Samoylova M. Enhancement of ovary endometriosis diagnostic and treatment methods, prophylactics of relapses and improvement of reproductive prognosis

The work is dedicated to an important problem of modern gynecology - enhancement of diagnostic and treatment methods of ovary endometriosis according to the stage of the disease based on the studying of neoangiogenesis and microhemocirculation factors, proliferation markers and collagens, developing of differential treatment tactics, increasing of fertility index and improving of perinatal outcomes. Using transvaginal ultrasonography with colored Doppler carting found the criteria for setting the preliminary diagnosis of ovary endometriosis on the early stages of the disease. While matching the results of Doppler, morphologic and immune histochemical investigations detected two different pathogenetic endometrioma variants with hypo- and hyperkinetic types of blood circulation, different levels of proliferation and collagen forming that allowed in further to justify the method and duration of postsurgical anti recurrent treatment. In the work on the basis of conducted morphometric investigation detected two pathogenetic variants of ovary endometriosis progression. In cystic variant in the endometrioma wall observed the sclerosis and collagens forming processes activation, hypokinetic type of blood circulation and developing of endometrioma by "retention mechanism". Determined that combined cystic variant of ovary endometriosis is characterized with hyperkinetic type of blood circulation, increased level of proliferation markers that clinically appears with significant chronic pelvic pain syndrome and different menstrual cycle disorders. Detected in the work reverse correlation between proliferation and neoangiogenesis markers and peripheral vessels resistance indexes indirectly testifies the varied propensity for recurrence of different variants of ovary endometriomas. Accordingly to different pathogenetic variants of ovary endometriosis and stages of process development in the investigation designed various treatment approaches with abidance of organ-preserved principle during laparoscopic endometrioma excision and anti-recurrent therapy in post-surgical period. In the work conducted investigation of follicle genesis in patients with ovary endometriosis that showed the decreased level of follicle number of all staged of development, corpus luteum cysts present, obturative atresia, dystrophic and degenerative changes in follicles of all stages. In patients with treated ovary endometriosis on the stage of pregravid preparation proposed use of ozonotherapy that helped to increase the number of pregnancies, rise the fertility index and improve the perinatal outcomes.