COMPLEX ASSESSMENT OF REPRODUCTIVE HEALTH IN PATIENTS WITH EXTERNAL GENITAL ENDOMETRIOSIS AFTER SURGERY

Aim. Complex assessment of reproductive health in patients with external genital endometriosis after surgery. Materials and Methods. The study involved 55 women of childbearing age who received treatment in the department of gynecology of Bauman City Clinical Hospital. 29 and 30 women observed in Central Clinical Hospital. 6. In 2014-2016 the patients underwent laparoscopic surgery for external genital endometriosis. External genital endometriosis of different extent and severity (according to R-AFS) was diagnosed and confirmed using laparoscopic and morphologic assessment methods. 70 patients underwent endometrioma nucleation, and 15 patients with retrocervical endometriosis were subjected to excision of endometrioma with mobilization of the anterior wall of the colon as well as coagulation of endometrioid heterotopias of various sites; all patients were subjected to adhesiolysis. Results. 48 (64%) patients had III-IV stage endometriosis. In 20% endometriosis was diagnosed during surgery. Anthropometric indicators were mostly associated with asthenic type. Emotional and behavioral disorders were observed in 25 (33.3%) patients with tendency to hysterical personality disorder; the rest had mood swing and liability to depression. In less than 60% of patients the severity of endometriosis was significantly related to pelvis pain intensity. The majority of patients were women of asthenic type and with expressed pain syndrome, and hysterical personality disorder according to Beck scale. Conclusion. Individual assessment of pain, anthropometric and personal traits in patients together with complex assessment of morphologic and anatomic changes in reproductive organs make it possible to see a real pattern of disease and condition in women with external genital endometriosis, which helps in choice of surgery volume and appropriate medical treatment

COMPLEX ASSESSMENT OF REPRODUCTIVE HEALTH IN PATIENTS WITH EXTERNAL GENITAL ENDOMETRIOSIS AFTER SURGERY

Aim. Complex assessment of reproductive health in patients with external genital endometriosis after surgery. Materials and Methods. The study involved 55 women of childbearing age who received treatment in the department of gynecology of Bauman City Clinical Hospital. 29 and 30 women observed in Central Clinical Hospital. 6. In 2014-2016 the patients underwent laparoscopic surgery for external genital endometriosis. External genital endometriosis of different extent and severity (according to R-AFS) was diagnosed and confirmed using laparoscopic and morphologic assessment methods. 70 patients underwent endometrioma nucleation, and 15 patients with retrocervical endometriosis were subjected to excision of endometrioma with mobilization of the anterior wall of the colon as well as coagulation of endometrioid heterotopias of various sites; all patients were subjected to adhesiolysis. Results. 48 (64%) patients had III-IV stage endometriosis. In 20% endometriosis was diagnosed during surgery. Anthropometric indicators were mostly associated with asthenic type. Emotional and behavioral disorders were observed in 25 (33.3%) patients with tendency to hysterical personality disorder; the rest had mood swing and liability to depression. In less than 60% of patients the severity of endometriosis was significantly related to pelvis pain intensity. The majority of patients were women of asthenic type and with expressed pain syndrome, and hysterical personality disorder according to Beck scale. Conclusion. Individual assessment of pain, anthropometric and personal traits in patients together with complex assessment of morphologic and anatomic changes in reproductive organs make it possible to see a real pattern of disease and condition in women with external genital endometriosis, which helps in choice of surgery volume and appropriate medical treatment

Complex Assessment of Reproductive Health in Patients with External Genital Endometriosis after Surgery

Закирова Яна Рявхатевна, аспирант кафедры акушерства и гинекологии с курсом перинатологии, Российский университет дружбы народов, г. Москва, [email protected]. Бабаева Эльвира Ильхамовна, аспирант кафедры акушерства и гинекологии с курсом перинатологии, Российский университет дружбы народов, г. Москва, [email protected]. Оразов Мекан Рахимбердыевич, доктор медицинских наук, профессор кафедры акушерства и гинекологии с курсом перинатологии, Российский университет дружбы народов, г. Москва, [email protected]. Арютин Дмитрий Геннадьевич, кандидат медицинских наук, доцент кафедры акушерства и гинекологии с курсом перинатологии, Российский университет дружбы народов, г. Москва, [email protected]. Y.R. Zakirova, [email protected], E.I. Babaeva, [email protected], M.R. Orazov, [email protected], D.G. Aryutin, [email protected] Russian Peoples' Friendship University, Moscow, Russian FederationЦель исследования: комплексная оценка репродуктивного здоровья пациенток с наружным генитальным эндометриозом после хирургического лечения. Материалы и методы. В исследование были включены 55 женщин репродуктивного возраста, проходившие лечение в отделении гинекологии ГКБ № 29 им. Баумана и 30 женщин – в ЦКБ № 6 ОАО «РЖД». За период 2014–2016 гг. данные пациентки прооперированы лапароскопическим доступом по поводу наружного генитального эндометриоза. Диагноз наружного генитального эндометриоза, разных степеней распространенности и тяжести по стадиям классификации по R-AFS, соответственно подтвержден лапароскопическим и морфологическим исследованиями. У 70 женщин произведена энуклеация эндометриомы, у 15 женщин с ретроцервикальным эндометриозом – иссечение эндометриоидного инфильтрата с мобилизацией передней стенки прямой кишки, а также коагуляция эндометриоидных гетеротопий различной локализации, адгезиолизис у всех пациенток. Результаты. У 48 (64 %) пациенток выявлены III–IV стадии распространения эндометриоза. У 20 % пациенток эндометриоз явился операционной находкой. Антропометрические показатели имели тенденцию к астеническому типу телосложения. Эмоциональные нарушения и поведенческие расстройства отмечались у 25 (33,3 %) пациенток с тенденцией к истерической психопатии, у остальных пациенток наблюдались лабильность эмоционального состояния, склонность к депрессиям. Менее чем у 60 % обследованных пациенток степень тяжести заболевания имела достоверную связь с интенсивностью тазовой боли. Подавляющим большинством из числа обследованных оказались женщины с астеническим типом телосложения и выраженным болевым синдромом, относящиеся к истерическому типу психопатий по шкале Бека. Заключение. Индивидуальная оценка болевых ощущений, антропометрических и личностных особенностей пациенток в комплексной оценке с морфологическими и анатомическими изменениями органов репродуктивной системы позволяют сформировать адекватную картину тяжести заболевания и состояния женщин с наружным генитальным эндометриозом, с последующим выбором объема оперативного вмешательства и назначением корректной лекарственной терапии. Aim. Complex assessment of reproductive health in patients with external genital endometriosis after surgery. Materials and Methods. The study involved 55 women of childbearing age who received treatment in the department of gynecology of Bauman City Clinical Hospital № 29 and 30 women observed in Central Clinical Hospital № 6. In 2014–2016 the patients underwent laparoscopic surgery for external genital endometriosis. External genital endometriosis of different extent and severity (according to R-AFS) was diagnosed and confirmed using laparoscopic and morphologic assessment methods. 70 patients underwent endometrioma nucleation, and 15 patients with retrocervical endometriosis were subjected to excision of endometrioma with mobilization of the anterior wall of the colon as well as coagulation of endometrioid heterotopias of various sites; all patients were subjected to adhesiolysis. Results. 48 (64%) patients had III–IV stage endometriosis. In 20% endometriosis was diagnosed during surgery. Anthropometric indicators were mostly associated with asthenic type. Emotional and behavioral disorders were observed in 25 (33.3%) patients with tendency to hysterical personality disorder; the rest had mood swing and liability to depression. In less than 60% of patients the severity of endometriosis was significantly related to pelvis pain intensity. The majority of patients were women of asthenic type and with expressed pain syndrome, and hysterical personality disorder according to Beck scale. Conclusion. Individual assessment of pain, anthropometric and personal traits in patients together with complex assessment of morphologic and anatomic changes in reproductive organs make it possible to see a real pattern of disease and condition in women with external genital endometriosis, which helps in choice of surgery volume and appropriate medical treatment

Патологический нейрогенез - ключевое звено патогенеза тазовой боли, обусловленной аденомиозом

Objective. To study morphological features of the myometrium neural apparatus in women with chronic pelvic pain syndrome associated with adenomyosis. Methods. 60 biopsy samples were studied, which were obtained from hysterectomies for grade I-III diffuse adenomyosis associated with severe pelvic pain syndrome. These women did not receive any hormonal therapy. The control group included 10 biopsies obtained from women with adenomyosis who had no pelvic pain syndrome and underwent a surgery for abnormal uterine bleeding. These women did not receive any hormonal therapy either. After hysterectomy, uterine wall samples including endometrium and myometrium were fixed in 10% neutral, buffered formalin (pH 7.4) for 24 hours. After dehydration, the material was embedded in paraffin highly purified with polymeric additives (Richard-Allan Scientific, USA) at a temperature 2 in the glandular zone and 9.2 ± 0.6 per mm2 in the stroma. Thin nerve fibers were visualized mainly in the stroma around blood vessels associated with the ectopic endometrium ingrowth zone. A dense plexus of thin nerve fibers was also found in the subserosal layer. Furthermore, both in myometrial subserosal and submucosal layers, ramified, thin nerve fibers predominated. The number of such fibers was significantly greater than in the comparison group (17.2 ± 1.4 vs. 11.8 ± 0.9 per mm2, p2 среза, в строме - 9,2 ± 0,6. Тонкие нервные волокна визуализировались преимущественно в строме вокруг кровеносных сосудов, сопровождающих зоны врастания эктопического эндометрия. Густое сплетение тонких нервных волокон также было обнаружено в субсерозном слое. Причем, как в субсерозном, так и в подслизистом слое миометрия превалировали разветвленные тонкие нервные волокна, количество которых статистически значимо (p2. Сравнение иннервационного аппарата матки у женщин контрольной группы и у пациенток с аденомиозом с болевым синдромом позволяет утверждать, что именно расширение иннервационного поля в миометрии является наиболее вероятной причиной формирования тазовой боли у пациенток с аденомиозом. Выводы. Результаты проделанной работы продемонстрировали, что основным местом локализации нервов в матке и потенциальной причиной формирования гипералгезии при аденомиозе является миометрий с формированием аномально избыточного иннервационного аппарата вокруг очагов эктопического эндометрия, в периваскулярных регионах и в строме между пучками гладких миоцитов

Combination therapeutic options in the treatment of the luteal phase deficiency

Luteal phase deficiency (LPD) is described as a condition of insufficient progesterone exposure to maintain a regular secretory endometrium and allow for normal embryo implantation and growth. There is evidence that both follicular and luteal phase abnormalities can result in LPD cycles. The aim of this randomized prospective noncomparative study is to evaluate the effectiveness of combination therapy in patients with LPD. This prospective study included 35 women of the reproductive age. They were diagnosed with the LPD with sonographically and laboratory-verified methods. The age of patients was 36 ± 0.46 years. The results of the study sonographically demonstrated an increase in the diameter of the corpus luteum from 1.36 ± 0.32 (initially) to 2.16 ± 0.21 mm after combination therapy. In addition, there was a statistically significant increase in the level of estrogens and progesterone in the corresponding phases of the menstrual cycle. Thus, the combination therapy for patients with LPD contributes to the recovery of cyclic events in the hypothalamic-pituitary-gonadal system, which determines the restoration of the endocrine function of the ovaries and promotes adequate secretory rearrangement of the endometrium in women of reproductive age. © 2017 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group on behalf of the UR MED GRUPP (LLC)

Патологический нейрогенез - ключевое звено патогенеза тазовой боли, обусловленной аденомиозом

Objective. To study morphological features of the myometrium neural apparatus in women with chronic pelvic pain syndrome associated with adenomyosis. Methods. 60 biopsy samples were studied, which were obtained from hysterectomies for grade I-III diffuse adenomyosis associated with severe pelvic pain syndrome. These women did not receive any hormonal therapy. The control group included 10 biopsies obtained from women with adenomyosis who had no pelvic pain syndrome and underwent a surgery for abnormal uterine bleeding. These women did not receive any hormonal therapy either. After hysterectomy, uterine wall samples including endometrium and myometrium were fixed in 10% neutral, buffered formalin (pH 7.4) for 24 hours. After dehydration, the material was embedded in paraffin highly purified with polymeric additives (Richard-Allan Scientific, USA) at a temperature 2 in the glandular zone and 9.2 ± 0.6 per mm2 in the stroma. Thin nerve fibers were visualized mainly in the stroma around blood vessels associated with the ectopic endometrium ingrowth zone. A dense plexus of thin nerve fibers was also found in the subserosal layer. Furthermore, both in myometrial subserosal and submucosal layers, ramified, thin nerve fibers predominated. The number of such fibers was significantly greater than in the comparison group (17.2 ± 1.4 vs. 11.8 ± 0.9 per mm2, p2 среза, в строме - 9,2 ± 0,6. Тонкие нервные волокна визуализировались преимущественно в строме вокруг кровеносных сосудов, сопровождающих зоны врастания эктопического эндометрия. Густое сплетение тонких нервных волокон также было обнаружено в субсерозном слое. Причем, как в субсерозном, так и в подслизистом слое миометрия превалировали разветвленные тонкие нервные волокна, количество которых статистически значимо (p2. Сравнение иннервационного аппарата матки у женщин контрольной группы и у пациенток с аденомиозом с болевым синдромом позволяет утверждать, что именно расширение иннервационного поля в миометрии является наиболее вероятной причиной формирования тазовой боли у пациенток с аденомиозом. Выводы. Результаты проделанной работы продемонстрировали, что основным местом локализации нервов в матке и потенциальной причиной формирования гипералгезии при аденомиозе является миометрий с формированием аномально избыточного иннервационного аппарата вокруг очагов эктопического эндометрия, в периваскулярных регионах и в строме между пучками гладких миоцитов

Combination therapeutic options in the treatment of the luteal phase deficiency

Luteal phase deficiency (LPD) is described as a condition of insufficient progesterone exposure to maintain a regular secretory endometrium and allow for normal embryo implantation and growth. There is evidence that both follicular and luteal phase abnormalities can result in LPD cycles. The aim of this randomized prospective noncomparative study is to evaluate the effectiveness of combination therapy in patients with LPD. This prospective study included 35 women of the reproductive age. They were diagnosed with the LPD with sonographically and laboratory-verified methods. The age of patients was 36 ± 0.46 years. The results of the study sonographically demonstrated an increase in the diameter of the corpus luteum from 1.36 ± 0.32 (initially) to 2.16 ± 0.21 mm after combination therapy. In addition, there was a statistically significant increase in the level of estrogens and progesterone in the corresponding phases of the menstrual cycle. Thus, the combination therapy for patients with LPD contributes to the recovery of cyclic events in the hypothalamic-pituitary-gonadal system, which determines the restoration of the endocrine function of the ovaries and promotes adequate secretory rearrangement of the endometrium in women of reproductive age. © 2017 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group on behalf of the UR MED GRUPP (LLC)