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Abstrak :
Dalam kurun waktu Juni 2003 sampai dengan Juni 2004, pasien-pasien yang menderita adenomiosis berdasarkan ultrasonografi transvaginal dan memiliki keluhan menorhagia, dismenore, mcmpun nyeri pelvis diikulsertakan dalam penelitian. Randomisasi dilakukan untuk mengalokasikan subjek ke dalam kelompok reseksi dan kelompok miolisis. Semua pasien dan kedua kelompok mendapal GnRH analog 3 siklus pasca-laparnskopi operatif. Penilaian dilakukan dalam jangka waktu 6 bulan, baik secara subjektif melalui kuesioner maupun secara objektif melalui evaluasi volume adenomiosis per ultrasonografi transvaginal di akhir semester. Terdapat 20 pasien yang menjalani pembedahan, 10 dalam kelompok reseksi dan JO dalam kelompok miolisis. Komplikasi bermakna tidak ditemukan pada kedua kelompok. Evaluasi subyektif dapat dilakukun pada semua pasien sedangkan evaluasi objektif hanya dapal dilakukan pada 17pasien. Tidak didapatkan perbedaan bermakna antar-kelompok dalam penentuan skor keluhan menorhagia (p = 0.399) dan dismenorea (p=0.213). Tidak ditemukan perbedaan bermakna dalam median penambahan volume adenomiosis (p = 0.630) antara kelompok reseksi (medicui= +15,35% (-100 - 159)) dengan kelompok miolisis (median=+48,43% (-100 - 553)). Lima pasien hamil, 3 dari kelompok reseksi, 2 dari kelompok miolisis, dengan satu kasus ruptur uteri pada usia kehamilan 8 bulan pada kelompok miolisis. Efektifitas reseksi adenomiosis per laparoskopi tidak berbeda bermakna dengan miolisis adenomiosis per laparoskopi dalam penataksanaan adenomiosis bergejala. Miolisis tidak disarankan bagi wanitayang masih ingin hamil. (Med J Indones 2006; 15:9-17).

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Effective therapy preserving reproductive function in adenomyosis is warranted. From June 2003 to June 2004, patients diagnosed as having adenomyosis by transvuginal ultrasound and had symptoms of menorrhagta, dysmenorrhea, and pelvic pain were randomly allocated to either receive laparoscopic resection or myolysis. GnRH analog was given for 3 cycles after surgery. Within 6 months, symptoms were evaluated using questionnaires and at the end of follow up, adenomyosis volume was assessed by transvaginal ultrasound. There were 20 patients included, 10 patients had resection and the rest underwent myolysis. Both procedures did not yield significant complications. Subjective evaluation by questionnaires was done in all patients. Three patients could not be evaluated objectively by transvaginal ultrasound, 2 patients resigned and I was pregnant. There was no significant difference in menorrhagia and dysmenorrhea reduction score between the 2 groups (p=0.399 and 0.213, respectively). In both groups, dysmenorrhea was reduced significantly after treatment. No significant statistical difference was found in median adenomyosis volume increment (p=0.630) between the resection (median= + !5.35% (-100-159)) and myolysis groups (median=+48.43% (-100-553)). Five patients were pregnant, 3 from the resection group and 2 from the myolysis group. Uterine rupture was found in I patient (from the myolysis group) at the age of 8 months of pregnancy. The effectiveness of laparoscopic adenomyosis resection was not significantly different compared with la-parascopic myolysis as an alternative conservative surgery in treating symptomatic adenomyosis. Myolysis was not recommended for women who wish to be pregnant. (MedJ Indones 2006; 15:9-17)

Abstrak :
Tujuan tulisan ini adalah mendiskusikan tatalaksana terkini pengobatan endometriosis dengan penekanan pada peran laparoskopi operatif dan pengobatan medikamatosa. Ketepatan mendiagnosis endometriosis tanpa Laparoskopi sangat lemah, dengan positif palsu 44 % dan negatif palsu 19 %. Tersangka endometriosis yang didiagnosis tanpa laparoskopi akan ditemukan 81 % secara laparoskopi, sisanya 19 % bukan endometriosis. Disimpulkan bahwa laparoskopi sangat dibutuhkan untitk mendiagnosis dan mengobati endometriosis. Pengobalun medikamentosa efektifdalam hal merendahkan progresifitas endometriosis. (MedJ Indones 2006; 15:121-4)

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The objective of this paper is to discuss the current guidelines for treatment of endometriosis, emphasis on the role of laparoscopic surgery and medical treatment. The accuracy of diagnosis ofendometriosis without laparoscopy is very low, as a false negative rate of 19 % and a false positive rate of 44 %, when a diagnosis was made pre iaparoscopy, 81 % had the diagnosis can confirmed on laparoscopy, while 19 % did not have endometriosis. It is concluded that laparoscopy is required for evaluation ami treatment of endometriosis. Medical therapy is effective in reducing progression of endometriosis score. (MedJ Indones 2006; 15:121-4)

Abstrak :
Latar belakang: Penelitian ini bertujuan untuk membandingkan kadar serum penanda biologis: interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-a), matrik-metaloproteinase-2 (MMP-2), dan vascular endothelial growth factor (VEGF) pada endometriosis stadium I-II dan stadium III-IV.

Metode: Penelitian ini adalah penelitian potong lintang pada empat puluh pasien endometriosis yang didiagnosis berdasarkan laparoskopi. Sampel serum diambil sebelum operasi, pemeriksaan penanda biologis dilakukan pada akhir penelitian dengan metode ELISA. Rerata kadar serum dibandingkan dengan menggunakan uji t tidak berpasangan. Variabel yang memiliki perbedaan rerata bermakna diuji dengan pemeriksaan ROC dan ditentukan titik potong optimal.

Hasil: Kadar serum IL-6, TNF-a, dan MMP-2 tidak berbeda bermakna pada pasien endometriosis stadium I-II dan stadium III-IV dengan hasil rerata 1,58 ± 0,78 vs 1,55 ± 0,98 pg/mL; 1,5 ± 0,47 vs 1,49 ± 0,29 pg/mL; 152,04 ± 27,32 vs 140,98 ± 28,08 ng/mL. Hanya kadar VEGF yang memiliki perbedaan yang bermakna (289,76 ± 188,13 vs 581,29 ± 512,85 pg/mL (p < 0,05)). Perbedaan rerata VEGF memiliki nilai AUC 74,5%. Titik potong optimal VEGF = 314,75 pg/mL dengan sensitivitas 78,6% dan spesifisitas 69,2%.

Kesimpulan: Penelitian ini menunjukkan penanda biologis serum VEGF (tetapi tidak IL-6, TNF-a, dan MMP-2)dapat digunakan untuk mengukur derajat keparahan endometriosis. Kadar VEGF dari 314,75 pg/mL merupakan titik potong antara stadium yang lebih rendah dan lebih tinggi dari derajat keparahan.

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Background: The focus of this study was to compare serum biomarkers: interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), matrix-metalloproteinase-2 (MMP-2) and vascular endothelial growth factor (VEGF) in endometriosis stage I-II and stage III-IV.

Methods: This is a cross-sectional study. Forty endometriosis patients were diagnosed using laparoscopy procedure. Serum sample was taken before the surgery. The serum biomarkers (IL-6, TNF-α, MMP-2, and VEGF) were analyzed with ELISA method at the end of research. Mean of serum biomarkers in endometrosis stage I-II and stage III-IV were compared using unpaired t-test. Variables that show significant mean difference were tested using ROC measurement and the optimal cut-off point was determined.

Results: There was no significant difference in mean serum biomarkers level of IL-6, TNF-α, and MMP-2 between endometriosis stage I-II and stage III-IV (1.58 ± 0.78 vs 1.55 ± 0.98 pg/mL, 1.5 ± 0.47 vs 1.49 ± 0.29 pg/mL, and 152.04 ± 27.32 vs 140.98 ± 28.08 ng/mL, respectively). On the other hand, the comparison of VEGF level in endometriosis stage I-II and stage III-IV demonstrated significant difference (289.76 ± 188.13 vs 581.29 ± 512.85 pg/mL (p < 0.05)). Mean difference of VEGF had AUC of 74.5%. Optimal cut-off point for VEGF was ≥ 314.75 pg/mL with sensitivity 78.6% and specificity 69.2%. Conclusion: This study showed that serum biomarkers of VEGF level (but not IL-6, TNF-α, and MMP-2) can be used to measure the degree of severity in endometriosis. VEGF level of 314.75 pg/mL represents the cut-off point between lower and higher stage of severity.