The experience of combined treatment of uterine submucous myoma

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Introductions. With the advent of new technologies in medicine, with ultrasound procedures being widely spread and available to every woman the diagnosed cases of uterine pathology today are about 40%. Submucous uterine myoma is diagnosed in every 3d-4th cases of diagnosed uterine myoma. Submucous nodes are accompanied with profuse irregular menstrual bleeding, sterility, pain syndrome but can be asymptomatic as well. With no regard to presence or absence of clinical signs nowadays such patients are actively treated.

Material and methods. For the period from 2001 to 2004 we have performed 848 hysteroscopic operations, with 212 operations for submucous myoms of different types.

Results. We consider it justified to carry out drug preparation before hysteroresectoscopic operations if there is submucous myoma of lst-2nd type. If there were nodes of О-type, hormonal preparation of endometrium was not carried out. Hysteroresectoscopy makes it possible to remove О-type nodes of any size. In our case the largest removed node was of the size of 10 cm. With the diagnosed 1 st-type myoma - 27%, 2nd-type myoma - 32% hormonal therapy makes it possible to shorten the time of operation, complications after the operation and with the adequate preparation of the endometrium and reaction of the tissue of myomatous node - to avoid repeated operation. Resectoscopic operations were carried out in case of myomatous nodes of up to 5-6 cm, with the presence of 2 interstitial-submucous nodes. As pre-operative preparation we used aGnRH in the 1st group (37 patients - 17,5%), gestrinon in the 2nd group (21 patients 10%), combined oral contraceptives (COC) in the 3d group (101 patients - 47,6%), no pre-operative drug therapy was carried in the 4th group (53 patients - 25%). The best result was achieved in case of aGnRH therapy in patients with 1 -2 type submucous myoms. Agonists of GnRH were injected on the 1st day of menstrual cycle, ultrasound evaluation was performed in 27-28 days, practically in all cases we found out the decrease of the myomatous node size by 20-30% during the 1st month, then the 2nd injection was performed and the operation was carried out in 2-3 weeks after the 2nd injection. The peculiarities of the operations preceded with aGnRG therapy were minimal bleeding, short operation time, absence of complications in post-operative period, performing of the operation in only stage without repeated resectoscopy, restoration of menstrual cycle within 1-2 months after the cancellation of therapy. In case of gestrinon used as pre-operative preparation there was worse individual tolerance of the drug, less involution of node tissue during pre-operative period. COC used as pre-operative preparation had no marked positive signs as compared with the absence of any pre-operative hormonal preparation. During post-operative period in case of resection of myoms of over 3 cm, especially in case of resection of more than 1 node, aGnRH was administered - 1-2 injections with the interval of 28 days, or COC during 5-6 months.

Conclusions. In the 1st group with aGnRH preparation within the 1st year of post-operative follow-up 3 cases of pregnancy were registered in patients of reproductive age. In the 2nd group no cases of pregnancy were registered. In the 3d group of patients with sterility there were 7 cases of pregnancy, in the 4th group - 2 cases. The obtained data received during 4 years of follow-up of such patients give us the reason to consider combined method of treatment of submucous uterine myoma of lst-2nd type appropriate and expedient.

About the authors

Е. G. Zaitseva

Kirov Regional Clinic, the Centre of minor -invasive surgery of Kirov Clinic № 6 “Lepse”

Author for correspondence.
Email: info@eco-vector.com
Russian Federation, Kirov; Kirov

А. G. Marenin

Kirov Regional Clinic, the Centre of minor -invasive surgery of Kirov Clinic № 6 “Lepse”

Email: info@eco-vector.com
Russian Federation, Kirov; Kirov

V. К. Biteev

Kirov Regional Clinic, the Centre of minor -invasive surgery of Kirov Clinic № 6 “Lepse”

Email: info@eco-vector.com
Russian Federation, Kirov; Kirov

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