Comparative analysis of different approaches in the surgical management of uterine leiomyoma in women with unrealised reproductive function

Abstract

DOI: 10.52705/2788-6190-2024-04.2-13
УДК: 618.14/.15 -007.42 – 079.4 -085.361:[615.385:611- 018.52:547.99]

Uterine leiomyoma (LM) is a benign hormone-dependent neoplasm of the myometrium that occupies a leading position in gynaecological pathology. The incidence of uterine LM ranges from 20–50% in women of reproductive age. Recently, there has been a tendency to detect this nosology in women aged 20–25 years. The reproductive function of women is often affected by
LM, based on the data of modern studies, LM in 20–30% leads to infertility and in 15–30% of cases is the cause of pregnancy failure and miscarriage.
The objective: to increase the effectiveness of cryoprotocols against the background of improving the algorithm for the treatment of uterine LM with submucosal location in women of reproductive age with PTSD by improving the receptivity of the endometrium.
Materials and methods. A comprehensive clinical, instrumental and laboratory examination of 210 women of reproductive age who met the following criteria was performed: age 18–40 years; presence of uterine LM with submucosal location, which was treated surgically; presence of vitrified embryos of satisfactory quality; traumatic event in the history with the formation of PTSD; informed consent to participate in the study.
Results. The results of our studies indicate that the frequency of reproductive function disorders in women with submucosal uterine fibroids and PTSD is 83.3% with a predominance of secondary infertility (50.0%) over primary infertility (33.3%). The use of our improved algorithm of pre-gravid rehabilitation measures (two-stage conservative myomectomy by hysteroscopic access) allows to reduce the frequency of pain syndrome by 36.7%; menstrual dysfunction – by 33.3%; impaired endometrial receptivity (with conventional rehabilitation – 28.3%), as well as to increase the effectiveness of restoration of reproductive function in the form of pregnancy by 18.0%.
Conclusions. The analysis of the short-term and long-term results of submucous myomectomy showed that two-stage conservative myomectomy is an appropriate and effective surgical treatment. The use of less invasive endoscopic approaches according to our improved and optimised algorithm leads to a more favourable course of the postoperative period, ensures complete restoration of the basal layer of the endometrium, reduces the length of hospital stay and the period of pregravid preparation, which, in combination with hormone therapy prescribed based on endometrial immunohistochemistry, normalises menstrual function and creates favourable conditions for the realisation of a woman’s reproductive function.