Chekhanov Y. Optimization of preoperative examination and hysteroscopic treatment in patients with single symptomatic submucous myoma

The dissertation for obtaining the Candidate of Medical Science Degree (Philosophy Doctor) in speciality 14.01.01 “Obstetrics and gynaecology” (22 — Health protection). Odessa National Medical University Ministry of Health, Odessa, 2018. The dissertation is dedicated to problem of the optimization of surgical treatment in women of reproductive age with submucous uterine myoma, by the means of improvement of diagnostic algorithm, effectiveness and safety of hysteroscopic myomectomy. During the process of scientific work the complex algorithm of diagnostics and treatment in patients with single symptomatic submucous myoma has been developed. The proposed algorithm was analyzed by the means of comparison of effectiveness of diagnostics and operative treatment in two groups of women at the age of 18–48 years: the main group (prospective, n=110), in which preoperative investigation and the choice of the operative treatment has been made due to developed algorithm, and the group of comparison (retrospective, n=90), in which the traditional way of diagnostics and surgical treatment has been used. The main principles of preoperative and intraoperative evaluation of safety and performance of surgical treatment of submucous uterine myoma have been formulated. The strongest positive association between the levels of fluid deficit and hysteroscopic myomectomy duration has been evaluated (r=0,74). The size of submucous myoma was determined as the basic prognostic criteria of safety and effectiveness of hysteroscopic myomectomy performance. A diagnostic criterion Cfd provides the opportunity to evaluate antecedently the potential risk of operative treatment in patients with submucous uterine myoma. Solutions that where proposed and implemented in research work help to promote the optimization of all evaluable spectrum of surgical treatment of submucous uterine myoma. Improved algorithm of diagnostic and treatment in patients with single symptomatic submucous myoma based on the results of the research work has been developed and implemented into gynaecological practice, which allowed us to improve significantly the results and effectiveness of hysteroscopic myomectomy in the patients: the complications rate decreased by 52,0 %, the rate of two-step hysteroresectoscopies decreased by 58,6 %, the rates of hyperhydration syndrome decreased by 76,7 %. Key words: submucous uterine myoma, diagnostic, treatment, hysteroscopy.