TUMOR-LIKE OVARIAN LESION IN FERTILE AGE WOMEN: COMPLEX ULTRASOUND DIAGNOSTICS AND TREATMENT
DOI:
https://doi.org/10.11603/24116-4944.2021.2.12738Keywords:
tumor-like ovarian involvement, ultrasonography, color Doppler mapping, treatmentAbstract
The aim of the study – to investigate (based on the analysis of literature sources and our own clinical experience) the effectiveness of hormonal and non-hormonal therapy in reproductive age patients (women) with tumor-like lesions of the ovaries, to study the complex ultrasound diagnostics using color Doppler mapping and dopplermetry and to analyze the frequency of cysts recurrence for a year period after treatment.
Materials and Methods. We analyzed the results of a complex ultrasound examination and treatment approaches to 130 patients of reproductive age with tumor-like ovarian involvement and examined 28 somatically healthy women of childbearing age who had no history of pelvic inflammatory disease, ovarian surgery, ovarian dysfunction and reproduction dysfunction, which served as control group. The mean age of the examined patients with tumor-like ovarian affection was: in the main group (29.0±0.5) years, in the comparison group – (27.0±0.5) years, in the control group – (28±0.5) years. Treatment of patients in the main group (65 women) included hormonal drugs depending on the type of ovarian tumor: in the presence of follicular cysts used a combined estrogen-progestogen drug containing 30 mcg of ethinyl estradiol and 3 mg of drospirenone, endometrioid estrogen-cyst drug 30 mcg ethinyl estradiol and 2 mg dienogest. In the treatment of corpus luteum cysts used a progestogen drug – dydrogesterone 20 mg per day from the 16th to the 25th day of the menstrual cycle for 3 months. Patients in the comparison group (65 patients) were prescribed complex anti-inflammatory therapy: individually selected course of antibacterial agents after bacteriological examination of the cervical canal to identify the pathogen and determine the sensitivity of selected microorganisms to antibiotics, nonsteroidal anti-inflammatory drugs, antispasmodics, spasmolytics for 9 days).
Results and Discussion. The main complaints of those surveyed in both samples were similar. In 75 (57.69 %) patients menstrual irregularities were observed: short-term secondary amenorrhea was noted in 54 (41.54 %) patients, abnormal uterine bleeding – in 21 (16.15 %). If necessary, separate diagnostic scrapings were performed for differential diagnosis. In 39 (30 %) subjects were observed pain of varying intensity, dyspareunia was observed in 3 (2.31 %) cases. 13 (10 %) women had no complaints. They went to the women's clinic for a preventive examination. After treatment, there was no pain in 80 % of patients in the comparison group and in 95 % of the main group. According to Doppler examination, there was an improvement in blood circulation in the pelvis in patients of the main group, which was an additional factor that contributed to the reduction of pain symptoms. Evaluation of the vaginal biocenosis of patients in the main group and the comparison group indicated a significant reduction in bacterial contamination of the mucous membranes of the genitals in the comparison group. Normalization of the menstrual cycle was noted and complaints of dyspareunia disappeared in 100 % of women in both clinical groups. After the course of therapy, the levels of follicle-stimulating and luteinizing hormones on the 14th day of the cycle in 43 (66.15 %) patients of the comparison group and in 65 (100 %) patients of the main group corresponded to the indicators of women in the control group. The tendency to normalize estradiol levels during the menstrual cycle was observed in 100 % of women in the main group, while in the comparison group the nature of hormone secretion remained unchanged. Normalization of progesterone levels in both clinical groups of patients was approved. In our opinion, complex ultrasound diagnostics using color Doppler mapping and spectral analysis of blood flow should be a mandatory step in the algorithm of examination of this group of patients. Clinical experience in the use of hormonal and non-hormonal treatment of ovarian tumors in women of childbearing age is presented.
Conclusions. It was established that hormone therapy in comparison with non-hormonal therapy shows significant effectiveness in normalizing hormonal homeostasis and optimizing functional connections of the hypophyseal portal system and demonstrates slightly higher efficiency in eliminating complaints, regression of tumour-like ovarian lesions and relatively small percentage of relapse throughout the year of observations in comparison with therapy with a complex of antibacterial and resorbing agents, nonsteroidal anti-inflammatory drugs and antispasmodics, but the choice of treatment of the tumour-like ovarian lesions in women of fertile age requires individualization. We believe that ultrasound scanning of the organs of the lesser pelvis using Doppler and color flow Doppler is a non-invasive method of research, which should be a mandatory step in the algorithm of examination of patients with tumour-like ovarian lesions, color Doppler ultrasonography visualises the blood flow in a solid component or in membranes of an ovarian tumour, which allows to detect ovarian growth at its minimum size (starting from 2 cm in diameter), specify the content, the presence of growths on the capsule, carry out topical diagnosis and detect concomitant pathology, differentiate the type of pathological process.
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