Optimization of endoscopic methods of treatment of uterine fibroids for the women of reproductive age

The objective:Improvement of results of treatment of uterine fibroids for the patients of reproductive age due to the individual selection of surgical tactic and perioperative therapy.Materials and methods. For decision of the put purpose 144 patients of reproductive age (from 18 to 44 years inclusive) were inspected, passing treatment concerning uterine fibroids. All investigated patients part on four groups: patients which the conducting of laparoscopic myomectomy with preoperative therapy a ulipristal acetate was planned were included in a 1 group; patients which the conducting of laparoscopic myomectomy was planned without a preoperative hormonotherapy were included in 2 groups; patients which the conducting of transcervical myomectomy was planned with the use of ulipristal acetate were included in 3 groups; to 4 groups women which implementation of transcervical myomectomy was planned without a preoperative hormonotherapy are attributed. Results. In a postoperative period at most patients complaints disappeared about menstrual hemorrheas, because of normalization of level of haemoglobin of patient marked the improvement of general feel. Control ultrasonic research of organs of small pelvis in groups 1 and 2 it is conducted in 6 months after operative treatment. To these patients during the term of rehabilitation with the purpose of contraception, and also for achievement of amenorrhea as favourable background of reparation of myometrium in 45 (71,4%) cases appointed the combined oral contraceptives. To the patients 1 and 3 groups, at which adenomyosis combined with uterine fibroids (n=43) a ulipristal acetate was appointed 5 mg during 3 or 6 months. In groups 3 and 4, where as a contraception also applied the combined oral contraceptives in 52 (68,4%) cases, ultrasonic research of organs of small pelvis (office hysteroscopy) executed in 3 months after the conducted operative treatment. It is necessary to mark that in basic groups with a plural uterine fibroids, where myomatous nodes were saved clinically not meaningful sizes, it is not marked on a background the hormonotherapy of growth of knots.Conclusions. Factors, complicative implementation of myomectomy, it is been: diameter of myomatous node over 25 mm at the second type of myomatous node, simultaneous resection a few myomatous nodes, location of myomatous nodes on the lateral walls of uterus in combination with a location them in overhead third of cavity. Ultrasonic descriptions of myomatous node have an also not unimportant value on the preoperated stage: at the thickness of intact myometrium 5 mm and less implementation of transcervical myomectomy can be attended with the risk of perforation of uterus, and also risk of thermal damage of surrounding tissue. Findings must be taken into account at development of algorithm of treatment­and­prophylactic measures. Keywords: uterine fibroids, endoscopic treatment, optimization, reproductive age.