Modern view of intra- and post-operative blood loss prevention during hysteroresectoscopy in patients with submucous uterine leiomyoma

Abstract

Intrauterine pathology is a complex of diseases, different in etiology and pathogenesis, which are associated with changes in the mucous or muscle membranes of the uterine cavity. In its structure, submucous uterine leiomyoma ranks third with a purity of 6.5%. The introduction of the hysteroresectoscopy method in gynecological practice allowed us to abandon the uterus extirpation in favor of organ-preserving surgery. Since hysteroresectoscopy is an operative intervention, as with any operation, there is a risk of complications. The world statisctics show that the frequency of complications of hysteroscopy varies between 0.4-6%. The objective: to reduce the frequency of intraoperative and postoperative blood loss in patients with submucous uterine leiomyoma during hysteroresectoscopy. Materials and methods. 183 women with submucous uterine leiomyoma was performed. Depending on the chosen treatment strategy, the women were divided into two groups: the main group included 76 patients who received the developed advanced diagnostic and treatment complex. The control group included 107 women, whose inpatient management was carried out in accordance with the current quality standards of medical care. In order to determine the amount of menstrual blood loss during the preoperative period and after 3 months in the operative one, all women were given a clinical interview with filling in the pictogram. Results. The average age of studied women was 31.2±0.34 years. The duration of menstrual discharge was in the range of 7 to 10 days and averaged 9.2±0.2 days. More than half of women - 97 (53.0%) used sanitary tampons along with daily pads. The “super-heavy” volume of menstrual blood loss was typical for 10 women (5.3%). The sizes of individual leiomyoma nodes varied between 1,0 and 3,0 cm in diameter (according to the inclusion criteria) and averaged 1,82±0,29 cm, in women with leiomyoma we noted that myomatous nodes were mapped primarily in blue (dense type according to the classification). Against the background of the developed complex, the average size of leiomatous nodes in patients of the main group significantly differed from the average size of nodes in patients of the control group by an average of 66.4% (the main group – 1.62±0.29; the control group-2.44±0.21; p<0.05). Analysis of hysteroresectoscopic intervention shows that in the main group, increased blood loss that required postoperative administration of uterotonic drugs was registered in 6 (7.9%) cases (the control group – 32 (29.9%) (p<0.05). Postoperative administration of uterotonic drugs in the main group was performed in 14 (18.4%) cases, while in the control group this value was 4.2 times higher and amounted to 82 (76.6%) cases. The “light” volume of blood loss was noted by 36 (33.7%) women in the control group and 50 (65.8%) women in the main group (p<0.05). Conclusions. The use of a two – step approach to intraoperative and postoperative bleeding preventing by applying triptorelin acetate 3.75 mg 28 days before hysteroresectoscopy and terlipresin acetate 0.2 mg 15 minutes before hysteroresectoscopy can significantly reduce the volume of intraoperative (main group – 4 cases (5.3%), control group – 25 cases (23.4%); (p<0.05) and postoperative blood loss (main group – 6 cases (7.9%), control group - 31 cases (28.9%); (p<0.05), reduce the time of endoscopic manipulation; it also reduces the material costs associated with its implementation and also helps prevent postoperative complications. Key words: bleeding, hysteroresectoscopy, intrauterine pathology, intra- and post-operative complications, submucous uterine leiomyoma.