• The role of hepatoprotective and venotonic treatment in the prevention of recurrence of benign and borderline ovarian tumors after performing conservative organ-sparing operations

The role of hepatoprotective and venotonic treatment in the prevention of recurrence of benign and borderline ovarian tumors after performing conservative organ-sparing operations

HEALTH OF WOMAN. 2018.7(133):89–95; doi 10.15574/HW.2018.133.89

Sukhanova A. A., Egorov M. Yu.
Shupyk National Medical Academy of Postgraduate Education, Kiev
Communal Nonprofit Enterprise «Consultative and Diagnostic Center of Obolonsky District», Kyiv

The objective: to increase the efficiency of treatment of patients with benign (DEOA) and borderline (PEOI) epithelial ovarian tumors after performing organ-sparing operations based on the appointment of a comprehensive anti-relapse therapy.

Materials and methods. A clinical examination of 246 patients was conducted. The retrospective group consisted of 112 patients with DEOI and PES. The retrospective group was divided into two subgroups: І subgroup – 85 (75.9%) patients with DEEA; The second subgroup – 27 (24.1%) patients with PED.

The prospective group included 60 patients with EOJ, of whom 30 women (subgroup III) were diagnosed with DEWI, and the remaining 30 women (subgroup IV) had PEOI. All women in the prospective group received a course of complex anti-relapse therapy with the inclusion of a non-hormonal modulator of estrogen metabolism, hepatoprotector and venotonics after the conservative surgical treatment was performed.

The control group included 64 patients with DEOA and PEDO who were given conservative surgical treatment without prescribing a comprehensive anti-relapse therapy in the future.

Used clinical, ultrasonographic with Doppler, histopathological, immunohistochemical studies.

Results. During the study of concomitant somatic pathology, it was found that the pathology of the pancreato-hepatobiliary system and venous disease was significantly more often diagnosed in patients with PEOI than DEOA (p<0.05). The purpose of a complex anti-relapse therapy, which includes the non-hormonal estrogen metabolism modulator Quinol (1 capsule twice a day) for 6 months with a repeated course of six months, hepatoprotector Hepanex (1 capsule twice a day) and Pentaven venotonik (1 each) a tablet per day) for 1 month with a repetition of the course 2 times a year for the entire observation period, allowed to reduce the relapse of the DEWD from 13.5% to 3.3%, and PESI – from 29.6% to 10% within three years follow-up assessment of the reproductive health of patients.

Conclusion. To optimize the management of patients with DEOA and PEOA after performing conservative surgical treatment, it is recommended to conduct a comprehensive anti-relapse therapy, which includes the use of a non-hormonal modulator of Quinol estrogen metabolism (1 capsule twice a day) for 6 months, repeating the course in six months, hepatoprotector Hepanex (1 capsule twice a day) and Pentavenic venotonics (1 tablet per day) for 1 month with a repetition of the course 2 times a year for 3 years.

Key words: benign and borderline ovarian tumors, conservative surgical treatment, estrogen metabolism modulator, hepatoprotector, venotonic.

REFERENCES

1. Veropotvelyan PN, Veropotvelyan NP, Avksentev OO i dr. (2009). Varikoznaya bolezn ven organov malogo taza i ee kompleksnaya terapiya s primeneniem venotonikov i antiagregantov. Zdorove zhenschiny 6(42):136–139.

2. Ryimashevskiy NV, Markina VV, Volkov AE i dr. (2000). Varikoznaya bolezn i retsidiviruyuschiy flebit malogo taza u zhenschin. Rostov-na-Donu, Izd. RGMU:245.

3. Hryhorenko AM. (2012). Varykozne rozshyrennia ven reproduktyvnoi systemy u zhinok (patohenez, diahnostyka, likuvannia). Dys. d-ra med. nauk: spets. 14.01.01 – Akusherstvo ta hinekolohiia. Vinnytsia.

4. Gavrilov SG, Kirienko AI, Dobrohotova YuE i dr. (2006). Differentsialnaya diagnostika hronicheskih tazovyih boley u zhenschin v svete sindroma tazovogo venoznogo polnokroviya. Rossiyskiy vestnik akushera-ginekologa 4:49–53.

5. Dmitrishen RA, Tsyigan VN, Dolgov GV. (2011). Profilaktika retsidivov dobrokachestvennyih novoobrazovaniy yaichnikov u zhenschin reproduktivnogo vozrasta posle urgentnyih operatsiy. Voenno-meditsinskiy zhurnal 332;5:36–41.

6. Yehorov OO. (2012). Laparoskopichne orhanozberihaiuche likuvannia pohranychnykh pukhlyn i rannoi onkolohichnoi patolohii yaiechnykiv. Tavrycheskyi medyko-byolohycheskyi vestnyk 2:ch. 1(58):115–117.

7. Zhuk SI, Drachevskaya MM. (2007). Rol prostaglandinov i polovyih gormonov v patogeneze disgormonalnyih narusheniy. Reproduktivnoe zdorove zhenschiny 1(30):174–176.

8. Kantemirova ZR, Torchinov AM, Zhigulina TA, Kadohova VV, Alekseeva EA, Devyatyih EA, Petuhov VA. (2003). Steroidnyie gormonyi, mioma matki i narusheniya funktsii pecheni: patogenez i perspektivyi lecheniya. Lechaschiy vrach 10:18–20.

9. Klymyenko ES. (2015). Kliniko-morfolohichni kryterii prohnozu perebihu hranychnykh pukhlyn yaiechnyka. Avtoref. dys. kand. med. nauk: spets. 14. 01.01 – Akusherstvo ta hinekolohiia. Kharkiv:21.

10. Lahno IV. 2009. Hronicheskaya venoznaya nedostatochnost v praktike ginekologa. Zdorove zhenschinyi 7(43):54–58.

11. Novikova EG, Shevchuk AS. (2014). Organosohranyayuschee lechenie bolnyih s pogranichnyimi opuholyami yaichnikov. Voprosyi onkologii 3(60):267–273.

12. Nosenko OM. (2013). Morfolohichni aspekty dotsilnosti provedennia orhano­zberihaiuchykh operatsii u zhinok reproduktyvnoho viku z kistoznymy dobroiakisnymy utvorenniamy yaiechnykiv, zatsikavlenykh u realizatsii reproduktyvnoi funktsii. Medyko-sotsialni problemy simi 2(18):51–55.

13. Dubossarska ZM, Puzii OM, Shchepankova NF, Kukina HO. (2012). Ovarialnyi rezerv u patsiientok z orhanozberihaiuchymy operatsiiamy na yaiechnykakh. Pediatriia, akusherstvo i hinekolohiia 6:80–81.

14. Pyrohova VI, Shurpiak SO, Kryvko BIa. (2015). Klinichni aspekty dovhostrokovoi terapii endometriozu suchasnym prohestahenom diienohestom. Zdorove zhenshchyny 4(100):118–121.

15. Asciutto G, Asciutto KC, Mumme A, Geier B. (2009, Sep). Pelviс venous incompetence: reflux patterns and treatment results. Eur J Vasc Endovasc Surg. 38(3):381-6.

16. Asciutto G, Mumme A, Asciutto KC, Geier B. (2010, Jul). Oestradiol levels in varicose vein blood of patients with and without pelvic vein incompetence (PVI): diagnostic implications. Eur J Vasc Endovasc Surg. 40(1):117–21. https://doi.org/10.1016/j.ejvs.2010.01.023; PMid:20202867

17. Du Bois A, Ewald-Riegler N, du Bois O et al. (2009). Borderline tumors of the ovary: A systematic review. Geburtsh Frauenheilk. 69:807–833. https://doi.org/10.1055/s-0029-1186007

18. Trillsch F, Mahner S, Ruetzel J et al. (2010, Jul). Clinical management of borderline ovarian tumors. Expert. Rev. Anticancer. Ther. 10;7:1115–1124. https://doi.org/10.1586/era.10.90; PMid:20645700

19. Champaneria R, Shah L, Moss J, Gupta JK, Birch J, Middleton LJ, Daniels JP. (2016, Jan). The relationship between pelvic vein incompetence and chronic pelvic pain in women: systematic reviews of diagnosis and treatment effectiveness. Health Technol Assess. 20(5):1–108. https://doi.org/10.3310/hta20050; PMid:26789334 PMCid:PMC4781546

20. Park SJ, Lim JW, Ko YT et al. (2004). Diagnosis of pelvic congestion syndrome using transabdominal and transvaginal sonography. AIR Am. J. Roentgenol. 182:683–688. https://doi.org/10.2214/ajr.182.3.1820683; PMid:14975970

21. Dorobisz TA, Garcarek JS, Kurcz J, Korta K, Dorobisz AT, Podgórski P, Skóra J, Szyber P. (2017, Mar-Apr). Diagnosis and treatment of pelvic congestion syndrome: Single-centre experiences.Adv Clin Exp Med. 26(2):269-276. PMid:28791845

22. Lee SY, Choi MC, Kwon BR, Jung SG, Park H, Joo WD, Lee C, Lee JH, Lee JM. (2017, May). Oncologic and obstetric outcomes of conservative surgery for borderline ovarian tumors in women of reproductive age. Obstet Gynecol Sci. 60(3):289–295. https://doi.org/10.5468/ogs.2017.60.3.289; PMid:28534015 PMCid:PMC5439278

23. Liehr JG, Ricci MJ. (1996, Apr 16). 4-Hydroxylation of estrogens as marker of human mammary tumors. Proc Natl Acad SciUSA. 93(8):3294-3296. https://doi.org/10.1073/pnas.93.8.3294; PMid:8622931

24. Rogan EG, Badawi AF, Devanesan PD, Meza JL, Edney JA, West WW, Higginbotham SM, Cavalieri EL. (2003, Apr). Relative imbalances in estrogen metabolism and conjugation in breast tissue of women with carcinoma: potential biomarkers of susceptibility to cancer. Carcinogenesis (England). 24(4):697-702. https://doi.org/10.1093/carcin/bgg004

25. Svintsitskiy VS, Vorobyova LI, Klymenko ES et al. (2013). Recurrence of borderline ovarian tumors. Experimental Oncology 2(35):118-121.

26. Tropé CG, Kaern J, Davidson B. (2012). Borderline ovarian tumours. Best. Pract. Res. Clin. Obstet. Gynecol. 26;3:325–336. https://doi.org/10.1016/j.bpobgyn.2011.12.006; PMid:22321906

27. Uzan C, Nikpayam M, Ribassin-Majed L, Gouy S, Bendifallah S, Cortez A, Rey A, Duvillard P, Darai E, Morice P. (2014, Jul). Influence of histological subtypes on the risk of an invasive recurrence in a large series of stage I borderline ovarian tumor including 191 conservative treatments. Ann Oncol. 25(7):1312-9. https://doi.org/10.1093/annonc/mdu139; PMid:24713312

28. Vancraeynest E, Moerman P, Leunen K, Amant F, Neven P, Vergote I. (2016, Oct). Fertility Preservation Is Safe for Serous Borderline Ovarian Tumors. Int J Gynecol Cancer. 26(8):1399–406. https://doi.org/10.1097/IGC.0000000000000782; PMid:27465897

29. Yousef Y, Pucci V, Emil S. (20160. The Relationship between Intraoperative Rupture and Recurrence of Pediatric Ovarian Neoplasms: Preliminary Observations. J. Pediatr. Adolesc. Gynecol. 29;2:111–116. https://doi.org/10.1016/j.jpag.2015.08.002; PMid:26300232