Ключевые слова: симультанная лапароскопия; безгазовая лапароскопия; лапаролифтингДля корреспонденции: Колодий Валентин Валентинович, кандидат медицинских наук, доцент кафедры хирургии № 2, Одесский националь-ный медицинский университет, Валиховский переулок, 2, г. Одесса, 65082, Украина;

No abstract

Запорожченко М. Б. доктор медичних наук, професор кафедри акушерства та гінекології Одеський національний медичний університет Парубіна Д. Ю. кандидат медичних наук, кафедра акушерства та гінекології Одеський національний медичний університет Сидоренко А. В. асистент кафедри акушерства та гінекології Одеський національний медичний університет Булгар А. В. лікар акушер-гінеколог КНП «Міська клінічна лікарня № 11» Одеської міської ради м. Одеса, Україна

Endometriosis and leiomyoma commonly co-exist inside one uterus. Specialized surgical centers report detection frequency of comorbid endometriosis during surgery or laparoscopy that varies from 20 to 87% in patients with symptomatic fibroids.In authors practice the histological study of surgery samples from patients diagnosed with symptomatic fibroids (113 hysterectomies) revealed concomitant endometriosis in 26.5% cases.Clinical and morphological analysis showed that in patients with multiply fibroids, large volumes or submucous myomas comorbid adenomyosis doesn’t interfere significantly with the clinic course. But in cases of small-size solitary intramural or subserosis fibroids the clinic of symptomatic myomas is determined by the comorbid adenomyosis of diffuse-nodular or diffuse-lesion forms and 2–3 stages.Thus, endometriosis associated with leiomyomas causes more severe course of comorbidity. Patients with symptomatic fibroids are exposed to higher risk of endometriosis development, which must be kept in mind when planning the surgery treatment. Authors propose to enhance laparoscopic myomectomy with target revision of pelvis to reveal possible endometriosis, because laparoscopy provides the best opportunity to visualization of endometriosis lesions.The choice of pharmacotherapy of concomitant uterine pathology is limited. Gonadotropin-releasing hormone agonists is the only currently available group of drugs that labeled both for the treatment of endometriosis and fibroids. Selective progesterone-receptor modulator ulipristal acetate due to its unique antiproliferative and selective proapoptotic effect on the leiomyomas cellular component is very promising in the uterine-sparing therapy of myomas. In addition, it has pharmacodynamic effects on the endometrium, including antiproliferative effects that may contribute to the treatment of endometriosis. Clinical trial of ulipristal on this indication is ongoing (NCT02213081). For the present, in the absence of approved algorithms for the treatment of co-morbid pathology, the individual approach with combining preparations of different classes is relevant.

The state of the microbial ecology of genital organs in women of reproductive age deserves special attention of the doctor-clinician. Infections of the genital tract are recognized as one of the triggers of uterine myoma. Leiomyoma of the uterus can arise as a result of lesions of the myometrium by inflammatory processes. The goal is to examine the tissues of distant leiomyomatous nodules for the presence of an associated microbial flora in women of reproductive age who suffer from asymptomatic and symptomatic clinical course of the uterine leiomyoma. The presence of infectious flora in the vaginal contents and cervical channel of 216 women of reproductive age, patients with uterine leiomyoma, and in 30 distant leiomyomatous nodules of the uterus was investigated. In the vaginal content of Virus herpes simplex was 30.6% in the IIA group and 32.4% in the group IIB, Cytomegalovirus, respectively — in 27.8% and 28.7%. The result to Chlamidia trachomatis was positive in 25.0% of women in the IIA group and 26.9% — in group IIB, Mycoplasma hominis — in 12.96% and 15.7%, Ureaplasma urealyticum — in 4.6% and 8.3 %, Virus papilloma hominis oncogenic type — in 3,7% and 5,6%. The dominant infections of the cervical canal of women of reproductive age, patients with uterine leiomyoma, were Virus herpes simplex in the IIA group — 34.3% and in group IIB — 38.0%, Chlamidia trachomatis — 32.4% and 37.0%, Cytomegalovirus — 33.3% and 32,4%, Mycoplasma hominis — 13.9% and 17.6%, Ureaplasma urealyticum — 6.5% and 10.2%, Virus papilloma hominis — 3.7% and 6.5% respectively. In the tissues of the leiomyomatous nodules, Mycoplasma hominis DNA was detected in 43.3%, Chlamidia trachomatis — in 40.0%, Ureaplasma urealyticum — in 36.7%, Cytomegalovirus and Mycoplasma hominis by 30.0%, Virus papilloma homynis — in 23.3%, Candida albicans — in 6.7% of cases of observations. Titres Enterococcus fec., St. epidermidis in the tissues of the leiomyomatous nodules were 108 CFU/ml. These pathogens in vaginal content were sown in titres 1010 and 105 CFU/ml, respectively. The viral flora in the tissues of the leiomyomatous nodules was determined 1.8 times more often, and the amount of CFU / ml was 1.7 times greater than in the vaginal contents. Streptococcus B, D, Staphylococcus aureus, Bacteroides sp., Mycoplasma hominis, Ureaplasma urealyticum, Chlamydia trachomatis in the tissues of the leiomyomatous nodules were determined on average with a frequency of 32.8%, and in the vaginal content — 15.7%, which is 2.1 times was more. The frequency of Mycoplasma hominis in the tissues of the leiomyomatous nodules was in 3 and 2.8 times, or 28.9% and 27.6% greater than the posterior vaginal vault and cervical canal, Ureaplasma urealyticum — in 5.6 and 4.4 times, or 30.2% and 28.4%, Virus papilloma homynis oncogenic type 16 of 18 — in 5.1 and 4.6 times, or 18.8% and 18.2% respectively. The results obtained indicate that infections in the tissues of the leiomyomatous nodules could have been given by intracanalicular, hematogenous, lymphogenous pathways. It is possible that these infections were in the body of a woman in an active form in the past. In the algorithm for monitoring patients with uterine leiomyoma at reproductive age, it is advisable to include bacteriological, PCR studies of the vaginal microbiocenosis, cervical canal, urethra in observation dynamics, tissues of remote leiomyomatous nodules by identifying microflora in order to prevent the occurrence of concomitant diseases of the urogenital tract and correction of organ biocenosis, which can to prevent the etiopathogenetic mechanisms, such as the occurrence of uterine fibroids and the transition of tumor growth from simple type in the proliferative and is one of the stages of pathogenetically substantiated prevention of uterine leiomyoma.