Abstract
Purpose of research: to improve the treatment effectiveness of patients with endometrial local hyperplasia by use of endoscopic technologies and pathogenetical postoperative therapy.Materials and methods. 66 women whose treatment algorithm included 4 stages (hysteroscopic polyp ablation followed by the morphological study, hormonal therapy aimed at the endometrium suppression, hormonal status optimization and dispensary observation within 5 years) were the subject of the study. After complex examination and histological verification of endometrial polyposis diagnosis patients were divided into two groups: A (n = 34) with the immune corrective therapy and B (n = 32). Examination algorithm included the endometrial immune histochemical examination with its immune histochemical profile definition.Study results. Histological screening of endometrium state resulted that 9 (26.5%) patients in the A group had the chronic endometritis features. The corresponding index for the B group stood for 15 patients (46.9%) that is 20.4% higher compared to the A group. Estrogen receptors expression with the background of progestogen treatment indicated the 1.2 times lowering for both groups. The viral and bacterial complex screening indicated the endometrial pathogenic contamination dramatic decrease. Study of tumor necrosis factor’s level determined the straightforward tendency with the CD 138 index dynamics. In a year term the complete treatment effect in A group was observed among 29 patients (85.2%), and the endometrial polyposis recurrence was observed among 5 (14.8%) patients.Conclusions. It is necessary to take into account the woman’s age, joint genital and somatic pathology’s presence and the immune histochemical profile of hyperplastic endometrial while determining the endometrial pathology differentiated treatment tactics. Additional immune corrective therapy with the antibacterial treatment determines the receptor phenotype restoration, normalization of tumor necrosis factor-α lever and increases the endometrial polyposis treatment effectiveness up to 22.7%.
Highlights
INTRODUСTION Unfavorable ecology, demographic situation in Ukraine, somatic and oncologic diseases frequency increase, immunity and living standard decrease have predetermined the increase of number of women with endometrial hyperproliferative processes who stand for 5–20% obstetric-gynecologic profile, according to the statistical data [2, 6, 14, 16, 19]
Nowadays regardless of the scientific achievements, diagnostics, surgery and curative methods improvement, the problem of intrauterine pathology treatment still remains topical in the medical and social aspects which is determined by the high risks of neoplastic transformation and steady tendency towards the recurrence frequency increase, which according to the homeland and foreign authors stands for 26 to 78% among women [1, 3, 15, 17–19, 22]
Examination and treatment were performed according to the protocol of the Ministry of Health of Ukraine, but algorithm of examination was supplemented by the immune histochemical study of the endometrium with determination of its immune histochemical profile, which allows to determining the receptor
Summary
T.V. KOVALIUK PhD, assistant professor, Obstetrics and Gynecology Department No 3, Bogomolets National Medical University, Kyiv ORCID: 0000-0001-9339-881X. S.V. BENIUK PhD, assistant professor, Obstetrics and Gynecology Department No 3, Bogomolets National Medical University, Kyiv ORCID: 0000-0003-4273-3934. I.A. USEVYCH PhD, assistant professor, Obstetrics and Gynecology Department No 3, Bogomolets National Medical University, Kyiv ORCID: 0000-0001-5200-8184. The disease’s etiopathogenesis complexity, different trends in its stages’ interpretation, tactical approaches ambiguity (with and without considering the hormonal disorder individual specific features) constitute definite difficulties while choosing the pathogenetically treatment. These are the circumstances to determine the increased scientific and practical interest in the endometrial polyposis treatment and management [7, 8, 9, 22]. The purpose of research: to increase the treatment effectiveness of patients with endometrium local hyperplasia (endometrium polyposis) by applying of the new endoscopic technologies and pathogenetically substantiated post-surgery therapy
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