CC BY
31Акушерство и Гинекология
UDC: 616-618.11-618.179
FEATURES OF LAPAROSCOPIC TREATMENT OF TEENAGE GIRLS
WITH OVARIAN APOPLEXY
ASHUROVA NIGORA GAFUROVNA
associative professor, dotsent of department of obstetrics and gynecology 2 of the Bukhara medical Institute. Uzbekistan, Bukhara.
ORCID 0000-0003-2261-4188 ZARIPOVA DILNOZA YASHINOVNA assistant teacher of department of obstetrics and gynecology 2 of the Bukhara medical Institute. Uzbekistan, Bukhara.
ORCID 0000-0003-0736-5654 SOLIYEVA NOZIMA KARIMOVNA assistant teacher of department of obstetrics and gynecology 2 of the Bukhara medical Institute. Uzbekistan, Bukhara.
ORCID 0000-0001-5679-8101 BOBOKULOVA SARVARA BOBOKULOVNA assistant teacher- of department of obstetrics and gynecology 2 of the Bukhara medical Institute. Uzbekistan, Bukhara.
ORCID 0000-0003-4473-7277 ABSTRACT
This article presents the results of studying the reproductive system after suffering ovarian apoplexy in 190 adolescent girls 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 adolescent girls 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.
ОСОБЕННОСТИ ЛАПАРОСКОПИЧЕСКОГО ЛЕЧЕНИЯ ДЕВОЧЕК-ПОДРОСТКОВ С АПОПЛЕКСИЕЙ ЯИЧНИКА
АШУРОВА НИГОРА ГАФУРОВНА
кандидат медицинских наук доцент кафедры акушерство и гинекологии 2, Бухарский Государственный медицинский институт имени Абу Али Ибн Сино, город Бухара Республика
Узбекистан. ORCID 0000-0003-2261-4188 ЗАРИПОВА ДИЛЬНОЗА ЯШИНОВНА ассистент кафедры акушерство и гинекологии 2, Бухарский Государственный медицинский институт имени Абу Али Ибн
Сино, город Бухара Республика Узбекистан.
ORCID 0000-0003-0736-5654 СОЛИЕВА НОЗИМА КАРИМОВНА ассистент кафедры акушерство и гинекологии 2, Бухарский Государственный медицинский институт имени Абу Али Ибн
Сино, город Бухара Республика Узбекистан.
ORCID 0000-0001-5679-8101 БОБОКУЛОВА САРВАРА БОБОКУЛОВНА ассистент кафедры акушерство и гинекологии 2, Бухарский Государственный медицинский институт имени Абу Али Ибн
Сино, город Бухара Республика Узбекистан.
ORCID 0000-0003-4473-7277 АННОТАЦИЯ
В статье представлены результаты исследования репродуктивной системы после апоплексии яичника у 190 девочек-
подростков, лечившихся в Бухарском областном перинатальном центре и в Бухарском филиале Республиканского научного центра экстренной медицинской помощи в период с 2017 по 2020 годы. Анализ показывает сохранение репродуктивного здоровья у девочек-подростков, перенесших эндоскопическое вмешательство. Авторы отмечают, что данный метод является методом выбора при лечении данной патологии, поскольку исключает образование спаек и снижает количество рецидивов.
Ключевые слова: апоплексия яичника, фолликул, спайки, репродуктивная функция, эндоскопия.
БАЛОГАТ ЁШИДАГИ АПОПЛЕКСИЯ БИЛАН ОГРИГАН КАСАЛЛАРДА ЛАПАРОСКОПИК ДАВОЛАШНИНГ УЗИГА ХОС
ХУСУСИЯТЛАРИ
АШУРОВА НИГОРА ГАФУРОВНА
т.ф.н., акушерлик ва гинекология №2 кафедраси доценти, Бухоро давлат тиббиёт институти, Бухоро, Узбекистон.
ORCID 0000-0003-2261-4188 ЗАРИПОВА ДИЛЬНОЗА ЯШИНОВНА акушерлик ва гинекология №2 кафедраси асситенти, Бухоро давлат тиббиёт институти, Бухоро, Узбекистон.
ORCID 0000-0003-0736-5654 СОЛИЕВА НОЗИМА КАРИМОВНА акушерлик ва гинекология №2 кафедраси асситенти, Бухоро давлат тиббиёт институти, Бухоро, Узбекистон.
ORCID 0000-0001-5679-8101 БОБОКУЛОВА САРВАРА БОБОКУЛОВНА акушерлик ва гинекология №2 кафедраси асситенти, Бухоро давлат тиббиёт институти, Бухоро, Узбекистон.
ORCID 0000-0003-4473-7277
АННОТАЦИЯ
Ушбу мацолада 2017 йилдан 2020 йилгача булган даврда Бухоро вилоят перинатал маркази ва Республика шошилинч тиббий ёрдам илмий маркази Бухоро филиалида даволанган 190 нафар успирин цизларда тухумдонлар апоплексиясидан сунг репродуктив тизимни урганиш натижалари келтирилган. Тацлил эндоскопик аралашувга учраган успирин цизларда репродуктив саломатликнинг сацланишини курсатади. Муаллифларнинг таъ-кидлашича, бу усул ушбу патологияни даволашда танлов усули цисобланади, чунки у чандиц шаклланишини камайтиради ва релапслар сонини камайтиради.
Калит сузлар: тухумдон апоплексияси, фолликул, чандиц касаллиги, 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%. 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, 9]. 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. 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, 10]. 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 190 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, 80 patients were operated on, 110 were treated conservatively. The average age of the patients was 14.3 +/- 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. Histologicalexamination 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 I (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).
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.
References:
1. Ashurova N.G., Amonov I.I. Retrospective analysis of the frequency, effectiveness of methods for correcting infertility depending on the level of medical institutions // News of dermatovenerology and reproductive health. 2007, No. 3, p. 25-27.
2. Ashurova N.G., Bobokulova S.B., Jumaeva M.M. Another look at the problem of juvenile age. //Biology and integrative medicine 2020 №2 - March-April (42), 95-107
3. Zaripova D.YA., Tuksanova D.I., Negmatullaeva M.N. Osobennosti techeniya perimenopauzal'nogo perekhoda zhenshchin s ozhireniem. //Novosti dermatovenerologii i reproduktivnogo zdorov'ya. 2020 № 1-2. Str.39-42.
4. Zaripova D.YA., Negmatullaeva M.N., Tuksanova D.I., Ashurova N.G. Vliyanie magnij deficitnogo sostoyaniya i disbalansa steroidnyh gormonov zhiznedeyatel'nosti organizma zhenshchiny. //Новый день в медицине 2019; 3 (27) Str- 14-18.
5. Zaripova D.YA., Negmatullaeva M.N., Tuksanova D.I., Ahmedov F.K. Rol' Aleandronovoj kisloty (Ostalon) v lechenii perimenopauzal'nogo osteoporoza. //Doktor ahborotnomasi 2019; 3 Str- 51-55.
6. Zaripova D.YA., Tuksanova D.I. Opyt primeneniya transdermal'nogo preparata Lenzetto u zhenshchin perimenopauzal'nogo vozrasta s soputstvuyushchimi zabolevaniyami. //Новый день в медицине 2020, 2(30/2), 286.
7. Negmatullaeva M.N., Zaripova D.YA., Dzhumaeva F.F. Primenenie raznogo vvedeniya puti estrogen soderzhashchih preparatov u zhenshchin klimaktericheskogo vozrasta. //Tibbiyotda yangi kun 2020, 3(31), 413-416
8. Zaripova D.Ya., Sharipova R.G. Effeciency of hormone replacement therapy in prevention menopausal therapy. //Academicia an international multidisciplinary research journal. 2020. Vol.10, issue 8. Page 422.
9. Zaripova D. and Sharipova R. Comparative evaluation of the use of aleandronic acid in menopausal women complicated by osteoporosis. //European journal of biomedical and pharmaceutical sciences. 2020. Vol-7, issue-6.P.142-146.
10. Khamdamova M.T. Аge echographic characteristics of the uterus and ovaries in women of the first and second period of middle age // Biology and integrative medicine. ISSN 2181-8827 2020. №2- March-April (42).-Р.75-86.
