INFLUENCE OF SURGICAL INTERVENTION IN PATIENTS WITH APOPLEXY OF OVARIES IN THE ASPECT OF PRESERVATION OF OVARIAN RESERVE AND IMPROVEMENT OF EFFICIENCY OF AUXILIARY REPRODUCTIVE TECHNOLOGIES

Abstract

Gyneclogscal diseases, requiring surgical treatment, acquire a special role among the reasons that may lead to a violation of the reproductive health of women.

The aim of the study – improvement of surgical treatment of patients with apoplexy of ovaries for maximal preservation of ovarian reserve.

Materials and Methods. We conducted a retrospective study of the results of treatment of 150 patients with apoplexy of the ovary for the period from 2014 to 2017 in the gynecological department of the Ternopil City Clinical Hospital No. 2. The share of surgical interventions for apoplexy over the past 3 years was (11.5+0.5)%. A total of 120 women were included in the study. Among them – 60 patients with apoplexy of the ovaries, who performed the laparoscopic surgery for the first time. These patients were included in the prospective study and divided into two groups depending on the hemostasis method used during the operation. Group 1 included 30 patients with hemostasis, whom hemostasis was carried out using bipolar coagulation, group 2 – 30 patients, whom bleeding from the ovary was stopped by applying sutures. The comparison group consisted of 30 patients with apoplexy of the ovaries, who received conservative treatment.

Results and Discussion. The apoplexy of the ovary in 40 % of cases requires an emergency surgical intervention, which leads to the loss of part of the body [5,10]. In the postoperative period, there is a deterioration of reproductive health, hormonal homeostasis, and circulatory disorders, which are caused not only by the trauma of the ovary and the reduction of the ovarian reserve, but also the appearance of the joint process in the pelvic organs [7,10]. Stopping bleeding in patients with apoplexy of ovaries with bipolar electrosurgery is faster but leads to a more significant decrease in ovarian reserve (anti-Mullerian hormone (AMH) – 30 %, antral follicle (AF) – 10 %) than the use of hemostatic sutures for this purpose (AMH on 22 %, AF on 8 % ) (p <0.05). In order to maximally maintain the ovarian reserve in operations in women with apoplexy of ovaries, it is always best to carry out hemostasis by extracting a cyst capsule within healthy tissues and superimposing on the ovarian wound of resorptive synthetic sutures with subsequent intracorporal binding of nodes. Regardless of the hemostasis method used during surgical treatment with applexia of the ovaries in patients 36 years of age and older, there is a greater reduction in ovarian reserve (AMH – 30 %, AF – on 20 %) than in patients whose age is less than 35 years (AMH – 20 %, AF – 12%) (p <0.05). For patients with a delivered childbearing function, regardless of age and all patients under the age of 35 years undergoing surgery for the apoplexy of the ovaries for the first time, bipolar coagulation is permissible to stop the bleeding. In the implementation of bipolar hemostasis in patients with applexia of the ovaries, spot coagulation of blood vessels should be performed, avoiding damage to the surrounding tissues.

Conclusions. Performing operative intervention in a sparing volume with the maximal preservation of healthy tissue allows preserving the ovarian reserve and reproductive health of women.