Клініко-патогенетичні аспекти гіперпроліферативних процесів ендометрія асоційованих з хронічним ендометритом

Abstract

The dissertation is dedicated to the solution of the current topic of modern gynecology - increasing the effectiveness of treatment measures in women with hyperplastic processes of the endometrium in combination with chronic endometritis by studying the clinical-anamnestic, anatomical-functional, morphometric and microbiological characteristics and establishing their relationships. The work is based on the experience of managing 161 women of reproductive age with gynecological pathology, who were observed at the Department of Obstetrics and Gynecology of Vinnytsia State Medical University named after M.I. Pirogov No. 2 and the surgical department of the Innomed Medical Center - the Endosurgery Center. 129 of them were women with verified endometrial hyperplasia and endometrial polyps, of which 71 had a diagnosis of chronic endometritis. The research was carried out by collecting anamnestic data, conducting a gynecological examination by bimanual examination, clinical and laboratory examination according to the usual scheme, including hormonal blood tests. Microbiological studies were carried out: evaluation of vaginal microbiocenosis, study of the microflora of the cervical canal and endometrial biopsy, identification of detected microorganisms. Detection of the genome of possible causative agents of chronic endometritis was carried out using the polymerase chain reaction. Ultrasound examination of pelvic organs, dopplerometry, hysteroscopy, morphological examination using computer morphometry and immunohistochemical examination were carried out. Statistical data processing was performed on a personal computer using Microsoft Excel spreadsheets and the Statistica for Windows v. 7.0, StatSoft Inc. (USA). The scientific novelty of the study is that the leading clinical and anamnestic risk factors for the occurrence of endometrial hyperplasia combined with chronic endometritis were formulated for the first time, which consist in the earlier development of the disease, at the age of 30-39 years, 5 or more years after an acute inflammation or intrauterine intervention . For the first time, the features of the clinical course of endometrial hyperplasia developed against the background of chronic endometritis in the form of pain syndrome (35.2%), metrorrhagia (31.0%), dysmenorrhea (45.1%) and asthenic syndrome (66.2%) were revealed. For the first time, echographic criteria of endometrial hyperplasia in combination with chronic endometritis were established, namely M-echo inhomogeneity, focal inhomogeneity of the endometrium, areas with an increased vascular pattern combined with areas of atrophy. For the first time, the peculiarities of the morphological picture of the state of the endometrium in hyperplasia against the background of chronic endometritis, such as mucosal hyperemia, the presence of point hemorrhages, an uneven vascular pattern, an increase in diameter and thickening of the gland walls according to morphometric data, were established. For the first time, the specifics of the effect of a microbial agent in chronic endometritis and the development of endometrial hyperplasia were established. For the first time, an algorithm for the inclusion of antibacterial and antiinflammatory therapy in the treatment scheme for endometrial hyperplasia against the background of chronic endometritis was developed, taking into account the detected pathological changes. The practical significance of the work is that the clinical and morphological features of endometrial hyperplasia against the background of chronic endometritis were revealed. We consider it expedient to include research on the detection of a microbial agent by the PCR method in the diagnostic standard. The prognostic significance of pathological long-term exposure to a microbial agent, as well as associations of microbial-viral agents in endometrial hyperplasia against the background of chronic endometritis, was revealed.