Gnatenko O. Optimization of diagnosis and treatment of adolescents and young women with ovarian cysts and extragenital pathology

The dissertation is devoted to improving the diagnosis and treatment of adolescent girls and young women of reproductive age with ovarian cysts on the background of extragenital pathology and the development of a rehabilitation algorithm to prevent menstrual and reproductive dysfunction in this group of patients. The scientific novelty of the work is that the author based on the study of clinical and pathogenetic properties of etiopathogenetic and morphological variants of ovarian cysts on the background of extragenital pathology, identified features of pubertу and reproductive system of the female body with subsequent comprehensive conservative and surgical treatment. The scientific data on the clinical course and features of the premorbid background, menstrual disorders, immunological and endothelial shifts and ovarian reserve, changes in the hormonal background in patients with ovarian cysts, taking into account age and features of somatic pathology. It was found that 83% of adolescents and 65% of women with ovarian cysts were found to have extragenital diseases significantly more often than in the control. The formation of a set of clinical, echosonographic, Doppler, pathomorphological criteria, indicators of tumor markers in the complex diagnosis of the nature of ovarian tumors, the exclusion of the oncological process, the prediction of disease recurrence was further developed. The connection between the formation of ovarian retention cysts and the pathological course of puberty (71.7% of adolescents) and disorders of the reproductive system in women on the background of immunological shifts (increased levels of proinflammatory cytokines in 64.7% of girls and 78.9% of women) and a decrease in ovarian reserve in 46.6% of women. It was proved the formation of endothelial dysfunction in patients with ovarian cysts and extragenital pathology, a close positive correlation of endothelin-1 with cytokines (IL-1β, - r=0.64; TNF-α, - r=0.52) and hormones. Extended scientific concepts about disorders of gonadotropic function of the pituitary gland, hormonal function of the ovaries in patients with ovarian cysts: proven imbalance of gonadotropins (in 59.6% of patients), ovarian hormones, increased cortisol levels (in 59% of adolescents). The level of leptin was determined, which in patients with functional and endometrioid cysts of the ovaries is closely correlated with body mass index, estradiol (r=0.75) and cortisol (r=0.68). A set of therapeutic measures has been developed to increase the effectiveness of conservative and surgical treatment, prevent complications and recurrence of ovarian tumors, depending on the nature of comorbid somatic diseases. Based on the mathematical analysis, an algorithm for predicting the recurrence of ovarian retention cysts, a set of organizational and treatment measures that reduce the incidence of pathological changes in the female reproductive system in girls and young women in the presence of ovarian cysts