Sulima A. Peritoneal pelvic adhesions in women at reproductive age: diagnosis and treatment.

The thesis paper is aimed at decreasing the frequency of reproductive function disorders in women with pelvic peritoneal adhesions by investigating new aspects of the pathogenesis of this disease, as well as to develop an advanced algorithm for diagnostic, therapeutic, preventive and rehabilitative measures. This paper expands the understanding of the pathogenesis of adhesions in the pelvis associated with the study of the role of proinflammatory cytokines and immune CD68-positive cells (macrophages) in the tissues of the pelvic peritoneal adhesions in women at reproductive age. It has been proved that peritoneal fluid imposes a pronounced influence on the development of adhesions as well as that the peritoneal fluid constitutes the most significant increase in the content of proinflammatory cytokines. Based on the accumulated clinical material which attests the effectiveness of different methods of topical diagnosis of abdominal and pelvic organs adhesions in women of reproductive age. The scientific work presents and justifies the selection of algorithm for surgical approach depending on the location of adhesions in the abdominal cavity and the type of operation. It suggests the pathogenetically proved prevention of adhesions and offers a differentiated approach to the management of patients with pelvic peritoneal adhesions, while taking into account the risk, effectively reducing the likelihood of recurrence and improving the long-term outcomes (reduction in the number and density of adhesions in the pelvis) among the patients who underwent surgical treatment.