THE CAPACITIES OF ECHOGRAPHY IN PATIENTS WITH TUBOPERITONEAL INFERTILITY DURING SURGICAL INTERVENTIONS

Objective. To improve the echographic diagnosis of a commissural process in the small pelvis to optimize surgical treatment policy in the achievement of pregnancy in women with tuboperitoneal infertility. Subjects and methods. Fifty-two women with infertility, including 30 patients with a diagnosed commissural process in the small pelvis and 22 patients with no commissural process being found at preoperative transvaginal echography. Physical examinations and echographic, X-ray, and endoscopic studies were performed. Results. Laparoscophic echography (LE) offers a means of examining the uterine tubes all the way to the uterine angle and defining the site of the fimbrial part, which cannot be frequently done at pre- and intraoperative transvaginal echography. In a significant commissural process and hydrosalpinx, LE makes it possible to accurately determine the fimbrial part of the uterine tubes and to perform the adequate surgical intervention — salpingostomy. LE in combination with endoscopic imaging can well define the borders of a space-occupying lesion and its adjacent organs in the manifest commissural process, thus preventing traumatization of the latter and finishing the operation through endoscopic access. In tuboperitoneal infertility concurrent with gynecological diseases, LE can differentiate small-sized functional masses from benign tumors and tumor-like masses of the ovary and, if any, accurately define the site of a tumor in the ovary, avoid extra incisions and coagulation of the ovarian surface, thus preserving the ovarian reserve in women with unrealized reproductive function and old reproductive-age women. Conclusion. There is evidence for the diagnostic value of intraoperative echography and LE in hydrosalpinx, liquid tumorlike and inflammatory diseases of the appendages concurrent with significant commissures and with the involvement of adjacent organs into the commissural conglomerate, which can define the scope of surgical intervention well, assure its safety, and preserve the appendages in young women with unrealized reproductive potential.

intraoperative echography, laparoscopy echography, commissural process in the small pelvis, hydrosalpinx, liquid tumor-like and inflammatory diseases of the appendages