Aleksenko O. Differential approach to organ-preserving surgical treatment in women with intramural leiomyoma of the uterus

In the dissertation the technique for determining uterine contractility has been improved using ultrasound, which allows to detect peristalsis disorders. Expanded scientific concepts regarding the contractile function of the uterus in women of reproductive age, depending on the phase of the menstrual cycle. When using the method, pathological peristalsis in women with uterine leiomyoma is 61.29%, which is 3.68 times more than in women without uterine leiomyoma. In women with leiomyoma and infertility 4.82 times more than in the control group (p <0.001). In the group of women with UL who have not yet been diagnosed with infertility, compared with virtually healthy women, uterine peristalsis was diagnosed 2.57 times more (p = 0.01). Based on a comprehensive study of clinical parameters, laboratory and instrumental examination of 124 women with UL, it was found that the adverse type of peristalsis, in the group of women with leiomyoma planning pregnancy, inversely correlates with the onset of pregnancy. The likelihood of becoming pregnant in women with UL with low contractility scores is 5.26 times higher than in women with scores of 5 points and above (p <0.001). The lower the score, the higher the chances of becoming pregnant: that is, with a score of 1-2 points, the probability of becoming pregnant increases 9.45 times (p = 0.001). Myomectomy has been found to have a beneficial effect on the uterine contractility: in 76.92% of cases it was possible to improve uterine peristalsis after myomectomy, which 5.01 times improved the chances of women fertility recovering from UL and disturbed peristalsis. In the group of women with UL and infertility in 65.38% of cases recovery of reproductive function was achieved. A model for predicting the recovery of reproductive function in women with intramural uterine leiomyoma has been developed, which includes a number of factors that cause infertility in the women studied. The total impact of the factors on the recovery of reproductive function is 79.21%. By influencing some factors by laparoscopic myomectomy, we managed to increase the chances of restoring reproductive function 21.27 times (95% CI 2.14 - 211.69). The predictive models obtained have excellent operational characteristics by ROC analysis and proven statistical significance (p <0.001).