Prophylaxis of the recidive of hysteromyoma after the surgical treatment
Keywords:hysteromyoma, relapses, prophylaxis, operative treatment
The objective: decline of frequency of relapses after operative treatment of hysteromyoma for the women of early genesial age on the basis of development and introduction of the improved algorithm of treatment-and-prophylactic and rehabilitation measures with the use of modern ендоскопічних technologies and directed medicinal correction.
Materials and methods. Researches carried stage-by-stage character. Yes, on I the stage (retrospective) the clinical analysis of a 1891 case of operative treatment of hysteromyoma is conducted.
On the II stage (prospective) by us was conducted complex clinical-and-laboratory and instrumental inspection 100 women with hysteromyoma under age 30 (basic (1) group), which had a testimony to operative treatment. It was the basic criteria of including. The basic criterion of exception was malignant new formations of uterus. The group (2) of comparison was made by 50 women with a hysteromyoma in age from 40 to 50, which also had a testimony to operative treatment.
A control group was made 30 gynaecological healthy women in age from 20 to 30 years.
Basic 1 group was up-diffused on two sub-groups for 50 women depending on tactic of conduct of postoperative period. Sub-group 1.1. made 50 women which as a method of postoperative rehabilitation was got by the combined oral contraceptives during 6–12 months, and sub-group 1.2 made 50 women which the appointed preparations of antigonadotropin-releasing hormone were
in the generally accepted dosage during 3 months.
The volume of inspection included the standard clinical, laboratory (biochemical, hemostasiological), ultrasonic, morphological and static methods of research.
Results. By the factors of risk of development of hysteromyoma for the women of early genesial age a genesial function is unrealized (82,0%); presence of somatic morbidity (61,0%); traumatic damages of uterus (medical and spontaneous abortions) – 32,0%; heredity (32,0%); presence of chronic inflammatory processes of uterus and appendages (27,0%) and late menarche (19,0%).
The women of early genesial age have posthemorrhagic anaemia the basic clinical displays of hysteromyoma (61,0%); hasty growth of sizes of uterus (51,0%); pain syndrome (46,0%); violation of menstrual function (43,0%); infertility (18,0%) and unmaturing (10,0%). To operative treatment of hysteromyoma the women of early genesial age have largenesses of tumour additional testimonies (except for clinical symptoms) (middle index – 15,1±1,5 week; a middle diameter of node knot is 9,2±0,8 sm); multiplicity of nodes (44,0%); violation of trophism (43,0%); mainly interstitial (79,0%); subserous-interstitial (24,0%) and interstitial with centripetal growth (22,0%) localization of myoma nodes.
The results of the conducted immunohistochemical researches testify that for the women of early genesial age for development of hysteromyoma characteristically general influence of steroid hormones on the rates of growth, what a simultaneous increase and decline of expression of receptors of estrogen and progesterone testifies to, thus the decline of indexes of expression is accompanied by diminishing of proliferative index. The most expressed expression of receptors of progesterone (94,0%) is marked in fabric of nodes with most of capillaries (>39) and the greatest index of proliferation (7,0%) in tumour fabric. For early diagnostics of hysteromyoma for the women of early genesial age it follows to pay regard to realization of genesial function, heredity, presence of concomitant somatic and genital pathology of inflammatory genesis, and also character of becoming of menstrual function. For control after efficiency of rehabilitation measures after operative treatment of hysteromyoma for the women of early genesial age it is necessary additionally to take into account the results of the got immunohistochemical researches of tumour. The use of the algorithm of rehabilitation measures improved by us allows to normalize a menstrual function (diminishing of duration is on 30,4%; clarity on 27,8% and to the sickliness on 29,4%); to decrease the amount of relapses (from 22,0% to 16,0%); sizes of myometrium – from 573,4±52,8 mm3 to 461,5±50,7 mm3 and also to normalize the level of steroid and sexual hormones.
Conclusions. The results of the conducted researches testify that a problem of hysteromyoma the women of early genesial age have actual enough on the modern stage. With the purpose of decline of amount of relapses after operative treatment of hysteromyoma for the women of early genesial age it is necessary to crush advantage to the combined oral contraceptives on a draught no less 6 months after operative treatment. For control after efficiency of rehabilitation measures after operative treatment of hysteromyoma for the women of early genesial age it is necessary additionally to take into account the results of the got immunohistochemical researches of tumour. The use of the algorithm of rehabilitation measures improved by us allows to normalize a menstrual
function (diminishing of duration, clarity and sickliness); to decrease the amount of relapses; sizes of myometrium, and also to normalize the level of steroid and sexual of hormones.