Značaj primene postoperativne hormonalne terapije u pojavi recidiva kod bolesnica operisanih od endometrioze jajnika

Abstract

Uvod:Endometrioza je jedno od čestih oboljenja u reproduktivnom dobu žene. Od nje boluje 5-10% celokupne ženske populacije.Tretman endometrioze može biti hiruški i medikamentozni. Poslednjih desetak godina u terapiji se upotrebljavaju analozi Gonadotropin rilizing hormona. Upotreba analoga GnRH značajno smanjuje simptome endometrioze . I pored velikog napredka u hiruškim tehnikama a i zbog same prirode oboljenja, endometrioza često recidivira. Ciljevi istraživanja:Utvrditi procenat pojave recidiva kod operisanih pacijentkinja zbog endometrioze jajnika u odnosu na stadijum bolesti i vrstu uradjene operacije, a koje su posle operacije primale supresivnu terapiju GnRH alaoga u odnosu na one koje posle operacije nisu primale supresivnu terapiju. Metode i materijal:Ispitivanje je predstavljalo prospektivnu studiju koja je izvedena na Ginekološko-akušerskoj klinici „Narodni Front“ u Beogradu, u dvogodišnjem periodu. Ispitivanjem je obuhvaćeno 200 pacijentkinja sa endometriomom jajnika a koje operisane laparoskopskim putem. Pacijentkinje su bile životne dobi od 20. – 45. godine.Operisane pacijentkinje su podeljene u dve grupe, ispitivanu i kontrolnu grupu. Ispitivanu grupu sačinjavaju 100 pacijentkinja operisanih laparoskopskim putem zbog endometriotičnih cista jajnika, a kod kojih je posle operacije primenjena supresivna terapija analozima GnRH. Od analoga GnRH primenjivan je Triptorelin u obliku acetata tj. Dipherelin 3,75 mg intra muskularno, jednom mesečno ili Goserelin u obliku acetata tj. Zoladex 3,6 mg subkutano u prednji trbušni zid, jednom mesečno. Analozi GnRH su davani u toku 4 do 6 meseci u zavisnosti od stepena težine endometrioze. U zavisnosti od vrste operativnog zahvata, sve pacijentkinje ispitivane grupe su podeljene u dve podgrupe. Prvu podgrupu sačinjavaju pacijentkinje kod kojih je urađena laparoskopska cistektomija, dok drugu podgrupu sačinjavaju pacijentkinje kod kojih je urađena laparoskopska cistotomija i koagulacija kapsule ciste. Odluku o tome koja je vrsta operacije urađena kod pacijentkinje donosio je operator u zavisnosti od operativnog nalaza.Stepen težine endometrioze je procenjen po klasifikaciji Američkog udruženja za fertilitet i sterilitet ( AFS klasifikacija)... Introduction:Endometriosis is one of the common diseases in the reproductive age of women. It affects 5-10% of the total female population.The treatment of endometriosis can be surgical and with medication. In the last ten years gonadotropin-releasing hormone analogues have been used in therapy .The use of GnRH analogues substantially reduces the symptoms of endometriosis. Despite great progress in surgical techniques and due to the nature of the disease, endometriosis often relapses. The research objective:Determine the percentage of occurrence of relapses in patients operated on for endometriosis of the ovary in relation to the stage of the disease and the type of performed operation, and which were receiving suppressive therapy with GnRH analogues after the surgery compared to those who were not receiving suppressive therapy after the operation. Methods and material:The testing represented a prospective study that was performed at the Gynaecology and Obstetrics Clinic "Narodni Front" in Belgrade during a two-year period.The study encompassed 200 female patients with ovarian endometrioma operated on with laparoscopic surgery. The patients were from 20-45 years of age.The operated patients were divided into two groups, the test and control groups. The test group consists of 100 patients operated on with laparoscopy due to endometrial cysts of ovary and in which suppressive therapy with GnRH analogues was applied after the surgery. Out of the GnRH analogues, Triptorelin was administered in the form of acetate, i.e. Dipherelin 3.75 mg intramuscularly once a month, or Goserelin in the form of acetate, i.e. Zoladex 3.6 mg subcutaneously into the anterior abdominal wall, once per month. GnRH analogues were administered over the course of 4 to 6 months depending on the severity of the endometriosis. Depending on the type of surgery, all tested patients were divided into two subgroups. The first subgroup consists of patients who had undergone laparoscopic cystectomy, while the other subgroup consists of patients who had undergone laparoscopic cystotomy and coagulation of the cyst capsule. The decision about which type of surgery was performed in patients was made by the operator depending on the operation report.The degree of severity of endometriosis was assessed according to the classification of the American Society for Fertility and Sterility (AFS classification).