Endometriosis remains one of the most studied pathologies in modern gynecology, as it is accompanied by such complications as constant pelvic pain, menstrual cycle disorders, and infertility. These complications not only prevent the implementation of a woman’s reproductive function, but also worsen the normal life of a woman in general. The early diagnosis and the right choice of treatment is the basis of prevention of disease recurrence. Therefore, most of the efforts of scientists are directed to this.The objective: to reduce the frequency of genital endometriosis recurrence and improve the implementation of reproductive functions based on the improved approaches to its diagnosis and treatment.Materials and methods. The study included two groups of patients. The 1st group included 60 women with a diagnosis of ovarian endometriosis, whose data were analyzed retrospectively based on the results of medical histories. The 2nd group was studied prospectively and included 60 women with a diagnosis of ovarian endometriosis.All patients had general clinical and laboratory examinations, specific laboratory and ultrasound examinations. In patients of the 2nd group tumor markers were additionally determined, in particular CA-125, HE4, CA 19-9, CA 72-4, CA 15-3, REA, and the level of anti-Müllerian hormone, magnetic resonance imaging was performed. Patients of both groups were operated and histological examination of the material obtained during the operation was performed.The difference in the management of the postoperative period in the 2nd group was that, in addition to anti-inflammatory therapy all women received hormonal therapy (gonadotropin-releasing hormone agonist (GnRH agonist) with subsequent use of combined oral contraceptives (COCs) or simultaneous use of GnRH agonist and COCs with subsequent transition in both variants for dienogest for 6 months continuously). Recurrence of the pathology was detected after 3 and 6 months on the basis of a repeated diagnosis of ovarian endometriosis.Results. The obtained data showed that in the postoperative period, 3 months after treatment 5 (8.3 %) women in the 1st group had a recurrence of ovarian endometriosis and 4 (6.7 %) patients – pelvic adhesions. Whereas in the 2nd group, there were no cases of recurrence and adhesions.In 6 months after treatment in the 1st group 11 (18.3 %) patients were diagnosed with ovarian endometriosis recurrence, and 6 (10.0 %) women were diagnosed with pelvic adhesions. In the 2nd group recurrence of ovarian endometriosis was found only in 1 (1.7 %) woman, pelvic adhesions were not detected (p<0.05). During the year after treatment the number of pregnant women among persons who wished to become pregnant and had a history of infertility was statistically higher in the 2nd group compared to the 1st group, in particular, 10 (16.7 %) and 2 (3.3 %) women, respectively (p<0.05).Conclusions. The proposed algorithm for the diagnosis and treatment of genital endometriosis minimizes the risk of its recurrence and improves reproductive function.
The objective: depression of frequency of recediving of genital prolapse at women after surgical treatment of the combined pathology of uterus on the basis of development and deployment of the differentiated approach to choice of technique of operation. Materials and methods. We carried out the analysis of results of surgical treatment of 90 patients which were operated concerning benign diseases of uterus and genital prolapse with use of vaginal quick access. As the main (basic) operation by all patient was executed vaginal hysterectomy. Options of vaginal operations had essential features at patients of various clinical groups. Separation of patients into clinical groups was made depending on indications for excision of uterus, existence of an accompanying prolapse of genitalias (complicated or with stressful incontience of urine) and age of patients. Results. Efficiency of the differentiated approach at surgical treatment of the combined pathology of uterus with genital prolapse makes 96.7%, thus 83.3% of women consider themselves healthy. The highest frequency of recediving (6.7%) takes place at women without genital prolapse by which the hysterectomy was executed only concerning benign diseases of uterus of appendages with laparoscopic assistention. Conclusion. Use of the differentiated approach to surgical treatment of the combined pathology of uterus and genital prolapse allows to increase efficiency, to reduce the frequency of recediving and to improve quality of life of women. Key words: combined pathology of uterus, genital prolapse, surgical treatment.
The objective: study of nosotropic aspects of violations of menstrual and genesial function at combined pathology of uterus. Materials and methods. For the decision of the put purpose we conducted a complex clinical and laboratory, functional and immunohistochemical inspection 109 women with combined pathology of uterus and violation of genesial function. 1 (n=69) and 2 (n=19) groups were formed from patients with chronic endometritis and concomitant genital pathology. In 3 (n=21) groups there were the included women after different endometrial manipulations. For the study of new aspects of pathogeny of violation of genesial function for women with combined pathology of uterus immunohistochemical researches of endometrium conducted the method of double antibodies with immunoperoxidase (streptovidin-biotinic) by a mark, used serial paraffin cuts. Results. The retrospective study of the given medicare rotined that a desire to have children had served by reason of active treatment at the most inspected women. Anti-inflammatory (including antibacterial) therapy is before conducted at 93,3% patients, thus in the half of cases – repeatedly. Hormonal preparations were before appointed 66,2% to the patients. Endoscopic surgical interferences on the organs of the genesial system are executed for 46,7% patients. Used the more than half of women programs of auxiliary reproductive technologies which did not bring the desired effect. The results of laboratory-instrumental inspection confirmed a presence different structurally functional changes of endometrium, which could be an independent factor, impedimental to implantation and successful development of pregnancy. The increase of proangiogenic potential plays a considerable role in pathogeny of combined pathology of uterus and violations of genesial function. Conclusions. Combined pathology of uterus is reason of violations of genesial function of women. The set nosotropic features testify to the necessity of more deep study of this problem for development of effective algorithm of diagnostic and лечебно-профилактических measures.
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