TREATMENT AND REHABILITATION OF PATIENTS OF REPRODUCTIVE AGE WITH PROLIFERATIVE UTERINE FIBROIDS

Study objective: Clinical and morphological features of rapidly growing myomatous nodes, and their frequent combination with hyperplastic processes of the endometrium, endometriosis and functional cystic changes in ovaries, suggests that their development is based on disorders caused by sex steroids, implemented due to cell proliferation with impaired apoptosis processes, which requires an integrated approach, both in treatment and in recovery period.

Aims: The aim of our study is to optimize combined treatment and rehabilitation of young patients, taking into account clinical and morphological features of uterine fibroids.

Materials and Methods: We examined 72 patients with uterine myoma of reproductive age, from 20 to 45 years old. According to survey data, 11 (15.2%) patients had additional signs of grade II adenomyosis; endometrial hyperplasia -14 (19.4%); external endometriosis - 6 (8.3%). Treatment was selected with prospect of restoring reproductive function and included three main stages: Stage I (3-4 months) - a temporary reversible decrease in estradiol in the blood serum of patients, by using synthetic analogues of natural luteinizing releasing hormone; Stage II - selective uterine artery embolization (UAE) followed by myomectomy in various modifications; Stage III - hormonal rehabilitation of patients with the prospect of restoring reproductive function.

Results: After the first stage of treatment, patients noted: scarcity or absence of menstruation - 52 (72.2%) observations, a decrease in pain - 37 (51.4%) and appearance of vegetative-vascular reactions in form of "hot flashes" - 17 (23. 6%). After selective UAE, ultrasonic signs of reduced blood flow were noted as early as 2 weeks later. Features of the molecular morphological picture of removed fibroid node were: normalization of cellular activity (proliferative index), bcl-2 and p53 apoptosis inhibitors, as well as a significant decrease in expression of estrogen and progesterone receptors in 70.8% of cases, compared with fibroid preparations, operated women, without prior hormonal therapy and UAE - 26.3%.

Conclusion: An integrated approach to treatment and rehabilitation of young patients with rapidly growing uterine fibroids is reasonable and promising for recommendations in everyday clinical practice, which is especially important in case of combined gynecological pathologies, such as uterine fibroids, endometriosis and endometrial hyperplasia