编号 10 (2025)

Laparoscopic myomectomy is the main surgical option in the treatment of uterine fibroids and it currently has become the gold standard in the uterus-sparing approach. Despite its minimally invasive nature and proven clinical efficacy, postoperative pain remains a significant concern. According to published data, up to 80% of patients report moderate to severe pain during the first 24 hours after surgery. This can affect the early postoperative period, delay mobilization, prolong hospitalization, and increase the need for systemic analgesics, including opioids. Persistent pain may also reduce patient’s satisfaction with the treatment and limit the implementation of Enhanced Recovery After Surgery (ERAS) protocols aimed at improving perioperative outcomes.

This review provides a comprehensive analysis of the pathophysiological mechanisms underlying postoperative pain after laparoscopic myomectomy. It discusses the activation of somatic and visceral nociceptors, the development of peripheral and central sensitization, and the role of intracellular signaling and inflammatory mediators. Particular attention is given to the anatomical and physiological characteristics of uterine innervation, including the zones of overlapping somatic and visceral nociceptive input, and the superior hypogastric plexus in pain transmission. The characteristics of visceral pain, a challenging and less manageable aspect of postoperative pain, are discussed.

The analysis of published materials provides up-to-date information on modern approaches to pain management in patients after laparoscopic myomectomy. Special focus is placed on multimodal and preemptive analgesia techniques aimed at reducing both pain intensity and opioid consumption. Local interventions such as anterior abdominal wall infiltration and superior hypogastric plexus block are discussed as part of a pathophysiology-based approach to postoperative pain control. Data on the effect of pain severity on recovery parameters, patient satisfaction, and overall quality of medical care are presented.

Conclusion: The findings support the need for personalized analgesic strategies that account for neurophysiological pain mechanisms and surgical specifics. The use of pathogenetically-based and preemptive analgesic strategies can not only reduce the severity of pain, but can also improve the overall course of the postoperative period, increase patient compliance and the effectiveness of ERAS protocols.

Borderline ovarian tumors (BOT) are a unique type of epithelial neoplasms that mainly affect women of reproductive age. Due to their favorable course and high detection rate in the early stages, organ-preserving treatment is becoming a top priority, especially for patients planning a pregnancy.

Objective: To summarize and systematize current data on oncological safety, surgical approaches, reproductive outcomes, and the role of assisted reproductive technologies (ART) in patients with BOT who had a previous history of fertility-sparing treatment.

Materials and methods: The literature was searched using PubMed, Scopus, Web of Science, and CNKI databases. The review article included original studies with more than 20 patients. The studies provided the data on the types of surgery, disease recurrence and reproductive outcomes. The total sample included 4,586 patients.

Results: The lowest recurrence rate after fertility sparing surgery (FSS) was observed in ultrasound guided ovarian wedge resection (UGOWR) (0–3%); intermediate rate was observed in unilateral salpingo-oopherectomy (USO) (10–15%); maximum rate was noted in cystectomy (25–31%); micropapillary serous variant is associated with a recurrence risk of up to 45%. In the total sample of 4,586 patients, the pregnancy rate after FSS was 39–52%, the proportion of live births was up to 30%, miscarriages were ~11%, and premature births were 9%; ART was effective after thorough selection (8.6–20% recurrences, more often after cystectomy); full staging procedure reduces recurrence rate to 8–12% versus 30–40% without staging.

Conclusion: Organ-preserving interventions in BOT are oncologically justified if there is an individualized approach combined with complete surgical staging; UGOWR demonstrates the best profile of oncological safety and fertility preservation, and the use of ART is acceptable in specialized centers with controlled stimulation.

Premature ovarian failure (POF) affects approximately 3.5% of female population. This condition is associated with decreased ovarian reserve, infertility and systemic complications.

Objective: To analyze methods of early diagnosis, modern and promising strategies for the treatment of POF with a focus on restoring ovarian function and overcoming infertility.

Materials and methods: The analysis included systematic reviews, meta-analyses, and randomized controlled trials. A total of 62 studies were analyzed.

Results: FSH (less than 25 IU/ml), AMH, and antral follicle count are used for early diagnosis; however, their prognostic value remains controversial. Inhibin B, insulin-like factor 3 (INSL3), and chronic inflammation markers have been noted as predictors. No biomarkers for POF have been identified. Currently, there are no criteria available for predicting the development and timing of POF. Preventive measures and fertility support methods for women with risk factors for POF include lifestyle modifications (adequate physical activity, smoking cessation, sleep restoration, and a balanced diet), nutritional supplements, antioxidants, and mitochondrial function restoration agents (CoQ10, resveratrol, melatonin). Women at risk for POF, as well as those with the latent form of the disease, are recommended to have their reproductive potential assessed before the onset of the disease and to use ART to obtain and vitrify their own eggs/oocytes or ovarian tissue. Hormone replacement therapy for the prevention of complications and the use of ART to overcome infertility (donor oocytes) are of primary importance in the treatment of the clinical form of POF. Promising approaches to fertility restoration include in vitro follicle activation, the use of stem cells, exosomes, platelet-rich plasma, ovarian tissue transplantation, and bioengineered (artificial) ovaries (their study is currently in the experimental stage).

Conclusion: Prediction of the risk for ovarian function loss and early detection of POF make it possible to take measures for preserving or restoring fertility. Preventive interventions help preserve ovarian reserve and increase the likelihood of restoring ovulation. Fertility preservation is achieved by assisted reproduction (cryopreservation of the woman’s own eggs/oocytes or ovarian tissue), while donor oocytes are used in cases of complete POF. Future research should focus on a more in-depth understanding of the pathogenesis of POF, a clear definition of predictors and their significance, as well as the development of personalized methods for prevention and treatment.

Objective: To explore the morphological features and clinical manifestations of insufficient uterine scar after cesarean section.

Materials and methods: The study included 109 patients with uterine scar after cesarean section. They were divided into four groups depending on the clinical and morphological features of insufficient uterine scar: group I – “vascular”type (n=23), group II – “connective tissue” type (n=39); III – “inflammatory” type (n=27), and Group IV – the comparison group (n=20). Histological and histomorphological evaluation of excised scar tissue, clinical assessment of anamnestic indicators, and statistical data analysis were performed.

Results: Three main morphological variants of insufficient uterine scar were identified – "inflammatory," "vascular," and "connective tissue." The clinical and morphological parallels of insufficient uterine scar were assessed taking into account the histological variant. The patients with the "vascular" type of insufficient uterine scar had a history of irregular menstrual cycles (r=0.71; 95% CI 0.81;0.89 p<0.001). The main indication for delivery was the risk of uterine rupture along the scar (r=0.67; 95% CI 0.78;0.95 p<0.001). The patients with the "connective tissue" type of insufficient uterine scar underwent the first cesarean section due to abnormal labor (r=0.81; 95% CI 0.65;0.74 p<0.001). Uterine scar insufficiency – thinning of the uterine scar (< 2 mm) was detected by ultrasound. At the same time, the clinical picture showed no risk of uterine rupture along the scar (r=0.88; 95% CI 0.76;0.85 p<0.001). The "inflammatory type" of insufficient uterine scar correlated with recurrent miscarriage in history (r=0.65; 95% CI 0.58;0.83 p<0.001) and fetal distress in current pregnancy (r=0.63; 95% CI 0.61;0.81 p<0.001).

Conclusion: The obtained data indicate that there is a need for an in-depth study of the pathogenetic mechanisms of uterine scar formation and the development of a prediction model.

Objective: To describe a case series on the use of in vitro maturation (IVM) technology in patients with cancer.

Materials and methods: This study included 34 patients aged 23–43 years who presented to the IVF Department of the Medsi on Solyanka Clinical and Diagnostic Center for fertility preservation programs. Transvaginal puncture of the antral follicles was performed, followed by aspiration of the follicular fluid. The resulting oocyte-cumulus complexes (OCCs) were matured for 24–48 h in an embryology laboratory.

Results: IVM were performed in 34 patients. In one case, no oocytes were retrieved, and in five cases, mature oocytes were not obtained after the culture. A total of 185 OCCs were retrieved, averaging 5.4 OCCs per patient. Additionally, 95 mature oocytes at the MII stage were retrieved, averaging 2.9 per patient, resulting in an average maturation rate of 51.8%. Oocyte cryopreservation was conducted in 13 patients, resulting in a total of 47 oocytes, or an average of 3.6 oocytes per patient. Fertilization was performed using oocytes obtained after IVM in 15 patients. In 10 cases, embryos were not produced (due to lack of cleavage or embryos being unsuitable for transfer according to the PGT-A results). In five cases, embryos suitable for transfer to the uterine cavity were obtained (either euploid according to PGT-A or PGT-A was not performed). Embryo storage continued in two cases, while one patient discontinued embryo storage. Two thawed embryos were transferred: one into the patient's uterine cavity, which did not result in pregnancy, and the other into a surrogate mother's uterus, resulting in pregnancy and delivery.

Conclusion: IVM is a promising approach for fertility preservation in patients with cancer in whom ovarian stimulation is not feasible. The effectiveness of this technique is influenced by the patient's baseline parameters, primarily age and ovarian reserve. However, further research is required to standardize the approaches and enhance the efficacy of this technology.

Relevance: Lipidome profile of follicular fluid (FF) in patients with ovarian endometrioma (OMA) offers valuable information about oocyte competence, embryo viability, and IVF outcomes.

Objective: To create a model for predicting the probability of clinical pregnancy in patients with OMA undergoing IVF based on the lipidome profile of follicular fluid.

Materials and methods: Patients baseline characteristics were collected, lipidome profile of FF and IVF outcomes in patients with OMA were analyzed (n=41). The lipidome signature of follicular fluid was analyzed using high-performance liquid chromatography coupled with mass spectrometry (HPLC-MS). Orthogonal projections to latent structures discriminant analysis (OPLS-DA) were used to create a differential model.

Results: Comparative analysis of FF samples from women who achieved pregnancy versus those with negative result revealed differences in lipidome signature within each group that correlated with IVF outcomes. Based on these findings, a predictive OPLS model was developed. The model allows to differentiate pregnant and non-pregnant women based on the levels of lipids belonging to the following classes: cholesteryl esters, phosphatidylcholines, sphingomyelins and triglycerides.

Conclusion: Lipidome profiling of follicular fluid using HPLC-MS allows for fairly accurate differentiation between women who achieve pregnancy and those who do not. These results are consistent with international data and confirm the potential for using this method to predict IVF outcomes in patients with ovarian endometriomas.

Relevance: The course of malignant epithelial ovarian tumors is considered to be highly aggressive. Limitations of diagnostic methods are associated with the late detection of tumors at stages III–IV, which is the cause with high mortality.

Objective: To compare the effectiveness of machine learning (ML) methods for minimally invasive diagnosis of early-stage ovarian cancer (OC) using scalable, objective lipid biomarker profile data.

Materials and methods: A single-center observational retrospective cohort clinical study included 239 patients with early-stage high-grade ovarian cancer (HGOC, n=10); with other tumor/proliferative processes (n=203, of which: including 30 cystadenomas, 59 endometrioid cysts, 21 teratomas, 28 borderline tumors; 16 – low-grade ovarian cancer (LSOC), HGOC of III-IV stages and control group women (n=26). Lipid extraction, analysis by high-performance liquid chromatography coupled with electrospray ionization mass spectrometry, and data preprocessing were performed. The SHAP method was used to interpret the predictions generated by building complex models. For multi-class classification, 7 ML methods were tested, including Naive Bayes classification, PLS discriminant analysis, Random Forest, External Gradient Boosting classification, Multilayer Percepton, and Convolutional Network. For binary classification, the following were additionally tested: support vector machine and extreme gradient boosting (Xgboos) classifications.

Results: In Stages I–II HGOC, a decrease in PC O-18:1/18:0, PE P-18:0/18:2, LPC O-16:0, PC 18:0_18:2, OxTG 16:0_18:1_16:1(CHO), OxPC 18:2_16:1(COOH), OxPC 20:4_14:0(COOH) and an increase in PC 16:0_18:0, PC P-18:1/20:4, PC 18:1_18:2, PC 16:0_18:0, PC 18:2_18:2 (compared to the control group) occurred, as well as a decrease in Cer-NS d18:1/22:0, PC P-16:0/18:1, PC P-18:1/20:4, PC P-18:0/18:1, oxidized lipids, carboxy- and carbohydroxy-derivatized and an increase in PC P-18:0/18:2, PC P-20:0/20:4 (compared to patients with OC). The best differentiation ability between the control group and the OC group was demonstrated by OPLS models, as well as random forest, and support vector machine with a radial kernel (90%).

Conclusion: The use of advanced ML methods strengthens the diagnostic potential of omics data and can be applied in gynecological oncology.

Objective: To evaluate the combined approach in the treatment of patients with mild cervical intraepithelial neoplasia (CIN I) accompanied by concomitant papillomavirus infection and recurrent bacterial vaginosis (BV) during destructive treatment of cervical pathology.

Materials and methods: The study included 100 patients aged 22 to 45 years with CIN I combined with papillomavirus infection and recurrent BV. The patients of group I (n=50) were prescribed suppositories Superlymph 25 IU intravaginally as perioperative therapy, the patients of group II (n=50) were administered traditional antiviral therapy and vaginal suppositories with dexpanthenol and chlorhexidine. Visual assessment of the cervix, colposcopy, cytological examination, human papillomavirus (HPV) testing, biopsy and determination of cytokine concentration in cervical mucus by enzyme immunoassay were performed. The statistical analysis was conducted using Microsoft Excel and Statistica 7.0 software.

Results: The complete elimination of HPV was noted 3 months after treatment in group I and negative test was observed after 6 months in 96% of patients; this parameter exceeded the indicator of group II by 1.6 times (p<0.001). The risk of recurrence of BV symptoms in group I was reduced by 2-5 times in the period from 1 to 6 months (p<0.05). The levels of TNFa, IFN-γ, and IL-6 were significantly lower in group I than those in group II after 1 and 3 months (p<0.001). The complete healing of the damaged area of the cervix was more frequently observed in group I. After 10 days, it was seen 1.4 times more often (p=0.04) and after 15 days, it was 1.3 times more common (p=0.04).

Conclusion: The use of Superlymph as a perioperative therapy for patients with mild CIN can increase the effectiveness of destructive treatment methods. This is achieved by completely eliminating HPV after three months and maintaining a negative HPV test after six months in 96% of cases. Additionally, Superlymph helps reduce levels of local pro-inflammatory cytokines and decrease the risk of bacterial vaginosis recurrence that in turn improves cervical epithelialization processes after surgery.

The detection rate of human papillomavirus (HPV) in women with bacterial vaginosis (BV) is significantly higher than in the general population. The disease may be a trigger factor that increases the risk of HPV reactivation.

Objective: To evaluate the effectiveness of complex therapy with activated glycyrrhizic acid (Epigen Intim, 0.1% spray) in patients with BV associated with papillomavirus infection (PVI).

Materials and methods: The study included 60 patients with BV: group 1 (n=20) consisted of patients with latent/subclinical forms of PVI, group 2 (n=40) included women with anogenital warts. Microscopic, molecular biological, and cytological techniques were the research methods used in the study. The patients were treated with clindamycin and intravaginal spray Epigen Intim, the latter was prescribed during 180 days follow-up period if triggering factors were present.

Results: Two weeks after therapy, all patients showed a decrease in the detection rate of abnormal vaginal discharge (by 94.7% in group 1 and 94.9% in group 2), pH of vaginal discharge >4.5 and positive amino test (by 94.1% and 97.4%), the presence of the key cells (by 94.1% and 97.1%) (p<0.001). During the 6-month follow-up period, BV recurrence was noted in 1/20 (5.0%) patients of group 1 and 4/40 (10.0%) patients of group 2 (p<0.001); recurrence of anogenital warts was observed in 4/40 (10.0%) patients (p=0.002). HPV elimination after six months was detected in 16/20 (80.0%) patients of group 1 and 30/40 (75.0%) of group 2 (p<0.001). Normal cytological findings were revealed after six months in 19/20 (95%) (p=0.031) and 38/40 (95%) (p=0.029) patients, respectively.

Conclusion: Epigen Intim, 0.1% spray has demonstrated a high level of efficacy in the complex therapy of BV associated with genital PVI. It can be recommended as an additional component of treatment and for the prevention of disease recurrence in case of the presence of triggering factors.

Background: The embryonic development of the uterus and vagina has been studied through a systematic review of scientific literature, from the earliest published papers to the most recent studies. According to the theory proposed by Muller in 1830, the fallopian tubes, uterus, and vagina develop from fused paramesonephric ducts, while the mesonephric ducts are reduced in the female fetus.

Results: A comparative analysis of clinical variations of uterine abnormalities was conducted based on the results of the observations between 1996 and 2025. Some complex issues have been identified, namely, how to draw a distinction line between the uterus, which has a thick layer of myometrium and endometrial cavity, and the fallopian tubes and vagina during the fusion of symmetrical genital ducts. The origin of the normal endometrium is still unknown. The results of the review demonstrated the chronological stages of embryonic morphogenesis; relevant references to primary sources were provided.

Conclusion: A new theory of uterine embryogenesis has been formulated: the fallopian tubes and vagina develop from the mesonephric ducts, and the uterus is formed by the fusion of the mesonephric ducts with the gonadal ridges. The proposed new theory may be the key to understanding abnormalities in the development of the uterus, as well as major gynecological diseases such as myoma and endometriosis from embryonic polypotent cells.