Results of comparative analysis of dynamics clinical­and­functional changes for women on the different stages of treatment after functionally sparing gynaecological operations

Abstract

DOI: 10.52705/2788-6190-2025-4-13
УДК 618.1-008-089.168.1-07-0368

The objective: to estimate the results of comparative analysis of dynamics clinical-and-functional changes for women on the different stages of treatment after functionally sparing gynaecological operations. Materials and methods. As a result of clinical-and-statistical research of primary medical document of gynaecological permanent establishment of copies information from 520 medical histories of gynaecological patients, which was executed functionally-sparing operations. A structure and dynamics of gynaecological diseases was analysed, the specific weight of organ-preserving operations was determined with the different types of accesses and volume of surgical treatment. From this group of gynaecological patients a basic group (224 women) and group of comparison (108 women), which parted on 2 sub-groups (after radical operations and after conservative therapy), was selected (with the observance of rules of statistical and clinical selection), comparable on age, by the stage and severity of disease. Plugging criteria in a basic group were women with specific gynaecological diseases (prolapsus of front and back wall of vagina II, III degree, from the elongation of cervix, cystocele and rectocele; by the uterine fibroids of different form and sizes (to 16–17 weeks pregnancy); of high quality formations of appendages of uterus and by the ovarian apoplexy for the women of reproductive period).
Results. High prognostic meaningfulness of action is set: to the choice of types of operating access; clinical diagnosis at a receipt; expressed and dynamics of clinical symptoms; personal anxiety, depression, metabolic and psycho-emotional changes; obstetric and gynaecological anamnesis; age, presence of concomitant chronic diseases; subjective estimation of health; level of the medical being informed and competence; to the timeliness and availability of clinicodiagnostic services and others like that on authenticity of changes of indexes of quality of life (on the types of functioning). In accordance with the developed algorithm of analysis of discriminant the operated women were up-diffused on the groups of the forecast changes (with the positive dynamics of indexes of quality of life; without the dynamics of indexes of quality of life; with the negative dynamics of indexes of quality of life) the made table on which it is possible with high authenticity (88,6%) to forecast efficiency of surgical treatment. The use of method of «tree of classification» allowed to estimate the degree of expressed of high-quality descriptions (diagnosis, localization, type of operating access and others like that). Presented prognostic calculations allowed to estimate grade priority of influences on efficiency of treatment with determination of the most meaningful factors (clinical diagnosis at a receipt, expressed of clinical symptoms, eyelids of women, indexes of scale of the social and hygienic functioning, presence of concomitant chronic diseases, gynaecological anamnesis, social and psychologic state, expressed of anxiety and depression, is burdened, level of the medical being informed and others).
Conclusions. More favourable and more reliable clinical and medical-and-social advantages of conduct of organ-preserving gynaecological operations are set as compared to radical operations. Analysis of efficiency of surgical treatment with conduct functionally sparing operations testifies laparoscopic access to the most favorable (as compared to other types of accesses) indexes of basic types of functioning in the structure of quality of life on all stages of medical process (to and after operations and at the estimation of remote results). At laparoscopic access the best descriptions of the physical functioning, social adaptation and capacity are marked for self-service, psycho-emotional prosperity, expressed of clinical complaints, sickly displays and total scale of quality of life.