Surgical treatment of patients with endometriosis

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With the expansion of the Arsenal of the components of complex conservative therapy used to treat patients with endometriosis, decreased frequency of surgical interventions, and a number of patients are able to do sparing volume of operations based on the regression of endometriosis under the influence of fixing of treatment with hormonal drugs, immunomodulators and other components of complex therapy. However, surgical treatment is important in solving complex tasks of deliverance women from endometriosis and its consequences.
In relation to some patients, surgery is regarded as an important component of a comprehensive treatment, other (in our material about 20 % of all patients treated for endometriosis) - this method is the only and does not require further hormonal treatment. More often it is possible to cure the sick one by surgery, and to him we give preference endometriosis post-operative scars, navel and single bleeding foci of endometriosis on the cervix.
At all other locations endometriosis (uterus, ovaries, vagina, pozavcherashny, intestines, bladder, and so on), some patients may be limited to surgical treatment when endometriosis removed within unchanged tissues. The latter is set thorough revision (visually and by palpation) during the operation. The question about the destruction of endometriosis within unchanged tissues easier to solve when operations on the intestine, bladder and ureters. It is enough to establish that all of endometrial glandular and nodular cystic education and seals removed and the walls of the body outside of the wound does not contain seals, knots and visible changes. The validity of such a view is based on the fact that when resection of the modified part of intestine, bladder or ureter within unchanged tissues (about 100 operations) we have never observed a relapse in the surgical site. Much more complicated is the situation in endometriosis, uterus, vagina, ovaries, pozavchera endometriosis. Almost 35 % of patients with the specified localization come relapses of endometriosis, even if the excision within macroscopically and by palpation unchanged tissues.
Some foreign authors consider radical surgery only when she, in addition to the lesion excision of endometriosis, including hysterectomy, accompanied by the removal of the ovaries (surgical castration). We can hardly agree with this interpretation. The fact that the effects of endometriosis in the form of stenosis intestine, ureter, and other violations may continue to grow due to scarring of tissues and after removal of endometriosis and ovaries. In addition, some patients activity is not fully remote foci of endometriosis can be supported by the adrenal glands and estrogen dysfunction of the immune system and other pathogenic factors. Finally, surgical castration does not prevent risk of malignancy remaining foci of endometriosis and relapse. De la Pava announced the development of sarcoma of the left in the pelvic area foci of endometriosis. Previously, the patient had been produced removal of the uterus with appendages for benign endometriosis, uterus and ovaries.
The issue of indications for surgical treatment is usually straightforward and solved from the very beginning in favor of surgery in patients with endometriosis post-operative scars, navel and endometrioid of cystadenoma ovaries. To cure the patient with symptomatic endometriosis navel or postoperative scar, requires prolonged treatment (from 2-3 to 5 and more years), large doses of hormonal preparations and carrying out of courses of anti-relapse treatment in the future. Therefore, the postoperative scar excision or navel within unchanged tissues with the mandatory audit of the pelvis and abdomen for them to be more gentle method in comparison with long-term hormone treatment.
Upon hearing cystadenoma ovary and assumes endometrioid the origin of it, then taking into account cancer precautions shown surgery. This will allow you to specify the diagnosis, to establish the prevalence of endometriosis and to decide on further treatment and management of the patient.
Other indications for surgical treatment are in the process of dynamic observation of patients and conservative therapy.
The absence of the effect of conservative therapy continuously for 6 months, with an increase in the severity of the disease, should be considered an indication for surgical treatment. Earlier, before making a decision about the operation, we were conservative treatment for 6-12 months or more. Currently, when conservative treatment is more complex, with the use of hormonal drugs (but immunomodulators, UFO autologous blood, HBO and other factors), the absence of the effect of treatment within 3 months is an indication for specification of the diagnosis, the detection of opportunistic diseases, which do not allow to achieve the desired effect, cause pain and other violations. A number of patients already at this stage it is possible to put the question about the operation. If no improvement from a complex of conservative treatment for 5-6 months, tactics patient needs to be reconsidered. We cannot allow patients received hormonal therapy for years to 10 years or more, began to suffer from the therapy (disease treatment and the worsening of somatic pathology), and for the operation resorted to only after severe complications (intestinal obstruction, stricture formation of the ureter and development of hydro-pielonefrita, the gap endometrioid cystadenoma ovary and others), loss of ability to work and/or development of polyvalent Allergy. Thus, in treatment of patients it is necessary to consider the potential danger of endometriosis, cancer aspects and growing allergization of the organism.