Sydorenko A.V. Comprehensive treatment of combined uterine pathology: leioma and adenomyosis in women of reproductive age. – Qualification scientific work as a manuscript.
Thesis for the degree of candidate of medical sciences (Ph.D.) in specialty 222 «Medicinа» – The Odesa National Medical University, Odesa, 2020.
The aim of this work was an improvement of treatment of reproductive age women, suffering from combined uterine pathology leiomyoma and adenomyosis by creating and implementing a comprehensive stage personalized care.
A prospective examination of 150 women of reproductive age was performed. The control (I) group included 30 healthy women. The main clinical (II) group (n=120) was divided into two groups. The first clinical group (IIA) included women (n=60) suffering from Lm m and AZ of the active clinical course (nodal, diffuse, diffuse-focal III-IV degrees of severity), the second group (IIB) included (n=60) patients suffering from Lm m and AZ of the inactive clinical course (diffuse and diffuse-focal I–II degrees of severity). Each of the clinical groups (IIA and IIB) was divided into subgroups depending on the therapy. The patients of subgroup IIA1 (n=30) and IIB1 (n=30) received therapy according to the current protocols of the Ministry of Health of Ukraine, the patients of subgroups IIA2 (n=30) and IIB2 (n=30) received in addition to the treatment of the basic disease our own developed metabolic therapy, which included the restoration of vitamins level (folic acid, thiamine, D, E), polyunsaturated amino acids, microelements, vaginal microbiocenosis, and nutrient therapy.
A feature of the metabolic processes of women in the main group is a decrease in blood folic acid by 1.5 times (p <0.05), thiamine by 1.5 times (p <0.05), vitamin D by 5.2 times (p < 0.05), vitamin E 1.5 times (p <0.05), ferritin 12.7 times (p <0.05), LDH 1.8 times (p <0.05) higher, zinc 2.0 times (p <0.05) lower, and copper, calcium 1.2 times (p <0.05) higher in relation to women in the control group. The content of zinc and copper in the removed uterine tissues in the group with Lm m and AZ of the inactive clinical course was respectively lower in 1.13; 1.35 times, and calcium 1.2 times higher than in the group with Lm m and AZ active clinical course (p <0.05).
Active AZ and the background of asymptomatic Lm m leads to an increase in the resistance index by 2.2 times (p <0.05) and a slowdown in blood flow (p <0.05) by 2.4 times in a. uterine, which can be a criterion for differential diagnosis in determining the priority disease Lm m or AZ.
An algorithm for examining women with CUP Lm m and AZ has been created, which with the help of Doppler ultrasound and MRI allows to determine the priority disease Lm m or AZ.
The proposed complex therapy helps to restore hormonal homeostasis, metabolic processes of generative function 3.2 times, or 41.3% (p <0.05) more often than with traditional therapy.
