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21УДК: 616-618.11-618.179 EFFICIENCY OF LESS-INVASIVE TREATMENT IN WOMEN WITH
OVARIAN APOPLEXIA
ASHUROVA NIGORA GAFUROVNA
Candidate of Medical Sciences, Associate Professor of Obstetrics and Gynecology No. 2 of the Bukhara State Medical Institute named after Abu Ali ibn Sino, Uzbekistan, Bukhara.
ORCID ID 0000-0003-2261-4188 ABSTRACT
This article presents the results of studying the reproductive system after suffering ovarian apoplexy in 200 women of reproductive age who received treatment at the Bukhara Regional Perinatal Center and at the Bukhara branch of the Republican Scientific Center for Emergency Medical Aid in the period from 2017 to 2020. The analysis shows the preservation of reproductive health in women who underwent endoscopic intervention. The authors point out that this method is the method of choice in the treatment of this pathology, since it eliminates the formation of adhesions and reduces the number of relapses.
Key words: ovarian apoplexy, follicle, adhesions, reproductive function, endoscopy.
ЭФФЕКТИВНОСТЬ МЕНЕЕ ИНВАЗИВНОГО ЛЕЧЕНИЯ У ЖЕНЩИН
С АПОПЛЕКСИЕЙ ЯИЧНИКОВ
АШУРОВА НИГОРА ГАФУРОВНА
кандидат медицинских наук, доцент кафедры акушерства и гинекологии № 2 Бухарского государственного медицинского института имени Абу Али ибн Сино, Узбекистан, Бухара.
Идентификатор ОР^СЮ 0000-0003-2261-4188 АННОТАЦИЯ
В данной статье представлены результаты изучения
репродуктивной системы после апоплексии яичников у 200 женщин репродуктивного возраста, получивших лечение в Бухарском областном перинатальном центре и в Бухарском филиале Республиканского научного центра экстренной медицинской помощи в период с 2017 по 2020 год. Анализ показывает сохранение репродуктивного здоровья у женщин, перенесших эндоскопическое вмешательство. Авторы указывают, что данный метод является методом выбора при лечении данной патологии, поскольку исключает образование спаек и уменьшает количество рецидивов.
Ключевые слова: апоплексия яичников, фолликул, спайки, репродуктивная функция, эндоскопия.
АЁЛЛАРДА ТУХУМДОНЛАР АПОПЛЕКСИЯСИНИ КАМ ИНВАЗИВ УСУЛЛАР БИЛАН ДАВОЛАШНИНГ САМАРАДОРЛИГИ
АШУРОВА НИГОРА ГАФУРОВНА
Тиббиёт фанлари номзоди, акушерлик ва гинекология №2 кафедраси доценти, Бухоро давлат тиббиёт институти, Бухоро,
Узбекистон ORCID ID 0000-0003-2261-4188 АННОТАЦИЯ
Ушбу мацолада Бухоро вилоят перинатал маркази ва Республика шошилинч тиббий ёрдам илмий маркази Бухоро филиалида 2017-2020 йиллар оралигида тухумдонлар апоплексияси билан даволанган 200 та репродуктив ёшдаги аёлларнинг репродуктив тизими цолатини урганиш маълумотлари келти-рилган. Тацлил эндоскопик усулда даволанган аёлларда репродуктив саломатлик сацлаб цолинганлигини курсатди. Муаллифлар бу усулни даволаш жараёнидаги танлов усули сифатида курсатдилар, чунки у битишмалар пайдо булишини олдини олади ва кайталанишлар сонини камайтиради.
Калит сузлар: тухумдонлар апоплексияси, фолликул, битиш-ма, репродуктив функция, эндоскопия.
Ovarian apoplexy (OA) is not a rare diagnosis and ranks 3rd in the structure of acute gynecological diseases, accounting for 16%. The recurrence rate of the disease, according to some authors, reaches 6570% - [10, 14, 15]. Ovarian apoplexy is an unexpected rupture of ovarian tissue that causes bleeding into the abdominal cavity. Violation of the integrity of the ovary is accompanied by a powerful pain syndrome - [4, 6, 12]. This usually occurs due to pathological changes in the vessels against the background of an active inflammatory process and occurs during ovulation or at the stage of vascularization of the corpus luteum - [9, 13]. This is more common in young reproductive years. Only a timely diagnosis with an assessment of its severity, immediate hospitalization and taking all necessary measures will help to avoid serious complications and preserve the woman's reproductive function. Research results show that conservative treatment of ovarian apoplexy is not always beneficial - [1, 8]. The blood that has entered the abdomen forms an active environment where aseptic inflammation occurs, as a result, adhesions are formed, and they disrupt the structure of the ovary and surrounding tissues. In such situations, a frequent complication is the termination of the reproductive function of patients - [2, 3].
At present, ovarian apoplexy is an object of comprehensive study, but the pathogenesis of ovarian bleeding, the choice of treatment methods and the amount of surgery, and most importantly, the question of the state of reproductive function in women who have undergone ovarian apoplexy remains open - [5, 7]. The aim of our study was to study the state of reproductive function in women who have undergone ovarian apoplexy.
Materials and research methods.
We analyzed 200 case histories with an established clinical diagnosis of ovarian apoplexy, who received treatment in the Regional Perinatal Center and in the Bukhara branch of the Republican Scientific Center for Emergency Medical Aid in 2017-2019. Of these, 90 patients were operated on, 110 were treated conservatively. The average age of the patients was 22.3 +/- 2.8 years. Out of those operated on, 60 patients underwent laparoscopic surgery, the scope of the operation consisted of coagulation of the bleeding vessels of the follicle and sanitation of the abdominal cavity. In 30 patients, laparotomy and partial ovarian resection with sanitation of the abdominal cavity were performed. Histological examination of the material was also applied. Conservative treatment included hemostatic and antibiotic therapy.
After discharge from the hospital, all patients, regardless of the forms of apoplexy (painful or with rupture of the follicles), underwent a set of rehabilitation measures, including: physiotherapy, COC intake for at least 3 months, examination of the genitourinary tract for STIs, followed by etiotropic treatment in two courses during the time of menstruation. Also, the necessary correction of the hormonal status and menstrual cycle was carried out before the planned pregnancy. Restoration of reproductive health was assessed at least 1 year after the end of rehabilitation treatment. For this, we used tests of functional diagnostics, ultrasound, HSG, and determined the levels of gonadotropic and thyroid-stimulating hormones. We considered cases of relapse of the disease to be an unsuccessful result of rehabilitation.
To study long-term results, 4 groups of patients were formed: -I group (n = 53) - operated patients who refused rehabilitation measures.
- Group II (n = 37) - operated patients who underwent full rehabilitation.
- Group III (n = 63) - patients with AE after conservative treatment who did not receive rehabilitation procedures.
- IV group (n = 47) - conservative treatment followed by rehabilitation.
Research results and their discussion.
During the operation, 34 (37.7%) patients had a concomitant adhesion process in the small pelvis. Histological examination of the material (ovarian biopsy) in patients of groups I and II (80 women), operated for the first time or repeatedly with recurrent ovarian rupture during ovulation, showed a violation of the integrity of the structures of the corpus luteum, against the background of changes in the surrounding tissues characteristic of chronic inflammation: plethora of blood vessels, leukocyte infiltration and fine-grained degeneration. In the dynamics of observation 6-9 months after treatment, women with conservative management revealed various menstrual irregularities of the type of dysmenorrhea, hyperpolymenorrhea or oligomenorrhea. Among women who refused rehabilitation, the frequency of dysmenorrhea significantly increased by an average of 9%. Significantly better results were found in groups after rehabilitation measures. Thus, dysmenorrhea among the operated patients was 2.5 times lower, in the conservatively treated groups by 1.5 times. Oligomenorrhea and hyperpolymenorrhea tended to decrease in the groups after rehabilitation, however, no statistically significant differences were found (p = 0.05).
Early miscarriage, after ovarian apoplexy, was quite high in all studied groups: 8.6%, 10%, 11.1%, 13.3%, respectively, i.e. ovarian apoplexy was a risk factor for miscarriage. This proves the need for rehabilitation therapy for the full restoration of reproductive function. The control over the restoration of reproductive function was carried out in the group of women planning pregnancy, since 40% did not plan pregnancy due to reasons of young age and lack of family. In group I, pregnancy ended in childbirth in 3 patients, which amounted to 16.6%. In group II, after surgical treatment with a full range of rehabilitation measures, 10 (43.4%) women gave birth. In the groups with conservative treatment, the
results were somewhat worse. So, in group III, 2 (13.3) had childbirth, in group IV, 6 (30%). Ectopic pregnancy occurred in 3 patients in group I and in 2 in group II (16.6% and 8.6%), respectively. In groups III and IV, ectopic pregnancy occurred in 4 (26.6%) and 3 (15%) patients, respectively.
Thus, pregnancy and childbirth successfully occurred in those groups where the whole complex of rehabilitation measures was carried out. When comparing the long-term results between the groups with conservative and surgical treatment, the restoration of reproductive function turned out to be better in the operated women. Apparently, this is due to the fact that during the operations, the adhesions existing by that time in the area of the uterine appendages were eliminated and the abdominal cavity was sanitized from the blood.
In the surgical treatment of ectopic pregnancy, ovarian apoplexy, paraovarian cysts in patients who had previously undergone ovarian apoplexy, the adhesive process was less pronounced than in those who received conservative therapy. During surgical interventions associated with a relapse of the disease, or with other reasons, it was found that in those groups where previously treated with laparoscopic access, the frequency of adhesions is lower than in groups with conservative treatment.
Studying cases of repeated ovarian apoplexy, we received even more convincing data on the need for preventive measures after ovarian apoplexy. This made it possible to reduce the number of relapses of the disease after surgical treatment by 3.5 times and conservative by 4.5 times. So, in group I, repeated apoplexy occurred in 6 (13.9%), in II in 1 (2.7%) patients, in group III in 14 (22%), in group IV in 4 (8.1%).
Conclusions: Issues of reproductive health after ovarian apoplexy are relevant due to the frequency of occurrence of this pathology in young women. Revealing the true causes of ovarian apoplexy and etiotropic therapy helps to preserve the reproductive health of a woman. Endoscopic
intervention is the method of choice in the treatment of this pathology, since it eliminates the formation of adhesions, reduces the number of relapses, helps to restore reproductive function, and should be used even with small blood loss from ruptured follicles.
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