Utero-ovarian hemodynamics after laparoscopic treatment of infertility caused by moderate to severe endometriosis

[R. Aničić]

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Medicina / Medicine

Uterusno-ovarijalni hemodinamski parametari, predstavljeni kroz indekse otpora i pulsatilnosti kod pacijentkinja koje imaju endometriozu umerenog i teškog stepena, odstupaju od normalnih (fizioloških) vrednosti. Osnovni cilj istraţivanja bio je da se ispita adekvatnost i efikasnost primene odreĎenog laparoskopskog postupka u lečenju endometrioze. Posebno su uzimani u obzir lokalizacija i stepen oboljenja. Poboljšanje uterusno-ovarijalne hemodinamike praćeno je kroz povećanje prokrvljenosti uterusa, folikularne aktivnosti ovarijuma i mogućnosti spontanih trudnoća. Ispitivani su hemodinamski uslovi koji bi, odgovarajućom terapijom, mogli da pruţe adekvatne uslove za ostvarenje implantacije, odnosno lečenje infertiliteta, kao krajnji cilj. Prospektivnom studijom u periodu od jula 2010. do januara 2011. godine obuhvaćeno je 60 infertilnih ţena sa konačnom dijagnozom endometrioze umerenog (35 slučajeva) ili teškog oblika (25 slučajeva) i 45 ţena bez endometrioze (bez ikakvog oboljenja koje uzrokuje infertilitet). U dijagnostičkom postupku, osim ultrasonografskog, laparoskopskog nalaza, kao dopunska metoda korišćen je nalaz serumske koncentracije biohemijskog markera CA-125. Svih 60 pacijentkinja bile su podvrgnute nekom vidu laparoskopskog operativnog zahvata u cilju lečenja infertiliteta. Primena ultrasonografskog color Doppler-a doprinela je u dijagnostičkom postupku ali je prvenstvena namena bila u terminima merenja krvnih protoka. Vizuelizacijom karakteristika cirkulacije na nivou arterija uterine i arterije ovarica utvrĎivana je hemodinamika kao indikator efekta terapije u lečenju endometrioze. Statistički metod obrade istraţivanih podataka obuhvatio je primenu deskriptivne statistike, analizu signifikantnosti razlika parametarskih i neparametarskih obeleţja izmeĎu istraţivanih grupa, testiranje značajnosti postavljenih hipoteza, testiranje varijanse, korelacionu, regresionu i ROC analizu. Rezultati su smatrani signifikantnima ukoliko je p-vrednost bila manja od 0.05. Koncentracije Ca125 veće od 60 U/ml, sa signifikantnom verovatnoćom su zastupljene pri umerenom ili teškom stepenu endometrioze. Najveća učestalost lokalizacije endometrioze bila je na jajnicima, peritoneumu, sakrouterinoj ligamenti a kod teškog stepena endometrioze bio je signifikantan broj rektovaginalnih lokalizacija...

Utero-ovarian hemodynamic parameters, presented by resistance and pulsatility indexes in patients with moderate to severe endometriosis, deviate from normal (physiological) values. Primary objective of the research was to examine adequacy and efficacy of administering certain laparoscopic procedure in endometriosis treatment. Localisation and disease severity were especially taken into consideration. Improvement of utero-ovarian hemodynamics was monitored through the increase in uteral blood supply, folicular activity of ovaries and the capability for spontaneous pregnancies. Hemodynamic conditions that could, with appropriate treatment, provide adequate conditions for achieving implantation and treating infertility were examined as an ultimate goal. Prospective trial from July 2010 to 2011 included 60 infertile women with final diagnosis of moderate (35 cases) or severe (25 cases) endometriosis and 45 women free from endometriosis (free from any disease that causes infertility). In the diagnostic procedure, besides ultrasonographic and laparoscopic finding, the finding of serum concentration of biochemical marker CA-125 was used as an additional method. All 60 patients were subjected to some form of laparoscopic surgery for the purpose of treating infertility. Use of ultrasonographic color Doppler contributed in the diagnostic procedure, but it was primarily used in order to measure blood flow. Hemodynamics as an indicator of effect of therapy in treating endometriosis was assessed through visualization of circulation at the level of uterine artery and ovarian artery. Statistical method for processing research data included the use of descriptive statistics, analysis of significance of differences in parametric and non-parametric attributes between research groups, testing the significance of hypotheses, testing variance, correlation, regression and ROC analysis. Results were considered to be significant if the p-value was below 0.05. Ca125 concentrations over 60 U/mL, with significant probability were present in moderate or severe endometriosis. Highest frequency of endometriosis localization was on ovaries, peritoneum, sacrouterine ligament, and in severe endometriosis there was a significant number of rectovaginal localizations...

618.1-02.1(043.3)

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