
Kista &nd+%&tri+sis /&rasa dari in3a'inasi&pit& +3ariu% 1an' -&%udian %&n'aa%i
%&tapasia
P0TO#ENESIS
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P 0 T O " O # IP 0 T O " O # I
Secara histologi endometriosis td!
0 K&&n5ar
0 Str+%a
0 K&&n5arstr+%a
0 D&n'antanpa #&%+sid&rin
0 Ma-r+pa'
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Susunan miri% endometrium yang menam%il&anSusunan miri% endometrium yang menam%il&an
%eru2ahan &linis se%erti endometrium%eru2ahan &linis se%erti endometrium
normal &avum uteri yang da%at tum2uhnormal &avum uteri yang da%at tum2uhdi ham%ir semua 2agian tu2uhdi ham%ir semua 2agian tu2uh
Elemen &elen8ar
Stroma
4emosiderin
Ma&rofaga mengandung hemosiderin
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1erdasar&an Tam%ilannya
0 L&si n+n pi'%&ntasi (?#it& Opa2i*i2ati+n)
n+n a-ti*
0 L&si %&ra# (r&d *a%&i-& &si+n) a-ti*
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"O$0SI"O$0SI
0 O3ariu%
0 P&rit+n&u%, i'.sa-r+ut&rina, -a3.d+u'asi,
dd' /-' ut&rus, tu/a Fa+pi,pi-a 3.Ut,
i'.r+t.
0 S&r3i-s,3a'ina,VU.
0 U%/ii-us
0 Paru,%ata,p&r-ardiu%, +ta-.
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ENDOMETRIOSIS "O$0"IS0SI
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"O$0SI"O$0SI
0 End+%&tri+sis int&rna (ad&n+%i+sis)
0 End+%&tri+sis p&3i-(&nd+%&tri+sis s&5ati)
0 End+%&tri+sis &-stra '&nita
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N+r%aN+r%a
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9terosacral ligament9terosacral ligament
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9terosacral ligament9terosacral ligament
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Side 6allSide 6all
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:ul de sac:ul de sac
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:hocolate cysts:hocolate cysts
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End+%&tri+sis +n in t#& O3ar1End+%&tri+sis +n in t#& O3ar1
0 F+r%s a dar-, chocolate cystic %ass.
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1o6el1o6el
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Dia%hragmDia%hragm
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1ladder1ladder
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#E70"0 ; T0ND0#E70"0 ; T0ND0
0 End O3ariu% "aran' /&r'&5aa
0 End p&rit+n&u% N1&ri p&rut t&ruta%a /a'
/a$a# saat #aid (Dis%&n+r&)
0 End 3a'ina -a3 D+u'asi Dispar&unia
0 End usus N1&ri A dan #&%at&%&sis
0 End V&si-a Disuri#&%aturi
0 End paru !&%apt+&
0 End Ota- N1&ri -&paa #&/at0 In*&rtiitas
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DI0#NOSISDI0#NOSIS
0 ANAMNESIS (tu dis%&n+r&in*&rtiitas)
0 PEM FISIS
VTRT didapat-an n+du dis&rtai n1&ri pdi' sa-r+ ut&rina-a3 D+u'asi
0 USG /isa -ista atau ad&n+%i+sis
0 LAPAROSKOPI &r2a- &nd+%&tri+sisdan -ista &nd+%&tri+sis (&nd+%&tri+%a)
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$"0SII$0SI$"0SII$0SI
0 A@OSTA
0 EE@ (End+s2+pi2 End+%&t @assi*i2ati+n)
0 AFS (A%&ri2an F&rtiit1 S+2i&t1) Mini%a (AFS I)
Rin'an (AFS II)
S&dan' (AFS III) &rat (AFS IV)
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Revised 0S ) )/?0 Stage III 3moderate5 )@ > .*?
0 Stage IA 3severe5 B .*?
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Stadium I;II
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Stadium III
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Stadium IA
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S&/&u% t&rapi S&suda# t&rapi
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Fa-t+r R&si-+Fa-t+r R&si-+
0 Sin'&nuipar+us
0 Ear1 %&nar2#&
0N+n +ra 2+ntra2&pti+n
0 S#+rt&r 212&+n'&r durati+n +* *+$
0 In*&riit1
0 Stenosis of cerviC
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PEN0N#0N0N ENDOMETRIOSISPEN0N#0N0N ENDOMETRIOSIS
P&nan'anan t&rdiri dari 0 M&di-a%&nt+sa
0 Op&rati*
0 M&di-a%&nt+sa Op&rati*
P&nan'anan M&di-a%&nt+sa B68 /uan td0 Pi -+%/inasi0 DMPA (In5&-si)0 MPA (Ta/&t)0 Dana4+0 L&pr+id&0 G+sar&in
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PEN0N#0N0N ENDOMETRIOSISPEN0N#0N0N ENDOMETRIOSIS
P&nan'anan &da# tdK+ns&r3ati* d&n'an
0 E&-tr+-aut&r
0 R&s&-si0 A/asi
D&*initi* d&n'an
0 !TSO
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PEN0#0N0N ENDOMETRIOSISPEN0#0N0N ENDOMETRIOSIS
Pii#an p&na'anan t&r'antun'
0 Rin'an/&rat &nd+%&tri+sis (-asi*i-asi)
0 A-ti*n+n a-ti* &nd+%&tri+sis
0 Ada ana-tida- ada ana-
0 Tin'-at r&-ur&nsi
0 Usia
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$ondisi endometriosis Pengo2atan
Mini%arin'an n+n a-ti* Kaut&rsi%pt+%ati-
Mini%arin'an a-ti* Kaut&rMPADana4+
S&dan'/&rat n+n a-ti* S&'&ra -aut&r-ist&-t+%i
S&dan'/&rat a-ti* GnR!Op&rati*
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ENDOMETRIOSIS ERTI"IT0SENDOMETRIOSIS ERTI"IT0S
End+%&tri+sis %&n1&/a/-an in*&rtiitas
0 O-usi tu/a
0 Dist+rsi anat+%i- +r'an p&3i-
0 M&n'#s- 4at t+Ci- %&n''an''u %+tiitas
sp&r%a, int&ra-si sp&r%as&
t&ur,transp+rtasi &%/ri+
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S O S A S & O OS S
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KISTEKTOMI KISTA SIMPLEK & ENDOMETRIOSIS
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