The dissertation is devoted to increasing the effectiveness of prevention,
diagnosis and treatment of peritoneal adhesions of the pelvic organs in women of
reproductive age with tubo-peritoneal infertility against the background of studying
the features of the pathogenesis of the adhesion process and through the development
and implementation of an effective complex of treatment and prevention measures.
To solve the set goal, the following tasks were defined: – to conduct a clinical
and statistical analysis of the state of health of women of reproductive age with pelvic
inflammatory disease; determine exogenous risk factors for the formation of
adhesions in women of reproductive age; to investigate instrumental (ultrasound and
laparoscopic) markers of the adhesion process; conduct a pathomorphological
examination of the joints in women of reproductive age with tubo-peritoneal
infertility; to investigate the peculiarities of the pathogenesis of the formation of the
sebaceous process in women of reproductive age by studying the metabolism of
connective tissue, general antioxidant capacity and coagulogram indicators; to study
the biochemical and immunoenzymatic analysis of the content of pro-inflammatory
cytokines (IL-1, IL-2, IL-6, TNF-α) in the peritoneal fluid of women of reproductive
age against the background of celiac disease; to develop, implement and prove the
8
clinical effectiveness of a complex of preventive and therapeutic measures in women
of reproductive age with tubo-peritoneal infertility.
The study was conducted at the clinical base of the Department of Obstetrics
and Shupyk National Healthcare University of Ukraine at KNP KOR «Kyiv Regional
Perinatal Center». The study was conducted in three stages, 252 women retrospectively and 162 women prospectively, who planned pregnancy during 2019-2022, were
involved in the study. All patients gave informed consent for permission to conduct
the study.
At the 1st stage of the retrospective study, a clinical and statistical analysis of
the outpatient history charts of 252 women of reproductive age who were operated on
the basis of the gynecological department of the KNP KOR «Kyiv Regional Perinatal
Center» in 2015-2020 using laparoscopic access and who were operated on as the
main or accompanying diagnosis was carried out had "peritoneal pelvic adhesions".
Data on the somatic, reproductive and gynecological history, age and social status of
the patients were evaluated. The main group (OG) 187 medical histories of women
with the presence of a sebaceous process, the comparison group (GP) included
65 women in whom adhesions in the abdominal cavity were not detected during
surgery. Data for the retrospective study were provided by the archive of the KNP
KOR «Kyiv Regional Perinatal Center».
At the II stage of the study, 132 women were examined – the main group (OG),
with tubo-peritoneal infertility. All examined women were divided into 2 groups by
random sampling: the 1st group included 68 patients before and after operative
laparoscopy who received our proposed algorithm; the II group included 64 patients
before and after operative laparoscopy, who received generally accepted medical and
preventive measures. Generally accepted treatment and preventive measures in
patients with peritoneal adhesions (PTS) operated on laparoscopically were carried
out in accordance with the order of the Ministry of Health of Ukraine No. 676 of
12.31.2004. The control group (CG) consisted of n=30 healthy women. To exclude
the causes of reproductive disorders, women with heavy weight were excluded from
the study somatic and allergic diseases, patients with endocrine factors of
9
reproductive disorders, with systemic diseases, including congenital thrombophilias,
antiphospholipid syndrome, acute inflammatory diseases of the genitals; patients who
received immunomodulators less than 6 months ago. Morphological studies of
adhesions were carried out in 66 OG women, the study of pro-inflammatory cytokines
in peritoneal fluid was carried out in OG 58women with peritoneal adhesions.
At the 3rd stage of the prospective study, after a comprehensive examination
and implementation of the algorithm for the prevention of the inflammatory process,
an evaluation of the prevention of the inflammatory process was carried out in the 1st
group of the study compared to the 2nd group. A study of indicators that reflect the
processes of malignancy was carried out: the level of fibrinogen, fibrin degradation
products, indicators of the exchange of connective tissue in the blood plasma and in
the peritoneal fluid during the postoperative period. The frequency of pregnancy
during 6-12 months in the studied women of the I and II groups was also observed.
