Differentiated approaches to the development of prolonged treatment regimens for patients with endometriosis in the postoperative period

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Дәйексөз келтіру

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Аннотация

Objective: To analyze the characteristics of the management of patients with endometriosis who underwent surgery in the gynecological department over two years in order to develop personalized therapy for endometriosis; to analyze the preferable duration of use of dydrogesterone as effective anti-relapse therapy for endometriosis.

Materials and methods: The retrospective study included 292 patients of reproductive age (16-49 years old) diagnosed with endometriosis. The patients underwent laparoscopic treatment for endometriosis at the Clinic of Obstetrics and Gynecology of Pavlov First Saint Petersburg State Medical University, Russia from 2021 to 2023. The preferable duration of treatment was discussed on the basis of retrospective analysis and clinical case series.

Results: Endometriomas were found in 176/292 (60.3%) patients and were significantly more frequent in groups with stage III and IV endometriosis (p<0.0001). Peritoneal endometriosis was detected more often intraoperatively in patients with stage I and II endometriosis (p=0.000002). All patients received long-term hormone-modulating therapy when there were indications and no contraindications. Recurrence of endometriosis was noted in women who received combined oral contraceptives and dienogest as they had poor tolerance to therapy.

Conclusion: Surgical treatment for endometriosis should be performed only when indicated and during intraoperative staging of the disease. Taking into account the risks of complications and decreased quality of life in case of repeated surgical intervention for recurrent endometriosis and possible reproductive plans of the patient, further treatment in the form of personalized drug therapy is advisable. Effective and safe therapy of endometriosis with dydrogesterone can be recommended to the patient for a long time, more than 48 months, which allows to minimize the risk of recurrence of the disease.

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Авторлар туралы

Vitaly Bezhenar

Pavlov First Saint Petersburg State Medical University, Ministry of Health of Russia

Хат алмасуға жауапты Автор.
Email: bez-vitaly@yandex.ru
ORCID iD: 0000-0002-7807-4929

Dr. Med. Sci., Professor, Head of the Departments of Obstetrics, Gynecology and Neonatology/Reproductology, Head of the Clinic of Obstetrics and Gynecology; Main Supernumerary Specialist Obstetrician-Gynecologist of the Health Committee of St. Petersburg

Ресей, St. Petersburg

Natalya Kuzmina

Pavlov First Saint Petersburg State Medical University, Ministry of Health of Russia

Email: dok.kuzmina@gmail.com
ORCID iD: 0000-0002-8404-1859

PhD, Head of the Oncology Department No. 7, Teaching Assistant at the Department of Obstetrics, Gynecology and Neonatology

Ресей, St. Petersburg

Sviatoslav Kruglov

Pavlov First Saint Petersburg State Medical University, Ministry of Health of Russia

Email: skruglov89@mai.ru
ORCID iD: 0000-0001-7399-3398

PhD, Teaching Assistant at the Department of Obstetrics Gynecology and Reproductology

Ресей, St. Petersburg

Ana Gramatikova

Pavlov First Saint Petersburg State Medical University, Ministry of Health of Russia

Email: frau.gramatikova@yandex.ru
ORCID iD: 0000-0001-7463-1831

PhD student at the Department of Obstetrics, Gynecology and Reproductology

Ресей, St. Petersburg

Vera Izorkina

Pavlov First Saint Petersburg State Medical University, Ministry of Health of Russia

Email: izorkina.vera@yandex.ru
ORCID iD: 0000-0002-1316-5280

Teaching Аssistant at the Department of Obstetrics, Gynecology and Reproductology

Ресей, St. Petersburg

Irina Medvedeva

Pavlov First Saint Petersburg State Medical University, Ministry of Health of Russia

Email: iriska18.05@mail.ru
ORCID iD: 0000-0002-5625-7855

Obstetrician-Gynecologist at the Oncology Department No. 7

Ресей, St. Petersburg

Aleksandr Demidov

Pavlov First Saint Petersburg State Medical University, Ministry of Health of Russia

Email: alexander.demidov.1997@gmail.com
ORCID iD: 0009-0006-7618-7272

PhD student at Department the Obstetrics, Gynecology and Reproductology

Ресей, St. Petersburg

Daria Strukova

Pavlov First Saint Petersburg State Medical University, Ministry of Health of Russia

Email: dashastr97@inbox.ru
ORCID iD: 0009-0008-1597-0946

PhD student at the Department the Obstetrics, Gynecology and Reproductology

Ресей, St. Petersburg

Dariia Fedosova

Pavlov First Saint Petersburg State Medical University, Ministry of Health of Russia

Email: fedosova.dariya@yandex.ru
ORCID iD: 0000-0003-1030-6110

PhD student at the Department the Obstetrics, Gynecology and Reproductology

Ресей, St. Petersburg

Ilarion Barnash

Pavlov First Saint Petersburg State Medical University, Ministry of Health of Russia

Email: Barnash.LA@yandex.com
ORCID iD: 0009-0006-9177-7166

PhD student at the Department the Obstetrics, Gynecology and Reproductology

Ресей, St. Petersburg

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2. Fig. 1. Laparoscopic picture of bilateral endometrioid ovarian cysts in patient A.

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3. Fig. 2. MRI image of endometrioid ovarian cysts in patient K.

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