• Innovative approaches to operational treatment of women of reproductive eligibility age with hyperplastic processes of the endometrium

Innovative approaches to operational treatment of women of reproductive eligibility age with hyperplastic processes of the endometrium

HEALTH OF WOMAN. 2016.6(112):41–45; doi 10.15574/HW.2016.112.41 
 

Innovative approaches to operational treatment of women of reproductive eligibility age with hyperplastic processes of the endometrium


Goncharenko V. N.

A.A. Bogomolets National Medical University, Kiev


The aim of the study: was improvement of results of surgical treatment of patients of reproductive age eligibility with hyperplastic processes of endometrium (HPE) through the introduction of individualized treatment algorithm with the use of monopolar radio wave and hysteroscopic endometrial ablation.


Materials and methods. The study included 62 women with non-atypical form of hyperplasia of the endometrium who were treated at the Center of General gynecology of the clinical hospital «Feofania», gynecological Department at the city maternity hospital № 3 of Kyiv. Depending on the age group, nature of the pathological process and method of treatment is randomized, the distribution of women according to groups: group 1 – 41 women's reproductive eligibility age netipichnaya forms of endometrial hyperplasia (PHEBA and KGEB), who were subjected to hysteroscopic monopolar endometrial ablation; group 2 – 21 female reproductive eligibility age netipichnaya forms of endometrial hyperplasia (PHEBA and KGEB), which was held radiowave ablation of the endometrium (RHAE). In the 1st group the age of patients ranged from 42 to 54 years, mean age was 49.9±4.7 years. In the 2nd group the age of patients ranged from 41 to 53 years, mean age of 51.6±4.3 years.


Results. A comparative analysis of the techniques for hysteroscopic monopolar ablation and RHEE showed the fact that for RHEE used local anesthesia, while carrying out hysteroscopic monopolar ablation was necessary intravenous anesthesia. The duration of the hysteroscopic monopolar endometrial ablation was 28.6±5.5 min, RAE – according to the standard method – 44.3±0.3 min. When performing hysteroscopic monopolar endometrial ablation in 2 patients (3.7%) patients observed the signs of intravasation of fluid, increased blood pressure and tachycardia. This syndrome was successfully docked, but in the future, women have conducted a thorough examination. When you run RHAE intraoperative complications have been identified.


Conclusion. 1. Women with netipichnaya forms of endometrial hyperplasia eligibility and late reproductive age who do not have reproductive plans as an alternative to hysterectomy, in the presence of contraindications or ineffectiveness of hormone treatment may be recommended or radiowave monopolar hysteroscopic ablation of the endometrium.

2. Monopolar hysteroscopic endometrial ablation is indicated for women with netipichnaya forms of endometrial hyperplasia, can be used in the presence of submucous form of uterine fibroids, postoperative scars on the uterus, but in the absence of adenomyosis II–III degree. The effectiveness of monopolar hysteroscopic endometrial ablation in women with non-atypical form of hyperplasia of the endometrium is 87.8%.

3. Women after endometrial ablation should be under observation for two years. The method of choice for dynamic monitoring of the condition of the uterus in women who underwent endometrial ablation is transvaginal ultrasound which should be performed after 1, 3, 6, 12 and 24 months of follow up.

4. In case of recurrence of hyperplastic process of the endometrium (bleeding, thickening of the M-mode echo according to the ultrasound) shows a hysteroscopy with a mandatory histopathological examination and verification of the diagnosis.


Key words: endometrial hyperplasia, women eligibility age, women of reproductive age, ablation of the endometrium.


REFERENCES

1. Benyuk VA, Goncharenko VN, Kuvita YuV. 2013. Vnutrimatochnaya patologiya: spravochnik vracha «Ginekolog»: rukovodstvo. Kiev, Biblioteka «Zdorove Ukrainyi»:203.

2. Dubossarskaya ZM, Dubossarskaya YuA. 2009. Giperplaziya endometriya. ZhInochiy lIkar 5:22–29.

3. Dubossarskaya ZM, Dubossarskaya YuA, Goncharenko VN. 2005. Teoriya i praktika ginekologicheskoy endokrinologii. Dnepropetrovsk, ChP «Lira LTD»:412.

4. Zaporozhan VN, Tatarchuk TF, DubInIna VG. 2012. Sovremennaya diagnostika i lechenie giperplasticheskih protsessov endometriya. Reproduktivnaya endokrinologiya 1(3):32–38.

5. Tatarchuk TF, Burlaka EV. 2003. Sovremennyie printsipyi diagnostiki i lecheniya giperplasticheskih protsessov endometriya. Zdorove zhenschinyi 4:107–113.

6. Vasyl O Beniuk, Rostyslav V Bubnov, Olga Melnychuk . Updating personalized management algorithm of endometrial hyperplasia in pre-menopause women. EPMA Journal 2016; 7(Suppl 1): A28. http: //link. springer. com/article/10.1186/s13167-016-0054-6. (16.09.2015)

7. Beniuk V, Goncharenko V, Kalenska O, Demchenko O, Spivak M, Bubnov R. 2013. Predictive diagnosis of endometrial hyperplasia and personalized therapeutic strategy in women of fertile age. EPMA J. 4:24. Доступен по: http://www.epmajournal.com/content/4/1/24/abstract (01.09.2013)

8. Goncharenko V, Bubnov R. 2014, March. Endometrial hyperplasia in women of fertile age: persolized diagnosis and therapeutic strategy. Conference Paper: 16th World Congress of the International Society of Gynecological Endocrinology (ISGE), Florence, Italy. 03/2014. http://gest.btcongress.it/viewAbstractPdf.php?id=2048 (15.10.2-14)