Modern aspects of diagnostics and treatment of apoplexy of ovary
Keywords:apoplexy of ovary, treatment, modern aspects
The objective: increase eatment and prognostication of different forms of apoplexy of ovary on the basis of development and introduction of the differential going near diagnostics and treatment with the use of modern endoscopic technologies and directed medicinal correction.
Materials and methods. On I the stage of researches the analysis of statistical data is conducted, and also clinical and paraclinical descriptions 200 patients which acted concerning the apoplexy of ovary which made group 1. Depending on the form of apoplexy of ovary they were up-diffused on two sub-groups: a sub-group is 1.1 – 100 women with the pain form of apoplexy of ovary, sub-group 1.2 – 100 women with the hemorragic form of apoplexy of ovary. A control group is formed by the method of the directed selection from level of basic signs and consisted of 50 women which did not have an apoplexy of ovary in anamnesis, realized a genesial function and on age there were comparable with the patients of group 1.
On the II stage research of basic indexes of the system to hemostasis was conducted and endothelial disfunction for patients with the apoplexy of ovary. By a control sub-group at research of the system to hemostasis and endothelial function 20 women of genesial age, which did not have an apoplexy of ovary in anamnesis, appeared. In the complex of the conducted researches were is included clinical, echographic, hemostasiological and statistical.
Results. The presence of markers of endothelial disfunction (factor of Villebranda, oxide of nitrogen), decline of amount and ability of aggregating of thrombocytes takes place in pathogeny of apoplexy of ovary. Boundary high maintenance of D-dimer in got punctuate at a hemorragic form testifies to the processes of intensive local thrombosis in the damaged ovary with the subsequent lysis of fibrin clots which appeared. Moderate hyperhomocysteinemia confirms, that the starting mechanism of development of
apoplexy of ovary are processes of local thrombosis on a background endothelial disfunction in the vessels of ovary (stage of ischemia, bloody) with subsequent exhaustion of vascular-platelet link of hemostasis, local fibrinolysis (stage of the intra-abdominal bleeding). Presence of disaggregation thrombocytopathy and local (in the area of blood stream of ovary)
hyperfibrinolysis for patients with the hemorragic form of apoplexy of ovary is a ground for additional use of preparations of tranexamic acid – for stimulation to vascular-platelet hemostasis and decline of fibrinolytic activity of blood in a local blood stream, as adding to surgical to hemostasis.
Conclusions. The use of the algorithm (preoperative use of tranexamic acid) improved by us allows for patients with the hemorragic form of apoplexy of ovary to shorten frequency of resections of ovaries at 3,5 time, the level of coagulations of vessels during lapascopy or inseamings of ovary at laparotomy grows at 2,2 time, enucleation of yellow body in 21,7%. Unefficiency coagulative to hemostasis as a result of enhanceable vascularization and fragility of vessels of ovary in 31,7% cases forces to extend the volume of operative interference. Operating is on violation in the system to hemostasis, discovered by us for patients with the hemorragic form of apoplexy of ovary is reserve of minimization of operative trauma of ovary.