В последние годы проявляется интерес к органосохраняющим методам лечения миомы матки, одним из которых является эмболизация маточных артерий (ЭМА). Среди отрицательных сторон метода -развитие тяжелого постэмболизационного синдрома (ПЭС), требующего своевременного начала адекватного лечения с целью избежания грозных осложнений, способных привести к удалению органа. Целью исследования был поиск прогностических критериев развития тяжелого ПЭС в дооперационном периоде. В исследование вошла 81 женщина с миомой матки 7-17 недель в возрасте 19-50 лет, прошедшая лечение методом ЭМА. В работе использовали антропометрические данные пациенток и показатели кожной микроциркуляции, полученные методом лазерной допплеровской флоуметрии (ЛДФ) с проведением окклюзионной пробы (ОП). На основании прогностических критериев построены модели с AUC (область под графиком ROC кривой) > 0,8. Антропометрические предикторы тяжелого ПЭС в моделях: возраст менее 38,5 лет (р < 0,05); ИМТ менее 25 кг/м 2 (р < 0,05) и показатель микроциркуляции (М) до ЭМА -менее 9,55 пф. ед. (р = 0,001). Показатели микрокровотока в ОП свидетельствуют о том, что чем выше значения индекса потребления кислорода (I), внутрисосудистого сопротивления (Rc), резерва капиллярного кровотока (РКК) в моделях, тем выше риск развития тяжелой формы ПЭС (р < 0,05). Низкие показатели угла альфа в ОП (р = 0,003) и эндотелиальных колебаний UVLF (р = 0,004) в моделях также ведут к повышенному риску развития тяжелого ПЭС. Многомерные прогностические модели позволят диагностировать развитие тяжелого ПЭС до проведения ЭМА и подготовить пациентку к определенному послеоперационному ведению и лечению.Recently specialists take an interest in organ-preserving methods of uterine fibroids treatment, one of which is uterine artery embolization (UAE). One of the method's negative aspects is the severe postembolization syndrome (PES) development, requiring timely initiation of adequate treatment in order to avoid severe complications that could lead to the organ removal. The study was aimed to search for the prognostic criteria of the severe PES development during the preoperative period. The study included 81 UAE-treated women aged 19-50 with 7-17 week uterine myoma. The patients' anthropometric measurements were used, as well as the skin microcirculation data obtained by laser Doppler flowmetry together with the occlusion test. Based on prognostic criteria, models with AUC (area under ROC curve) > 0.8 were presented. According to the models, the anthropometric predictors of the severe PES were the following: age under 38.5 (р < 0.05); BMI lower than 25 kg/m 2 (р < 0.05), and microcirculation value (M) prior to UAE below 9.55 PU (р = 0.001). Microvascular blood flow during the occlusion test indicate that the higher the oxygen consumption index (I), intravascular resistance (Rc), capillary blood flow reserve capacity in the models, the higher the risk of the severe PES development (р < 0.05). Low alpha angle value obtained by the occlusion test (р = 0.003) as well as the UVLF value (р = 0.004) ...
Uterine fibroids are one of the main causes of hysterectomy. This radical method of treatment allows to control such symptoms as pain and bleeding, but significantly worsens womens quality of life, preventing them from their childbearing function. This article includes the results of domestic and foreign studies on organ-preserving methods of treatment of uterine fibroids published within 10 years. The method of uterine artery embolization, which is preferred by an increasing number of doctors and patients suffering from fibroids, is also described in the article. The search for articles was carried out in the databases Pubmed, Web of Science, Scopus.
The work includes the published results of domestic and foreign studies on the course and correction of post-embolization syndrome that occurs after embolization of the uterine arteries in the treatment of symptomatic uterine fibroids. The articles were searched in the Pubmed, Web of Science, Scopus, Google Scholar, and еLibrary databases.
Recently specialists take an interest in organ-preserving methods of uterine fibroids treatment, one of which is uterine artery embolization (UAE). One of the method’s negative aspects is the severe postembolization syndrome (PES) development, requiring timely initiation of adequate treatment in order to avoid severe complications that could lead to the organ removal. The study was aimed to search for the prognostic criteria of the severe PES development during the preoperative period. The study included 81 UAE-treated women aged 19–50 with 7–17 week uterine myoma. The patients’ anthropometric measurements were used, as well as the skin microcirculation data obtained by laser Doppler flowmetry together with the occlusion test. Based on prognostic criteria, models with AUC (area under ROC curve) > 0.8 were presented. According to the models, the anthropometric predictors of the severe PES were the following: age under 38.5 (p < 0.05); BMI lower than 25 kg/m2 (р < 0.05), and microcirculation value (M) prior to UAE below 9.55 PU (р = 0.001). Microvascular blood flow during the occlusion test indicate that the higher the oxygen consumption index (I), intravascular resistance (Rc), capillary blood flow reserve capacity in the models, the higher the risk of the severe PES development (p < 0.05). Low alpha angle value obtained by the occlusion test (p = 0.003) as well as the UVLF value (p = 0.004) in the models also indicate the increased risk of severe PES. Multidimensional prognostic modelling admits to expect the severe PES development prior to UAE, which allows the doctor to prepare the woman for specific management and treatment.
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