Repair of the reproductive function of the endometrium after hysteroscopic myomectomy

Abstract

The aim. To reduce the frequency of reproductive function disorders and preserve fertility in women after conservative myomectomy by developing and implementing a complex of rehabilitation measures into clinical practice. Materials and Methods. The study involved 301 women of reproductive age (221 with a diagnosis of submucosal uterine fibroid (UF)), who were divided into groups: 1 Group - 121 people who used the proposed postoperative rehabilitation therapy; Group 2 - 100 women operated on for submucous uterine fibroids, but without the use of restorative therapy, Group 3 C (control) - 80 somatically and gynecologically healthy women of reproductive age. Depending on the clinical assessment of the complexity of hysteroscopic resection of the node, hysteroscopy or laparoscopy was performed (according to FIGO recommendations). Clinical, instrumental, and laboratory research methods and methods of statistical analysis were used. Results. The main risk factors for the development of submucosal UF are a combination of interdependent factors - genital endocrine-dependent pathological processes (64%) and chronic inflammation of the endometrium on the background of its traumatization - during abortions or directly by a submucosal node (36%). The obtained results made it possible to substantiate pathogenetically the need to improve the scheme of treatment and rehabilitation therapy for women with submucosal leiomyoma of the uterus in the postoperative period in order to preserve reproductive function, which included drugs with antiproliferative, anti-inflammatory, immunomodulating, NO-donor and angioprotective effects. The proposed scheme of treatment and rehabilitation measures is based on a pathogenetic orientation, which allows obtaining a long-term antiproliferative effect on the endometrium and makes it possible to normalize the hormonal relationships and receptor status of the endometrium without the appointment of long-term traditional progestogen-estrogen monotherapy, makes it possible to restore the processes of synchronization of proliferation /transformation of the endometrium to the follicular and luteal phases of the menstrual cycle with the formation of the window of implantation, which contributes to the onset of pregnancy. Thus, in the operated women of the 1 Group, pregnancy after hysteroscopic myomectomy occurred in 15% after 6 months, after a year - in 22%, after one and a half - in 45%, which ended in childbirth through the natural birth canal - in 48%, by cesarean section in 34.5% of people, and 18% had premature births, 10% had spontaneous termination of pregnancy. Accordingly, in the 2 Group (without the proposed therapy) the following data were observed: pregnancy after 6 months in 12%, after a year in 20%, after one and a half - in 40%, which ended in childbirth through natural birth canals - in 40%, by cesarean section in 30.5% of people, and in 17.5% there was a premature birth, in 12% - spontaneous termination of pregnancy occurred. Conclusions. The clinical effectiveness of using the proposed, developed, and improved scheme of treatment and rehabilitation therapy within 6 months was 35.1% in the main group compared to 15.4% in women of the comparison group (without therapy).