Ovarian blood supply in women of reproductive age and echo-graphic evaluation of influence of subtotal hysterectomy on it

Abstract

Purpose of the study . To study the peculiarities of ovarian blood supply after subtotal hysterectomy in the reproductive age. Materials and methods of research . In accordance with the purpose and objectives of the work 150 women of reproductive age were included, there were 4 groups. 125 patients suffered from uterine leiomyoma, 100 of whom had a hysterectomy (HE) – a supravaginal uterus amputation (SUA), which corresponds to a subtotal HE (SHE). Results . When examining a group of healthy women of the control group, we determined the average volume of the ovaries – 5.2 ± 0.2 cm 2 , which did not differ from the average size for healthy women of reproductive age. When studying the structure of the ovaries and their size, several large ovarian dimensions (6.0 ± 0.4 cm 2 ) and the presence of cystic changes in some of them have attracted attention in patients with leiomyoma of the uterus. In addition to the study of the anatomical characteristics of the ovaries, we investigated the blood flow in the ovarian arteries, and the study of blood flow was carried out according to the phases of the menstrual cycle in the women of the control group, as well as in patients with uterine leiomyoma – one year before and after the operation. Conclusions. Ultrasound showed a gradual decrease in volume as the duration of the postoperative period increased. Duplex scanning with the determination of indices characterizing the blood flow revealed a slight deterioration in the blood supply of the ovaries within 1 year after removal of the uterus compared with patients with uterine leiomyoma and healthy women of similar age. IER was the most sensitive index, which was the first to react to the change in the tone of the vascular bed. In more than half of operated patients we did not find any cyclic changes in the blood flow in the ovarian artery, which was characteristic of healthy patients of reproductive age. Change in blood flow is early and more sensitive sign of impaired ovarian function. Cystic ovarian changes, found in 2.5 % of patients with uterine leiomyoma after SHE, were combined with a sharp suppression of the blood flow, which allowed us to assert that cystic ovarian changes, in fact, are the cystic degeneration against the background of severe ischemia of the organ. The results obtained should be taken into account when developing an algorithm for managing patients after surgical treatment of uterine fibroids in the volume of the SHE.