Kryvokulsky B. Optimization of diagnostic and surgical tactics at venous thromboembolism in patients with endometrial cancer

The thesis is devoted to the improvement of surgical treatment and prevention of postoperative venous thromboemolic (VTE) complications in the early postoperative period in patients with endometrial cancer (EC). In the work shows results of treatment of 267 patients with endometrial cancer are presented. The main group consisted of 147 patients, diagnostics and surgical treatment, which were carried out using the algorithm, a comparison group of 120 patients - according to the existing clinical protocols. The value of D-dimer (as a prognostic marker of thrombosis) and dynamics of changes in the pre-, intra- and early postoperative period (1,5,8 days) was studied. A reliable correlation (p<0,05) between thrombosis in the veins of the pelvis and the level of D-dimer on the preoperative stage was established. A mathematical model for predicting the presence (absence) of blood clots in the veins of the pelvis has been created. The efficiency of modification of hysterectomy by revision of the veins of the small pelvis, in terms of the presence of thrombotic masses in their lumen, has been proved. The thrombotic lesion of the small vein is detected in 11.56% of patients in the EC of the main group. During the thrombectomy, 19 thromboses were removed, which were localized in the ovary – 78,96%, in the uterine veins – 10,52%, and in the veins of cardinal connections – 10,52% histological - the thrombotic masses were fresh (70,58%), without tumorous embolism, and have not been diagnosed with ultrasonography of the doppler of the pelvic veins in the preoperative stage. The algorithm of optimization of diagnostic and surgical tactics was developed and implemented, taking into account the risk of possible VTE, the reduction of the frequency of postoperative VTE from 11,67% to 1,36% and the mortality rate from the pulmonary embolism from 4,17% to 0% in the early postoperative period.