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.
References
Boychuk, A. V., & Isniuk, N. O. (2017) Deiaki aspekty vplyvu dysfunktsii shchytopodibnoi zalozy na vynyknennia leiomiomy matky [Acts aspect vplyvu dysfunctions shchitopodibnoy zalozi vinikennya leiomyomi uteri]. Aktualni pytannia pediatrii, akusherstva ta hinekolohii, 2, 25–30. [in Ukrainian]. doi: 10.11603/24116-4944.2017.2.7793.
Gromova, A. M., Gromova, A. L., & Ketova, O. M. (2011) Rol ultrazvukovykh parametriv pry vybori reproduktyvno-plastychnykh operatsii pry leiomiomakh matky [The Role of Ultrasound Parameters in Choosing Reproductive and Plastic Surgery in Uterine Leiomyoma]. Visnyk problem biolohii i medytsyny, 3, 2(111), 260–262. [in Ukrainian].
Gromova, A. M., Gromova, A. L., Tarasenko, K. V., Martynenko, V. B., Nesterenko, L. A., & Lytvynenko, A. V. (2017) Osoblyvosti matkovo-yaechnykovoho krovotoku pry leiomiomi matky [Characteristics of uteroovarian blood flow in case of leiomyoma of uterus]. Zbirnyk naukovykh prats asotsiatsii akusheriv-hinekolohiv Ukrainy, 2(40), 101–104. [in Ukrainian].
Kosei, N. V. (2009) Leiomioma matky (klinika, patohenez, diahnostyka ta likuvannia) (Avtoref. dis… dokt. med. nauk) [Leiomyoma of the uterus (clinic, pathogenesis, diagnosis and treatment) Dr. med. sci. diss.]. Kyiv. [in Ukrainian].
Litvinenko, A. V., Gromova, A. M., Sakevich, R. P., & Fadda, B. (2013). Yakist zhyttia u zhinok z leiomiomoiu matky pislia embolizatsii matkovykh arterii [Quality of life in women with uterine leiomyoma after uterine artery embolization]. Svit medytsyny ta biolohii, 2(38), 136–139. [in Ukrainian].
Litvinenko, O. V. (2013). Vplyv topohrafichnykh osoblyvostei leiomiomy matky na efektyvnist embolizatsii matkovykh arterii [The influence of topographic features of uterine leiomyomas on the efficacy of uterine artery embolization]. Medychna nauka-2013 Proceedings of the All-Ukrainian Scientific and Practical Conference, (P. 52). Poltava. [in Ukrainian].
Lutsenko, N. & Oleynik, N. (2014). Negormonal'naya al'ternativa lecheniya lejomiomy matki [Non-hormonal alternative of treatment of the uterine leyomioma]. Reproduktivnoe zdorov'e. Vostochnaya Evropa, 6(36), 143–151. [in Russian].
Lutsenko, N. S., Oleynik, N. S., & Rudenko, D. Yu. (2015). Ultrazvukova otsinka vaskuliaryzatsiia leiomiomy matky [Ultrasonic assessment of vascularization of the leiomyoma of the uterus]. Aktualni pytannia pediatrii, akusherstva ta hinekolohii, 1(25), 152–154. [in Ukrainian]. doi: 10.11603/24116-4944.2015.1.4709}.
Medvediev, M. V. (2013). Leiomioma matky: novi pidkhody do zastosuvannia orhanozberihaiuchykh tekhnolohii v likuvanni (Avtoref. dis… dokt. med. nauk) [Uterine leiomyoma: new approaches to use of conservative treatment technologies. Dr. med. sci. diss.]. Kyiv. [in Ukrainian].
Radzinskij, V. E., Fatkullin, I. F., Bakanova, A. R., & Dobrecova, T. A. (2014). Mioma matki: ot dyskussij k innovaciyam. Prakticheskie rekomendacii [Uterine fibroids: from discussions to innovations. Practical recommendations]. Moscow. [in Russian].
Lutsenko, N. S., Oliinyk, N. S., Yevtiereva, І. O., & Shapoval, O. S. (2015). Patohenetychno obgruntovani pidkhody do likuvannia leiomiomy matky v zalezhnosti vid osoblyvostei anhioarkhitektoniky matky [Pathogenetically based approaches to treatment of uterine leiomyoma depending on characteristics of angioarchitectonics of uterus]. Zb. nauk. prats spivrobitnykiv NMAPO imeni P.L. Shupyka, 24(3), 403–408. [in Ukrainian].
Tatarchuk, T. F., Cossey, N. V., Tutchenko, T. N., & Dzhupin, V. A. (2014). Novaya e'ra v lecheii miomy matki u zhenshchin razlichnykh vozrastnykh grupp [New era in treatment of uterine fibroids in women of different age groups]. Reproduktivnaya e'ndokrinologiya, 6(20), 9–20. [in Russian].
Tatarchuk, T. F., & Kosej, N. V. (2015). Novoe v gormonal'noj regulyacii razvitiya miomy matki [New in hormonal regulation of uterine myoma development]. Zdorov'e Ukrainy, 7(93), 21–27. [in Russian].
Tikhomirov, A. L. (2013). Mioma. Patogeneticheskoe obosnovanie orhanosokhranyayushchego lecheniya [Myoma. Pathogenetic substantiation of organ-preserving treatment]. Moscow. [in Russian].320
Carbonell, J. L., Acosta, R., Pérez, Y., Garcés, R., Sánchez, C., & Tomasi, G. (2013) Treatment of uterine myoma with 2,5 or 5 mg mifepristone daily during 3 months with 9 months posttreatment follow up: randomized clinical trial. Obstetrics and Gynecology, 2013. http://dx.doi.org/10.1155/2013/649030.
Downloads
How to Cite
Issue
Section
License
Authors who publish with this journal agree to the following terms:- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access)
