Abstract
The aim of the research – to identify violations of quality of life after hysterectomy with opportunistic salpingectomy, considering different approaches to surgery.
 Materials and methods. Quality of life assessments of hysterectomy with opportunistic salpingectomy for uterine fibroids were performed in 160 women of reproductive age, who were divided into two groups: I – 90 patients with vaginal access, and II – 70 patients with abdominal access. The control group included 50 women with asymptomatic fibroids of reproductive age. The diagnostic algorithm included a physical examination, ultrasound examination of the pelvic organs, assessment of urogenital dysfunction questionnaire using the MOS SF-36 questionnaire; to identify signs of vegetative changes in Wayne, to assess general fatigue, physical and mental fatigue MFI-20 was performed using a standardized POP-Q system.
 Results. The leading violations of quality-of-life parameters are general somatic symptoms 107 (66.9±6.0 %), psycho-emotional disorders 89 (55.6±6.7 %), genitourinary and sexual disorders 39 (24.4±3.0 %). Among the most common somatic ones – complaints of headaches, edema and fluctuations in blood pressure. The dominance of asthenic, anxiety and depressive disorders among psycho-emotional disorders has been established. The diagnosis of “organic asthenic disorder” was established in 47 (52.2±9.7 %) and 39 (55.7±7.3 %), respectively, in the groups of examined patients. Vaginal hysterectomy causes more increase in the proportion of urogenital disorders 25 27.7±8.3 %) compared to control – 7 (14.0±4.8 %) (p<0.05). An ultrasound examination showed a 2.25-fold increase in ovarian volume one month after the hysterectomy, and a reduction in ovarian tissue volume in both study groups 2 years after surgery.
 Conclusions. Hysterectomy with opportunistic salpingectomy affects the parameters of quality of life. The leading violations of quality-of-life parameters are general somatic symptoms, psycho-emotional disorders without statistically significant difference in groups, but the indicators are better in group I. The minimal effect on ovarian function and size was determined – 2 years after surgery, there was a decrease in ovarian tissue volume in both study groups, but statistically significant – in the second group (3.12±0.7 cm3, p<0.05) against the data control (5.82±1.7 cm3). Although the results showed a more frequent manifestation of pelvic floor descent in vaginal access, quality of life parameters were higher in these patients. Given its safety, efficiency and cost-effectiveness, it is advisable to choose it as a method of choice
Highlights
Despite the significant variety of treatments for uterine fibroids at the present stage of development of gynecology, the frequency of hysterectomy remains consistently high, in Sweden – 38 %, in the US – 36 %, in the UK – 25 % [1]
The step was a comprehensive assessment of the impact on quality of life of hysterectomy with opportunistic salpingectomy for uterine fibroids in 160 women of reproductive age, who were divided into two groups: I – 90 patients aged 45.9±1.3 years, where it was performed vaginal hysterectomy with tubes, both classical and associat
According to the results of this study, in women of reproductive age after hysterectomy with opportunistic salpingectomy for fibroids, we found that the leading violations of quality of life are somatic symptoms 107 (66.9±6.0 %) compared with control – 13 (26.0±8.7 %), psycho-emotional disorders 89 (55.6±6.7 %) compared with control – 11 (22.0±8.7 %), genitourinary and sexual disorders 39 (24.4±3.0 %) compared with control
Summary
Despite the significant variety of treatments for uterine fibroids at the present stage of development of gynecology, the frequency of hysterectomy remains consistently high, in Sweden – 38 %, in the US – 36 %, in the UK – 25 % [1]. After surgery on the uterus, the prevalence of mental disorders and psychological problems is 50–90 %, sexual changes are observed in 48–50 % of cases [6] It should be noted not entirely definite and contradictory point of view on the pathogenesis of vegetative-neurotic and metabolic disorders in hysterectomy, when the main in the occurrence of psycho-autonomic disorders see psychological factors – inferiority, defeminization, etc. Over the past two decades, it has become clear and increasingly accepted that most ovarian cancers originate in the epithelium of the fallopian tubes rather than the ovary itself. There was no difference in hormonal postoperative status between groups after hysterectomy with or without opportunistic salpingectomy, but insufficient data were found to assess whether there was any difference in the occurrence of surgical complications. The maximum difference before menopause, calculated from the lower limit of 95 % CI and the natural mean decrease in AMG, was approximately 20 months, which was considered clinically insignificant [7]
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