USE OF INTRAOPERATIVE LAPAROSCOPIC ECHOGRAPHY IN WOMEN WITH TUBOPERITONEAL INFERTILITY

Objective. To improve pre- and intraoperative echography to perform the optimal surgical volume in women with tuboperitoneal infertility. Subjects and methods. One hundred and thirty-two infertile women examined and endoscopically operated on using pre- and intraoperative echographic diagnostic techniques were followed up. A control group included 59 patients undergoing conventional small pelvic ultrasound studies pre- and postoperatively. General clinical, echographic, radiological, and endoscopic studies were used. Results. Comparing the capacities of transvaginal echography and laparoscopy indicated that the sensitivity and specificity in diagnosing a commissural process in the small pelvis were 91.2 and 92.6%, respectively; the prognostic value of a positive result (PVPR) was 81.6% and that of a negative result (PVNR) was 89.3%; diagnostic accuracy (DA) was 84.8%. Their sensitivity and specificity in diagnosing hydrosalpinx were 50 and 98.7% and PVPR and PVNR were 84.2 and 93.5%, respectively; DA was 92.8%. The sensitivity and specificity of laparoscopic chromohydrotubation were 100 and 49.2%; PVPR and PVNR were 18.4 and 100%, respectively; DA was 54.4%. DAfor a grade 1—2 and 3—4 commissural process was 72.7 and 88.9%, respectively; in its absence, it was 87.5%. In the comparison group, a recurrence was observed in 5.1% of the women with hydrosalpinx; no recurrences were seen in the study group. Pregnancy occurred in 20% of the women in the study and control groups and in 16.9% in the comparison group. Laparoscopic echography makes it possible to examine the uterine tubes all the way to the uterine angle, to evaluate their patency, to define the site of the fimbrial part, and to perform adequate surgical intervention. Conclusion. Intraoperative echography is a valuable technique that, in hydrosalpinx concurrent with a pronounced commissural process, estimates more clearly the volume of surgical intervention, assures its safety, and preserves the appendages in young women with unrealized reproductive function.

интраоперационная эхография, лапароскопическая эхография, спаечный процесс в малом тазу, гидросальпинкс