Saving surgery for endometriosis

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It is known that the result of surgical treatment of endometriosis depends on radical surgery. However, the expansion of operations decreases the chances of preserving the specific features of the female body. The marked position is the cause of the postponement of the operation, which leads to the progression of the disease, particularly in young patients, involvement in the process of adjacent organs, the emergence of neurological disorders, and when the decision about the surgery, it is often the volume is such that we can talk only about the deliverance of women suffering from painful and restoration of health. Time for the production of organ-retaining operations is lost.
Taking into account these peculiarities we have developed methods savings operations at various locations genital and extra genital endometriosis.
Indications for such operations are:
1. Congenital forms of endometriosis in women, the young and the young age (endometriosis, ovarian, plus the horns of the uterus, rear side of the isthmus of the uterus, pozavcherashny endometriosis).
2. Endometriosis in women of reproductive age, which is the cause of infertility. This includes patients whose pain is missing or disappeared after conservative therapy and leading manifestations of the disease are still infertility or habitual miscarriage because of endometriosis (often POSADSKOGO or ovaries).
3. The desire to preserve the menstrual function, when the possibility of procreation is already lost.
The presence of extra genital endometriosis (defeat of the intestine, ureter, and bladder), as evidenced by our experience, not a contraindication for savings transactions.
Patient F., 30 years old, was admitted to the hospital 02.11.81, about severe genital and extra genital endometriosis. Monthly 12 years, in 3-4 days after 28 days, painful. Pregnancies was not. Since 1974, received treatment for allegedly inflammation of the uterus. In 1979 he moved a tonsillectomy and chrevosechenie with the removal fibromatous node resection of the uterus and cystic changed part of the right ovary.
In the result of the profound examination in the clinic was diagnosed with adenomyosis cancer, cystic form of endometriosis of the left ovary, pozavcherashny endometriosis proliferation in the pararectal cellular and paravaginal fiber, and the front wall of the rectum without germination in its clearance; cicatricial stricture formation and deformation of the lower section of the left ureter, endometriosis rectosigmoid Department of the colon with severe stenosis it in four places; primary infertility; patency of the fallopian tubes saved.
Taking into account the young age of the patient and great desire to have a child decided to carry out the operation in the savings volume.
During the operation 20.11.81, the presumptive diagnosis is fully confirmed. There were three focus of endometriosis in the bladder, multiple foci on the back of the TIR wide uterine ligaments (more left). Left hematocolpos with foci of endometriosis in the pipe.
The volume of operations: chrevosechenie, resection of cystic modified portion of the left ovary, removing gematogenka. The selection of the scars of the lower section of the left ureter with the elimination of its deformation and stenosis. Excision of endometriosis of the bladder and back sheets wide uterine ligaments. If this were allocated from cicatrices the lower part of the right ureter and right the uterus. Excision POSADSKOGO endometriosis together with the pararectal cellular and paravaginal sklerozirovanie fiber, in which were found the foci of endometriosis (removed the block tissue 6X6X5 cm). Resection recto-sigmoid Department of the colon (length resected of the plot is about 25 cm) with formation of the anastomosis end to end.
In the postoperative period patient was actively conducted. Got out of bed the next morning, after 12 hours from the moment of completion of the operation, washed and later independently went to the toilet, accompanied by a nurse ICU. The patient was a blanket massage, adequate parenteral nutrition (2500 kJ/day) using solutions of glucose with insulin, complexes of amino acids (Albazin, aminosol, gepstein, moriamin and others with addition of solutions of albumin and protein, fat emulsions (intralipid and lipofundin), sorbitol, exasoft, algerine and vitamins. Maintained WWTP and water and electrolyte balance.
Histologically diagnosed with endometriosis all these localizations confirmed.
The patient was discharged from the clinic on the 29 th day after operation under the supervision of experts of the place of residence. For 9 months was spent fixing hormone therapy (biscarini and oksiprogesterona kapronat) and resolving therapy. Menstrual function is normalized, the pain stopped. Later came the pregnancy. 08.06.83, the pregnancy 36-37 weeks alone gave birth in the pelvic presentation boy and girl are weighing 2550, the loss of Blood in childbirth - 200 ml Duration birth to 4 h 20 min Postpartum period was uneventful.
Postpartum 7 years. The mother is healthy. Children develop normally.
This observation is of interest in various aspects:
1. The possibility of operation in the savings volume with extensive genital and extra genital endometriosis.
2. Despite the significant volume of operations, managed to preserve the specific features of a female organism, which resulted in a pregnancy with twins and spontaneous delivery with a favorable outcome.
3. Confirmed established position on the rapid spread of endometriosis in the younger patients.
Later in young patients spending savings transactions with the defeat of endometriosis retroperitoneal Department of the rectum and the stenosis last, we have repetirovali the affected part of the colon with overlay compression anastomosis.