Ультрасонографічні особливості репродуктивних органів у жінок з рецидивом ектопії шийки матки
Ескіз недоступний
Дата
2018
Автори
Назва журналу
Номер ISSN
Назва тому
Видавець
Полтавський державний медичний університет
Анотація
У статті висвітлено особливості будови репродуктивних органів, структуру гінекологічної пато-
логії, що були виявлені під час ультразвукового обстеження, виокремлено та проаналізовано відмінності у
здорових жінок, за наявності ускладненої вперше діагностованої та рецидивуючої ектопії шийки матки. У пацієнток з рецидивуючою ускладненою ектопією шийки матки було виявлено значну частоту дисгормональної
патології: структурних змін ендометрію, нетипових для даної фази циклу (ущільнене, гіперехогенне, неоднорідне М-ехо, наявність рідинних включень) – у 22,47±4,42% випадків, міоми матки (з більшим середнім розміром міоматозних вузлів) – у 30,34±4,84% випадків, аденоміозу (24,72±4,57%) та кист яйників (17,98±4,07%)
у порівнянні із пацієнтками з вперше діагностованою ектопією шийки матки.
В статье освещены особенности строения репродуктивных органов, структура гинекологической патологии, которые были обнаружены во время ультразвукового обследования, выделены и проанализированы различия у здоровых женщин, при наличии осложненной впервые диагностированной и рецидивирующей эктопии шейки матки. У пациенток с рецидивирующей осложненной эктопией шейки матки было обнаружено значительную частоту дисгормональной патологии: структурных изменений эндометрия, нетипичных для данной фазы цикла (уплотненное, гиперэхогенное, неоднородное М-эхо, наличие жидкостных включений) – в 22,47±4,42% случаев, миомы матки (с большим средним размером миоматозных узлов) – в 30,34±4,84% случаев, аденомиоза (24,72±4,57%) и кист яичников (17,98±4,07%) по сравнению с пациентками с впервые диагностированной эктопией шейки матки.
Physiological cervical ectopy (CE) does not require treatment and is subject to dynamic observation, whereas the complicated (pathological) CE, in particular in conditions of vaginal microbiota disturbances, colpitis and/or vaginitis and human papillomavirus infection (HPV), requires intervention, especially taking into account the significant rate of relapse, which has no tendency to decrease and reaches 40%. Reproductive organs ultrasonography (USG), in particular using transvaginal sensor, is an affordable, highly informative, widely used diagnostic method in gynecological practice allowing comprehensive assessment of the reproductive organs state in this patients contingent. The aim of research is to study the USG features of reproductive organs in women with recurrent complicated CE. Object and methods. In the observational cross-sectional retrospective study using the continuous sampling method were included 180 case reports of women, who underwent inpatient treatment of gynecological pathology in Lviv Municipal Clinical First Aid Hospital in 2006-2017 with performed transabdominal or transvaginal pelvic organs USG. It was determined and studied: position, form, structure, size of the uterus, structure of myometrium and endometrium, size and structure of the ovaries and cervix. Subsequently, three groups were formed: control group (n=95) – healthy women who applied for a regular prophylactic examination, aged 18 to 46 years (average age – 24.70±0.69 years); group 1 (n=91) – women with firstly diagnosed CE, aged 18 to 39 years (average age 25.19±0.61 years); group 2 (n=89) – women with recurrent CE, aged 25 to 51 years (average age – 32.32±1.01 years). Differences in mean values were considered significant with a probability level of at least 95% (p<0.05). Research results and discussion. In about 90% of women of all studied groups the uterus was in the anteflexio/- versio position. The pear-shaped form of the uterus was found in 94.74±2.29% of women in the control group, significantly (p=0,006) less frequently in patients with the firstly diagnosed CE and only in 66.29±5.01% of patients in group 2 (p=0,000003, compared to the control group). In patients with a firstly diagnosed and recurrent CE, all three dimensions of the uterus exceeded those in control group women, but significant (p<0.05) differences were noted only among women who had at least one childbirth (per vias naturalis or via Caesarean section) in anamnesis. Endometrial changes that were untypical for the cycle phase (compacted, hyperhogenous, non-uniform M-echo, presence of liquid inclusions) were found in 4.21±2.06% of women in the control group, 4 times more often (p=0,002) detected in patients of group 1 (in 18.68±4.09% of cases) and accordingly 5 times more often (p=0,0004) – in patients with recurrent CE (22.47±4.42%). Asymmetry of the uterine walls was detected in only 1.05±1.05% of women in the control group, while significantly (p=0,01) more often – in patients of group 1 (in 10.99±3.28% of cases) and more than 20 times more frequently (p=0,00002) in patients with recurrent CE (22.47±4.42%) compared to the control group. A similar tendency was observed in the study of structural features of myometrium – its heterogeneity the presence of pathological inclusions was found in 4.21±2.06% of women in the control group, significantly (p=0,02) more often in patients with the first detected (18.68±4.09%) and recurrent CE (p=0,0004), where the rate reached 22.47±4.42%. The presence of uterine fibroids was only detected in 1.05±1.05% of women in the control group, significantly (p=0,0002) more frequent in patients of group 1 (17.58±3.99%) and in more than one third of patients with recurrent CE (30.34±4.84%), this indicator in group 2 was significantly higher than in the control group (p=0,0000002) and in group 1 (p=0,047). In patients of group 2, the average size of uterine fibroids (40.81±2.98 mm) was almost twice as high (p=0,00004) as in patients with the firstly diagnosed CE (25.34±1.77 mm). Sonographic signs of adenomyosis were found in 12.09±3.42% of patients in group 1, twice as often (p=0,03) – in group 2 patients (24.72±4.57%). In patients with recurrent CE the presence of ovarian cysts was more often noted (p=0,04) – in 17.98±4.07% of cases (in patients in group 1 – 7.69±2.79%). Conclusion 1. According to USG data, patients with recurrent complicated CE have a significant proportion of morphofunctional changes in reproductive organs, namely: changes in the structure of the endometrium, uterine fibroids (with a higher average size), adenomyosis and ovarial cysts compared to the patients with the firstly diagnosed CE. 2. Taking into account the revealed changes, patients with recurrent complicated CE are recommended to carry out USG of reproductive organs in dynamics: before and after appropriate comprehensive treatment.
В статье освещены особенности строения репродуктивных органов, структура гинекологической патологии, которые были обнаружены во время ультразвукового обследования, выделены и проанализированы различия у здоровых женщин, при наличии осложненной впервые диагностированной и рецидивирующей эктопии шейки матки. У пациенток с рецидивирующей осложненной эктопией шейки матки было обнаружено значительную частоту дисгормональной патологии: структурных изменений эндометрия, нетипичных для данной фазы цикла (уплотненное, гиперэхогенное, неоднородное М-эхо, наличие жидкостных включений) – в 22,47±4,42% случаев, миомы матки (с большим средним размером миоматозных узлов) – в 30,34±4,84% случаев, аденомиоза (24,72±4,57%) и кист яичников (17,98±4,07%) по сравнению с пациентками с впервые диагностированной эктопией шейки матки.
Physiological cervical ectopy (CE) does not require treatment and is subject to dynamic observation, whereas the complicated (pathological) CE, in particular in conditions of vaginal microbiota disturbances, colpitis and/or vaginitis and human papillomavirus infection (HPV), requires intervention, especially taking into account the significant rate of relapse, which has no tendency to decrease and reaches 40%. Reproductive organs ultrasonography (USG), in particular using transvaginal sensor, is an affordable, highly informative, widely used diagnostic method in gynecological practice allowing comprehensive assessment of the reproductive organs state in this patients contingent. The aim of research is to study the USG features of reproductive organs in women with recurrent complicated CE. Object and methods. In the observational cross-sectional retrospective study using the continuous sampling method were included 180 case reports of women, who underwent inpatient treatment of gynecological pathology in Lviv Municipal Clinical First Aid Hospital in 2006-2017 with performed transabdominal or transvaginal pelvic organs USG. It was determined and studied: position, form, structure, size of the uterus, structure of myometrium and endometrium, size and structure of the ovaries and cervix. Subsequently, three groups were formed: control group (n=95) – healthy women who applied for a regular prophylactic examination, aged 18 to 46 years (average age – 24.70±0.69 years); group 1 (n=91) – women with firstly diagnosed CE, aged 18 to 39 years (average age 25.19±0.61 years); group 2 (n=89) – women with recurrent CE, aged 25 to 51 years (average age – 32.32±1.01 years). Differences in mean values were considered significant with a probability level of at least 95% (p<0.05). Research results and discussion. In about 90% of women of all studied groups the uterus was in the anteflexio/- versio position. The pear-shaped form of the uterus was found in 94.74±2.29% of women in the control group, significantly (p=0,006) less frequently in patients with the firstly diagnosed CE and only in 66.29±5.01% of patients in group 2 (p=0,000003, compared to the control group). In patients with a firstly diagnosed and recurrent CE, all three dimensions of the uterus exceeded those in control group women, but significant (p<0.05) differences were noted only among women who had at least one childbirth (per vias naturalis or via Caesarean section) in anamnesis. Endometrial changes that were untypical for the cycle phase (compacted, hyperhogenous, non-uniform M-echo, presence of liquid inclusions) were found in 4.21±2.06% of women in the control group, 4 times more often (p=0,002) detected in patients of group 1 (in 18.68±4.09% of cases) and accordingly 5 times more often (p=0,0004) – in patients with recurrent CE (22.47±4.42%). Asymmetry of the uterine walls was detected in only 1.05±1.05% of women in the control group, while significantly (p=0,01) more often – in patients of group 1 (in 10.99±3.28% of cases) and more than 20 times more frequently (p=0,00002) in patients with recurrent CE (22.47±4.42%) compared to the control group. A similar tendency was observed in the study of structural features of myometrium – its heterogeneity the presence of pathological inclusions was found in 4.21±2.06% of women in the control group, significantly (p=0,02) more often in patients with the first detected (18.68±4.09%) and recurrent CE (p=0,0004), where the rate reached 22.47±4.42%. The presence of uterine fibroids was only detected in 1.05±1.05% of women in the control group, significantly (p=0,0002) more frequent in patients of group 1 (17.58±3.99%) and in more than one third of patients with recurrent CE (30.34±4.84%), this indicator in group 2 was significantly higher than in the control group (p=0,0000002) and in group 1 (p=0,047). In patients of group 2, the average size of uterine fibroids (40.81±2.98 mm) was almost twice as high (p=0,00004) as in patients with the firstly diagnosed CE (25.34±1.77 mm). Sonographic signs of adenomyosis were found in 12.09±3.42% of patients in group 1, twice as often (p=0,03) – in group 2 patients (24.72±4.57%). In patients with recurrent CE the presence of ovarian cysts was more often noted (p=0,04) – in 17.98±4.07% of cases (in patients in group 1 – 7.69±2.79%). Conclusion 1. According to USG data, patients with recurrent complicated CE have a significant proportion of morphofunctional changes in reproductive organs, namely: changes in the structure of the endometrium, uterine fibroids (with a higher average size), adenomyosis and ovarial cysts compared to the patients with the firstly diagnosed CE. 2. Taking into account the revealed changes, patients with recurrent complicated CE are recommended to carry out USG of reproductive organs in dynamics: before and after appropriate comprehensive treatment.
Опис
Ключові слова
ультразвукова діагностика, репродуктивні органи, рецидивуюча ектопія шийки матки, ультразвуковая диагностика, репродуктивные органы, рецидивирующая эктопия шейки матки, ultrasound diagnosis, reproductive organs, recurrent ectopic cervix
Бібліографічний опис
Мазур Ю. Ю. Ультрасонографічні особливості репродуктивних органів у жінок з рецидивом ектопії шийки матки / Ю. Ю. Мазур // Вісник проблем біології і медицини. – 2018. – Вип. 2 (144). – С. 184–188.