ORGAN-SAVING THERAPY OF UTERINE PATHOLOGY IN PATIENTS WITH EXTRAGENITAL PATHOLOGY
DOI:
https://doi.org/10.11603/24116-4944.2018.2.8945Keywords:
hyperplastic processes of endo- and myometrium, somatic pathology, treatment, preventionAbstract
The aim of the study – to assess the effectiveness and safety of using intrauterine cryosurgery for the treatment of combined pathology of endo- and myometrium in patients in perimenopause who have a somatic pathology.
Materials and Methods. 100 patients with endometrial hyperplasia and complex somatic pathology were examined and treated. The age of patients ranged from 46 to 60 years and averaged (54.2±6.7) years. Cryosurgical interventions were performed with the help of Cryo-Pulse installation in which liquid nitrogen is used as coolant. The temperature of cryoexposure to the pathological endometrium was from -1400 to -1700С. The duration of cryoexposure and the temperature of the cryoapplicator depended on the pathomorphological diagnosis and increased in cases of complex (adenomatous) non-atypical hyperplasia in combination with adenomyosis. For the prevention of inflammatory and TEC in the postoperative period, oral antibacterial and rectally thrombolytic drugs were prescribed. In cases of high risk of developing a TEC, patients were recommended to take low-molecular heparins, elastic compression of the lower extremities, and taking vascular medications within 2–3 months.
Results and Discussion. Based on the results of the complex examination before and after using our therapy and prevention of complications in the treatment of combined pathology of endo- and myometrium, based on the results of dispensary monitoring of our patients for 1 to 6 years, we determined the criteria for the effectiveness of therapy. After 3 months and during the next 2 years of follow-up, the criteria should be: no complaints, no complaints during bimanual examination, a decrease in the size of the uterus (ultrasound), thickness of the endometrium 3–4 mm, negative results of pathomorphological examination of aspirates from the uterine cavity. According to our results, the effectiveness of treatment, according to the clinical examination and the results of ultrasound, was 82.0 %, prevention of TEC and inflammatory complications – 100 % of cases.
Conclusions. 1. Patients of the perimenopausal period with combined pathology of endo- and myometrium on the background of extragenital pathology should be attributed to the risk group for the development of TEC.
2. The method of choice of treatment and prevention of inflammatory and TEC in such patients may be intrauterine surgery in combination with thromboprophylaxis.
3. Clinical approbation of the pathogenetically substantiated therapeutic-prophylactic method has shown its high efficiency and harmlessness for gynecological patients with severe somatic pathology.
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