COMPARISON OF LAPAROSCOPIC MYOMECTOMY AND EMBOLIZATION OF THE UTERINE ARTERIES IN WOMEN WITH SYMPTOMATIC UTERINE LEIOMYOMA
DOI:
https://doi.org/10.11603/24116-4944.2020.2.11836Keywords:
uterine leiomyoma, еmbolization of uterine arteries, conservative myomectomyAbstract
The aim of the study – to compare the efficacy, safety of the disease and the reproductive consequences of treatment of uterine leiomyoma performed by laparoscopic access and uterine artery embolization technique (EMA).
Materials and Methods. The studies were carried out on the basis of the Gynecological Department of the Municipal Non-commercial Enterprise Ternopil Municipal Hospital No. 2. During the period from 2018 to 2020, 112 laparoscopic procedures and 52 methods of uterine artery embolization were performed. In order to diagnose leiomyoma, an ultrasound examination of the pelvic organs was carried out; to perform UAE, a cytological aspirate from the uterine cavity was a prerequisite. UAE was performed in an operating room equipped with an angiographic apparatus.
Results and Discussion. The average age of women who underwent laparoscopic surgery ranged from 38 to 42 years, body mass index from 25.0 to 31.0, the average number of removed nodes from 2 to 5. The average diameter of nodes ranged from 4 to 6 cm. blood loss during the operation was 100–150 ml using bipolar diathermy, the average duration of the operation was 50–60 minutes. Postoperative complications were observed in 30 % of women. In the group of women who underwent EMA, the average age ranged from 36 to 45 years. Body mass index was within 34.2. The average number of nodes that underwent embolization (sclerosis) was mainly 2–3 nodes. There is no blood loss during the uterine artery embolization operation. The average duration of the operation is 50–60 minutes. Duration of hospital stay is 3–4 days. Women who planned a pregnancy are 26.7 % – 30 women after laparoscopy, and 38.4 % – 20 women after UAE. In group 1 40 % – 12 women were able to fulfill the reproductive function, in group 2 – 25 % – 5 women.
Conclusions. Thus, summarizing the results of both methods of treating uterine fibroids, we did not receive data indicating the benefits of one or another method of treating uterine fibroids. Summarizing the data described, it should be said that EMA can be an alternative to laparoscopy, especially in a group of women who would like to perform a reproductive function in terms of childbirth.
References
Pamfamirov, Yu.K., Zabolotnov, V.A., & Karapetyan, O.V. (2013). Organosberegayushchiy podkhod v lechenii miomy matki [Organ-saving approach in the treatment of uterine fibroids]. Zdorovye zhenshchiny – Women's Health, 1, 162-164 [in Russian].
Dorohaya, O.P. (2014). Optymizatsiia metodu vidnovlennia reproduktyvnoi funktsii u zhinok iz submukoznoiu miomoiu matky [Optimization of the method of restoring reproductive function in women with submucosal uterine fibroids]. Klinich. endokrynol. endokr. khir. – Clin. Endocrinol. Endocr. Surg., 3 (48), 47-52 [in Ukrainian].
Sabry, M. (2012). Innovative oral treatments of uterine leiomyoma. Obstet. Gynecol. Int., 2, 1-10.
Kichigin, O.V., Arestova, I.M., & Zanko, Yu.V. (2013). Faktory riska razvitiya miomy matki i kachestvo zhizni patsiyentok, operirovannykh po povodu miomy matki [Risk factors for the development of uterine fibroids and the quality of life of patients operated on for uterine fibroids]. Okhrana materinstva i detstva – Protection of Motherhood and Childhood, 2 (22), 36-41 [in Russian].
Tropeano, G., Amoroso, S., & Stasi, C. (2011). The timing of natural menopause after uterine fibroid embolization: a prospective cohort study. Fertil. Steril., 96, 980-984.
Sidorova, I.S., Unanyan, A.L., Kogan, Ye.A., & Guriyev, T.D. (2012). Mioma matki u bolnykh molodogo vozrasta: kliniko-patogeneticheskiye osobennosti [Uterine fibroids in young patients: clinical and pathogenetic features]. Akusherstvo, ginekologiya, reproduktsiya – Obstet. Gynecol. Reprod., 4 (1), 16-20 [in Russian].
Makarchuk, O.M., & Havrylyuk, H.M. (2016). Porivnialne otsiniuvannia pokaznykiv yakosti zhyttia u patsiientok pislia operatyvnoho likuvannia z pryvodu miomy matky [Comparative assessment of quality of life in patients after surgical treatment for uterine fibroids]. Zdorove zhenshchyny – Women's Health, 8 (114), 94-97 [in Ukrainian].
Sharafutdynov, B.M., Akberov, R.F., & Sharafeev, A.Z. (2015). Optimizatsiya renthenendovaskulyarnoy embolizatsii matochnykh arteriy pri lechenii bolnykh s miomami matki y matochnymi krovotecheniyami [Optimization of endovascular embolization of uterine arteries in the treatment of patients with uterine fibroids and uterine bleeding]. Praktycheskaya medytsyna – Practical Medicine, 1 (86), 94-97 [in Russian].
Vilos, G.A., Allaire, C., Laberge, P.Y., & Leyland, N. (2015). The management of uterine leiomyomas. J. Obstet. Gynaecol. Can., 37 (2), 157-178.
Czuczwar, P., Stepniak, A., Milart, P., Paszkowski, T., & Wozniak, S. (2018). Comparison of the influence of three fibroid treatment options: supracervical hysterectomy, ulipristal acetate and uterine artery embolization on ovarian reserve – an observational study. J. Ovarian. Res., 11 (1), 45. DOI:10.1186/s13048-018-0420-1.
Zaporozhchenko, M.B. (2015). Leiomioma matky – alhorytmy likuvannia zhinok reproduktyvnoho viku [Leiomyoma of the uterus – algorithms for the treatment of women of reproductive age]. Zdorovye zhenshchiny – Woman᾽s Health, 5, 55-58 [in Ukrainian].
Oliynyk, N.S. (2016). Dyferentsiiovanyi pidkhid do vykorystannia innovatsiinykh tekhnolohii v likuvanni miomy matky [Differentiated approach to the use of innovative technologies in the treatment of uterine fibroids]. Candidate᾽s thesis. Zaporizhzhia: ZMAPO [in Ukrainian].
Lytvynenko, O.V. (2015). Vplyv profilaktychnoho zastosuvannia antykoahuliantiv na efektyvnist embolizatsii matkovykh arterii z pryvodu leiomiomy matky [Influence of prophylactic use of anticoagulants on the efficiency of uterine artery embolization due to uterine leiomyoma]. Visnyk problem biolohii i medytsyny – Bull. Probl. Biol. Med., 3 (120), 2, 171-175 [in Ukrainian].
Lytvynenko, A.V. (2015). Profilaktika tromboembolicheskikh oslozhneniy posle embolizatsii matochnykh arterii pri leyomiome matki [Prevention of thromboembolic complications after uterine artery embolization in uterine leiomyoma]. Reprod. zdorovye. Vostochn. Evropa – Reprod. Health. East. Eur., 3 (39), 40-46 [in Russian].
Gromova, A., Litvinenko, O., & Gromova, O. (2015). Influence of uterine arterial embolization on endometrial hyperplasia progress: Proceedings of the 16th World Congress on Human Reproduction. Berlin.
Kukharchik, Yu.V., Gutikova, L.V., & Kolesnikova, T.A. (2017). Techeniye beremennosti i rodov u zhenshchin s miomoy matki [The course of pregnancy and childbirth in women with uterine fibroids]. Sb. nauch. trudov “Sovremennyye perinatalnyye meditsinskiye tekhnologii v reshenii problem demograficheskoy bezopasnosti” – Collection of scientific works “Modern perinatal medical technologies in solving problems of demographic security”. Minsk: GU RNPTs “Mat i ditya” [in Russian].
Kongnyuy, E.J., & Wiysonge, C. (2014). Interventions to reduce haemorrhage during myomectomy for the treatment of fibroids (Cochrane Review). Cochrane Database Sys. Rev., 8, CD005355. DOI:10.1002/14651858.CD005355.
Gennaro Della Rossa, M.N., Navarro Santana, B., Rodriguez Verdejo-Arias, M., Valer Cardenas, E., & Plaza Arranz, J. (2016). Uterine reconstruction due to a giant myoma. A case report and literature review. Open J. Obstet. Gynecol., 6, 64-72. DOI:10.4236/ojog.2016.61008.
Moroni, R.M., Vieira, C.S., Ferriani, R.A., dos Reis, R.M., Nogueira, A.A., & Oliveira Brito, L.G. (2015). Presentation and treatment of uterine leiomyoma in adolescence: a systematic review. BMC. Womens Health, 4, 15. DOI:10.1186/s12905-015-0162-9.
Gutikova, L.V., & Kukharchik, Yu.V. (2020). Mioma matki bolshikh razmerov: taktika vedeniya na etape pregravidarnoy podgotovki, vynashivaniya beremennosti i rodorazresheniya [Large uterine fibroids: management tactics at the stage of pregravid preparation, gestation and delivery]. RMZh. Mat i ditya – RMJ. Woman and Child, 2, 83-87. DOI:10.32364/2618-8430-2020-3-2-83-87 [in Russian].
Tsigkou, A., Reis, F.M., Lee, M.H., Jiang, B., Tosti, C., Centini, G., …, & Petraglia, F. (2015). Increased progesterone receptor expression in uterine leiomyoma: correlation with age, number of leiomyomas, and clinical symptoms. Fertil. Steril., 104 (1), 170-175.e1.
Donnez, J., & Dolmans, M.M. (2016). Uterine fibroid management: from the present to the future. Hum. Reprod. Update, 22 (6), 665-686.
Munro, M.G. (2017). Practical aspects of the two FIGO systems for management of abnormal uterine bleeding in the reproductive years. Best. Pract. Res. Clin. Obstet. Gynaecol., 40, 3-22.
Ferrero, S., Racca, A., Tafi, E., Alessandri, F., Venturini, P.L., & Roberti Maggiore, U.L. (2016). Ulipristal acetate before high complexity hysteroscopic myomectomy: a retrospective comparative study. J. Minim. Invasive Gynecol., 23 (3), 390-395.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2021 Actual Problems of Pediatrics, Obstetrics and Gynecology
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish in this journal agree to the following terms:
1. The authors reserve the right to authorship of the work and pass the journal right of first publication of this work is licensed under a Creative Commons Attribution License, which allows others to freely distribute the work published with reference to the authors of the original work and the first publication of this magazine.
2. Authors are entitled to enter into a separate agreement on additional non-exclusive distribution of work in the form in which it was published in the magazine (eg work place in the electronic repository institution or publish monographs in part), provided that the reference to the first publication of this magazine.
3. Policy magazine allows and encourages authors placement on the Internet (eg, in storage facilities or on personal websites) manuscript of how to submit the manuscript to the editor and during his editorial processing, since it contributes to productive scientific discussion and positive impact on the efficiency and dynamics of citing published work (see. The Effect of Open Access).
