Personalized approaches to the treatment of uterine leiomyoma
DOI:
https://doi.org/10.14739/2310-1210.2018.6.146696Keywords:
uterine neoplasms, leiomyoma, Doppler ultrasound, treatment, outcome assessmentAbstract
Aim. To study personalized approaches to the treatment of uterine fibroids taking into account type of the blood supply.
Materials and methods. 190 women with pathology of the uterus and endometrium were included in the main group. 34 practically healthy female volunteers were included in the control group. Treatment results of the patients with pathology from 2011 till 2015 years were analyzed. Ultrasound diagnostics was performed following methodic of the color Doppler imaging (CDI) with Voluson Е8 machine (UK) using vaginal transducer with the frequency of 7.5 MHz and convex abdominal transducer with the frequency of 3.5 MHz. Examination was performed in the follicular phase of the menstrual cycle. Uterine fibroids were measured using transabdominal transducer in the case of a large uterus.
Results. Features of the uterine fibroids blood supply, which influence the course of the disease, were identified. Classification of the uterine fibroids depending on the type of perfusion was presented. Personalized approach to the uterine leiomyoma treatment was proposed taking into account features of the individual blood circulation measured by Doppler imaging.
Conclusions. Type of the uterine fibroid blood perfusion influences the disease course. High IR (0.7 and higher) was identified in the case of avascular and peripheral types of the angioarchitecture, which indicates a low level of the blood supply and need in dynamic observation and antiproliferative drugs. Uterine artery embolization and operative treatment for uterine fibroid should be considered when IR is 0.69 and less in patients with central and mixed types of vascularisation. IR 0.45 and less is symptom of sarcoma and fibroid destruction. Such patients should be referred to an oncogynecologists consultation.
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