The application of ultrasonography to select tactics for treatment of women of reproductive age with uterine leiomyoma

Abstract

Objective. To study the condition of the pelvic organs in women of reproductive age with uterine leiomyoma UL, depending on the type of treatment based on ultrasonographic monitoring.Materials and methods. 299 women of reproductive age were examined. Patients were divided into 3 groups: 1 group consisted of 159 women with uterine leiomyoma (UL) who underwent surgical treatment, 2 group – 120 women with UL who underwent conservative treatment, 3 control group consisted of 20 healthy women of reproductive age. In order to obtain the most complete information about the size of the uterus, the structure and topography of myomas, the features of their vascularization, patients underwent ultrasound before and 3 months after treatment.Results. Ultrasound examination of the average parameters of the uterine body in the main groups showed an excess of these indicators relative to the control group (3.2 times in group 1 and 1.3 times in group 2). Uterine volume was greater in women of group 1 compared with women of groups 2 and 3 (p <0.05). In most cases, in 139 (49.0%) women of the main groups, the localization of fibroids was intramural with central growth, without changing the configuration of the uterus from the outside and was not deformed cavity. Whereas, intramural nodes with centripetal growth deformed the uterine cavity in 39 (14.0%) cases, and centrifugal - in 100 (36.0%) subjects - its contour. Mixed and central types of angioarchitectonics were characteristic of women with the largest uterine sizes. In dynamic ultrasound examination in women after conservative myomectomy who did not receive hormone therapy, the level of myometrial perfusion was higher than in those who received gonadotropin-releasing hormones before and after treatment, which may be more prognostically favorable for UL recurrence. Women in group 2 after receiving conservative treatment had a positive tendency to reduce the volume of the uterus and fibroids.Conclusions. Ultrasound diagnostics can be considered a highly informative, non-invasive method that helps to identify the presence, location, structure, size of the myoma, the presence of concomitant pathology of the pelvic organs, as well as in addition to Doppler color flow mapping and pulsed Doppler blood allows us to detect the presence of tumor blood circulation. Echographic and Doppler evaluation of uterine leiomyoma with peculiarities of vascularization in the diagnostic algorithm helps to differentiate the choice of the method of treatment (conservative or surgical).