The work is devoted to increasing the effectiveness of treatment of women with chronic salpingo-oophoritis with different variants of the course by substantiating and implementing personalized methods of their diagnosis and therapy.
The study involved 171 patients, aged 17 to 45 years, who sought counseling for preconception training. With the help of complex ultrasound, 141 women with chronic salpingo-oophoritis and 30 somatically healthy women of the same age were selected and examined. Taking into account the obtained ultrasound data, 69 patients with chronic salpingo-oophoritis were not a complicated course (group I), and 72 patients with salpingo-oophoritis and hydrosalpinx (group II). All patients underwent bacteriological and bacterioscopic examination of the vagina and cervical canal. The endometrial microbiome was studied on the basis of morphological samples obtained during aspiration biopsy on the 5-10th day of MC. Immunohistochemical and morphological examination of the endometrium and fallopian tubes was performed. Assessment of the hormonal status of patients was performed on the basis of determination of plasma levels of steroid and sex hormones in the I and II phases of the menstrual cycle. In the energy Doppler mode, three-dimensional Doppler indices VI, FI, VFI and endometrial volume were determined using VOCAL, 3D reconstruction of the endometrium and fallopian tubes was performed to determine the site of occlusion. The peristalsis of the uterus and fallopian tubes is studied on the basis of the proposed method.
As a result of research in patients with chronic salpingo-oophoritis with different variants of the course, the sonographic features of the pelvic organs (uterus, fallopian tubes, ovaries) were studied on the basis of in-depth ultrasound examination of the endometrium and peristalsis of the uterus and fallopian tubes using 3D reconstructive VI, FI, VFI), which increased the sensitivity of the diagnosis of benign genital pathology. The results of the assessment of the species spectrum of the microbiocenosis of the vagina, cervical canal and endometrium of women with a complicated course of HSO are compared and the differences of the microflora indicators are revealed.
Based on the obtained results, a personalized management tactics for patients with different variants of HSO were developed and substantiated, and an improved treatment complex was proposed. Therapy was performed on 114 patients of selected groups, which were randomly divided into two subgroups depending on the treatment received. Women of I a (25 people) and IIa (33 women) subgroups received an advanced treatment complex (ULC) (combination of ornidazole + fluoroquinalone, immunobiotic, fluconazole, streptokinase, streprodornase and vitamin D). The treatment regimen for women Ib (24 patients) IIb (32 women) subgroups did not include resorption therapy. At the end of therapy as a preconception preparation, patients were recommended to continue taking vitamin D for up to 6 months.
An algorithm for diagnosing the functional state of the reproductive system in women with different variants of HSO, which is aimed at personalized tactics of such patients in relation to the choice of surgical treatment.
Based on the obtained results, a personalized management tactics for patients with different variants of HSO were developed and substantiated, and an improved treatment complex was proposed. Therapy was performed on 114 patients of selected groups, which were randomly divided into two subgroups depending on the treatment received. Women of I a (25 people) and IIa (33 women) subgroups received an advanced treatment complex (ULC) (combination of ornidazole + fluoroquinalone, immunobiotic, fluconazole, streptokinase, streprodornase and vitamin D). The treatment regimen for women Ib (24 patients) IIb (32 women) subgroups did not include resorption therapy. At the end of therapy as a preconception preparation, patients were recommended to continue taking vitamin D for up to 6 months.
A personal comparison of previous sonographic markers of functional activity of the fallopian tubes with the results of conservative treatment showed a coincidence of detection of peristaltic movements in 17 (73.91%) of 23 (35.38%) people with regression of hydrosalpinx in group II. The choice of surgical tactics in favor of radical volume in 8 (12.31%) cases out of 12 (18.46%) performed tubectomies was based, inter alia, on the absence of sonographic signs of fallopian tube peristalsis in these patients.
The proposed therapy helped to improve the morpho-functional condition of the fallopian tubes, restore the microbiocenosis of the vagina and endometrium, which increased the effectiveness of conservative treatment and optimized the choice of volume and duration of surgery.
