endoscopic conservative myomectomy
А.Yu. Danilov, E.М. Bakuridze, Т.S. Foteeva
Uterine leiomyoma is the most frequent tumor of human female reproductive tract. The frequency of this tu-mor is 25-50% of all gynecologic disorders. Myomectomy is still the most common method of therapy espe-cially in reproductive aged women.
The variety of myomectomy efficacy significantly depends on reparative processes in postoperative period.
The objective of this study was the assessment of postoperative rehabilitation with plasmapheresis, ozone therapy and its combination in women undergoing myomectomy.
319 reproductive aged patients (mean age 31±2.9 years) were scheduled for laparoscopic surgery. Two groups of women undergoing laparoscopic myomectomy were analyzed according to the method of postoperative rehabilitation: the main group - 185 patients divided into 3 subgroups (87 women with plasmapheresis (PA), 52 patients with ozone therapy (OT) and 46 with its combination (PA+OT) in postoperative rehabilitation therapy) and the comparative group consisted of 134 patients who received traditional postoperative rehabilitation (therapeutic antibiotic use).
All the patients were adjusted on clinical and anamnesis features as well as operative time (mean – 143.8±31.4 min.) and blood loss (mean - 326.5±75.07 ml). Multiple leiomyomas were observed in 31.3% in comparative group and in 28.7%, 32.6% operative and 34.7% in PA, OT and PA+OT groups, respectively. De-generative changes in myomas were revealed in 51.4%, 57.4%, 55.7% and 54.3% of patients in comparison and PA, OT and PA+OT groups, respectively.
Rehabilitation included intraoperative peritoneal lavage using ozone physiological solution with ozone concentration 2.5-3 mg/L. Subsequent OT was performed by IV infusion of ozone physiological solution with ozone concentration 2 mg/L 5 times every one day. PA was prescribed 3 times every one day since 2-3 post-operative days.
The main significant remote operation results were menstrual function normalization, subsequent pregnancy rate, recurrence of myoma, adhesion formation.
The shortest time of menstrual cycle restoration observed in PA group (1.6±0.7 months) compared with the comparative group (2.4±0.9 months).
Pregnancy rate after myomectomy was 63% PA patients and 39.8% in comparative group. The recur-rence of myoma and adhesion formation was noted in 4.4%, 25.7% and 21.6%, 67.3% of PA and comparative groups, accordingly.
Thus, it has been shown that PA and OT as well as their combination influence positively on menstrual function restoration, decrease the incidence of myomas recurrence and the degree of adhesion formation.