THE 30 YEARS' CLINICAL EXPERIENCE IN DIAGNOSIS AND TREATMENT OF ENDOMETRIAL OVARIAN CYSTS IN PATIENTS OF REPRODUCTIVE AGE

Abstract

Endometriosis occurs in 50 % of women with infertility. Ovarian endometriosis affects 55 % of women with this disease. Surgical treatment of endometrium is indicated if its size is over 3 cm. After removal of the endometriomas there are used diathermic, bipolar energy, radio wave energy, argon plasma coagulation for hemostasis of ovarian tissue. The use of argon plasma coagulation in ovarian hemostasis causes not only hemostatic but also protective effect, which is mediated by the induction of HSP27, SOD2, VEGF and iNOS, which renders an organ−preserving effect when applied to ovarian tissues. Repeated surgery for ovarian endometrium should be performed taking into account the risk of reduced levels of antimullerian hormone, which may adversely affect the further implementation of reproductive function, including the use of assisted reproductive technologies. The authors comparatively have evaluated the treatment of 900 patients of reproductive age with endometrioid cysts of the ovaries and other concomitant gynecological pathology, which were three clinical groups. The patients received radiowave energy, argonoplasmic coagulation, intraoperative use of various anti−adhesive drugs and combinations of drugs in the postoperative period. It was found that the use of argon plasma coagulation for hemostasis of ovarian tissues after removal of endometrioid cysts, polyethylene oxide gel with carboxymethylcellulose intraoperatively and gonadotropin−releasing hormone agonists, dienogest 2 mg per day for three months contributed to the pregnancy onset in post−srugery period in 56.7 % of patients. It has been noted that in women the presence of adhesions in combination with corpus luteum cysts, endometrial polyps, uterine leiomyoma reduces the onset of pregnancy by 8.0, 12, and 24 times, respectively. Key words: endometrial ovarian cysts, diagnosis, treatment, rehabilitation in the post−surgery period.