{"paper_id":"69348ee5-409a-4922-b859-367b602d908f","body_text":"МЕДИЦИНСКИЙ ВЕСТНИК СЕВЕРНОГО КАВКАЗА \n2014. Т. 9. № 2\nMEDICAL NEWS OF NORTH CAUCASUS\n2014. Vоl. 9. Iss. 2\n137\nГИНЕКОЛОГИЯ\n© Е. M. Aleksanova, V . A. Aksenenko, 2014\nUDC 618.14-006; 618.14-002; 616.541-34.1; 616-018.2-007.17-053.2\nDOI – http://dx.doi.org/10.14300/mnnc.2014.09039 \nISSN – 2073-8137\nEFFECTIVENESS OF COMPLEX THERAPY FOR ENDOMETRIOID OVARIAN \nCYSTS DEPENDING ON THE PRESENCE OR ABSENCE  \nOF UNDIFFERENTIATED DYSPLASIA OF CONNECTIVE TISSUE \nAleksanova E. M. , Aksenenko V. A.  \nStavropol State Medical University, Russian Federation\nE\nndometrioid cysts were first described \nby R üssel (1899) and Pick (1905), who \ncalled them the «chocolate» or «tar» cysts \n[16]. Considering the frequency of lesions of \nthe genital system, endometrioid ovarian cysts \noccupy the second place [1, 7, 13]. Despite \nthe studies of over a century years there is \nstill no consensus about the mechanisms of \npathogenesis, occurrence and recurrence.\nSuch as therapy for endometrioid formations of \nthe ovaries which are also ambiguous. According \nto modern concepts, the most positive effects in \ntreatment were shown when using a three-phase \napproach, including a surgical stage, an anti-\nrelapse hormonal therapy and a re-laparoscopy \n[6, 8]. The main criterion for the effectiveness of \ntherapy, regardless of method or combinations, \nshow no recurrence of the disease [8, 11, 17]. \nRelapses of endometrioid ovarian cysts for \n5 years after laparoscopic treatment (cystectomy, \nresection of the ovary, adnexectomy) occur \nin 10–25 % of cases, and significantly more \nfrequently in patients not treated with hormonal \ntherapy in the postoperative period [9, 15].  \nUndifferentiated dysplasia of connective tissues – \ngenetically determined developmental disorder \nof connective tissue, resulting in the change of its \nstructure, functions and properties which cause \norgan manifestations flowing with human immunity, \ncontributing to the progression of pathological \nchanges in the genital organs. In modern gynecology \nmany studies confirm the impact of undifferentiated \ndysplasia of connective tissues in the development \nof gynecological diseases [2, 3, 4, 5, 10, 14].\nDespite the interest of researchers about \nundifferentiated dysplasia of connective tissues, \nso far there are no research on the effectiveness \nof standard therapy for endometrioid ovarian \ncysts, depending on the degree of concomitant \nundifferentiated dysplasia of connective tissues.\nObjective: evaluation of effectiveness of complex \ntherapy of endometrioid ovarian cysts depending \non the availability of undifferentiated dysplasia of \nconnective tissues. \nMaterial and Мethods. Under our supervision \nthere were 70 patients aged from 18 to 40 years, \ndepending on the presence or absence of \nundifferentiated dysplasia of connective tissue they \nwere divided into 2 groups: I study group consisted \nof 35 patients with endometrioid ovarian cysts, \nwho wereidentified to have more than 6 external \nphenotypic traits of undifferentiated dysplasia of \nconnective tissues, II a comparison group consisted \nof 35 patients with endometrioid ovarian cysts with \n6 and less phenotypic traits of undifferentiated \ndysplasia of connective tissues.\nTo externally establish the phenotype a modified \nphenotypic map was used, including 63 metric units \n[12]. Patients of the main group and comparison \ngroup did not differ in age, complaints, reproductive \nand somatic factors, gynecological pathologies and \nthe state of endometriosis. All the patients had not \nreceived specific therapy of endometriosis before \nthe surgery. All patients diagnosed for endometrioid \novarian cysts were confirmed histologically.  \nfor all the patients after a complete observation \na laparoscopy was performed, followed by \ntheremoval of cysts in healthy tissues, separation of \nadhesions, hydrotubation. After surgery the patient \nof both groups within 6 months received an agonist \nGonadotropin releasing hormone «Buserelin-\ndepot» («pharmsintez», Russia): intramuscularly in \na dose of 3.75 mg once every 28 days for 6 months.  \nFor the comparative evaluation of the clinical effect \nof complex therapy for endometrioid ovarian cysts, \nthe patients were observed and monitored the \nfrequency of detection of pain syndrome, menstrual \nfunction, the level of CA-125 (through 1, 3, 6 and \n12 months after completion of treatment), as well \nas infertility within 12 months after the treatment. \nIn the absence of pregnancy after 12 months \nafter completion of treatment, a second-look \nlaparoscopy was performed to estimating the \nfrequency of possible recurrence of endometrioid \novarian cysts. laparoscopy evaluated the state of \norgans of the pelvis area and abdomen, in case \nof endometriosis taking into account their size, \ncolor , location, extent, and depth of invasion, the \nseverity of adhesions and patency of the fallopian \ntubes. After which a standard volume of operative \nAleksanova Ekaterina, Assistant of obstetrics  \nand gynecology department, Stavropol State Medical University; \ntel.: +79280069003; e-mail: alexanova@mail.ru\nAksenenko Victor, MD, PhD, Professor,  \nHead of the obstetrics and gynecology department,  \nStavropol State Medical University; tel.: +78652716536\n\n138138138\nORIGINAL  RESEARCH\n Obstetrios  and  gynecology\nОРИГИНАЛЬНЫЕ  ИССЛЕДОВАНИЯ\nАкушерство и гинекология138\ninterventions were conducted, depending on the \nextent of damage to the tissues.\nStatistical data processing was performed on a \ncomputer running PENTIUM IV with the use of the \nprogram «Statistica 6.0» [9]. In accordance with \nthe purposes and objectives of the study, as well \nas taking into account the specifics of the analyzed \nvariables the elementary statistics were solved with \n(mean values (M), medium errors (m), calculation \nof shares (%), standard error of the proportion (N)); \ncomparison of the qualitative parameters in the \ngroups studied with the help of non-parametrical \nmethods 2, Fisher’s adjusted Yeats; comparison \nof quantitative indicators using the nonparametric \ncriterion Mann — Whitney. The criterion for \nstatistical validity of the obtained conclusions was \np<0.05, as considered in conventional medicine.\nResults and Discussion.  Complaints on pain \nsyndrome before the treatment were 100.0 % from all \nthe patients, regardless of undifferentiated dysplasia \nof connective tissues. 1 month after treatment there \nwere no complaints of pain syndrome. 3 months after \nthe end of therapy in the primary group and in the \ncomparison group pain syndrome was reported in 3 \npatients (8,6 ± 4.7 %). 6 months after completion of \ntherapy in the main group the resumption of the pain \nsyndrome was observed in 10 (28.6 ± 7.6 %) patients, \nand in the group without undifferentiated dysplasia of \nconnective tissues – 6 patients (17.1 ± 6.4 %). After \n12 months of monitoring, the number of patients \nwith pain syndrome in the main group increased to \n12 (34.3±8.0 %), and in the group of comparison – \nup to 8 (22.9±7.1 %) (Fig. 1).\ncases-by 8.6 ± 4.7 % patients in each group. After 12 \nmonths of monitoring, the number of patients with \nmenstrual cycle in the main group was 4, and in the \ngroup of comparison was 3 patients (11.4±5.4 % \nand 8.6±4.7 %, respectively) (Fig. 2).\nFig. 1.  Dynamics of pain syndrome in patients  \nwith endometrioid ovarian cysts depending on the presence  \nor absence of undifferentiated dysplasia of connective tissue \none year after completion of therapy.  \nBefore starting therapy, the symptoms of menstrual function \ndisorders were detected in 18 (51,48,4 %) patients of the main \nand 17 (48,68,4 %) patients in the comparison group\n1 month after the end of therapy complaints of \nmenstrual dysfunction in both groups were noted. \n3 months after the treatment of various disorders \nof the menstrual cycle met in one patient in each \ngroup. At the end of 6 months after completion of \ntherapy menstrual irregularities observed in a three \nThe content of serum CA-125 blood above 35 IU/\nml was determined in 24 patients of main group and \n22 patients in the comparison group (68.6 ± 8.3 % \nand 62.9 ± 8.2 %, respectively).\n1 month after completion of treatment the level \nof CA-125 above 35 IU/ml was not registered in \nany group studied. 3 months after completion of \ntreatment the increase in the concentration of CA-125 \nin peripheral blood were observed in 1 (2.9 ± 2.8 %) \npatient of the main group and 1 (2.9 ± 2.8 %) patient \nin the comparison group. 6 months after completion \nof therapy noted an increase in the concentration \nof CA-125 in 6 (17.1 ± 6.4 %) patients of main group \nand 3 (8.6 ± 4.7 %) patients in the comparison group. \nBy the end of the year noted a growth in the number \nof patients with elevated CA-125 in the peripheral \nblood. Increase of CA-125 shown in 8 (22.9 ± 7.1 %) \npatients of main group and in 4 (11.4 ± 5.4 %) patients \nin the comparison group (Fig. 3).\nFig. 2.  Dynamics of menstrual disorders in patients  \nwith endometrioid ovarian cysts depending on the presence  \nor absence of undifferentiated dysplasia of connective tissue \none year after completion of therapy\nFig. 3.  Dynamics of the level of CA-125 in the peripheral  \nblood of patients with endometrioid ovarian cysts depending  \non the presence or absence of undifferentiated dysplasia  \nof connective tissue one year after completion of therapy\n\n\nМЕДИЦИНСКИЙ ВЕСТНИК СЕВЕРНОГО КАВКАЗА \n2014. Т. 9. № 2\nMEDICAL NEWS OF NORTH CAUCASUS\n2014. Vоl. 9. Iss. 2\n139139139139\nBefore the beginning of the treatment infertility \nwas observed in 13 (37.1±8.2 %) patients of \nmain group and 12 (34.3±8.0 %) patients in the \ncomparison group.\n3 months after completing therapy pregnancy \noccurred in 2 patients with infertility in the group \nof comparison and 1 patients of the main group \n(16.7±10.8 % and 7.7 ± 7.4 %, respectively). After \n6 months after completion of therapy pregnancy \noccurred in 5 (41.7 ± 14.2 %) patients in the \ncomparison group and 4 (30.8 ± 12.8 %) patients \nof the main group. After 12 months pregnancy \nreporteded in 7 (58.3 ± 14.2 %) patients without \nundifferentiated dysplasia of connective tissue \nand 5 (38.5 ± 13.5 %) patients with undifferentiated \ndysplasia of connective tissue (Fig. 4).\nIn case of recurrence of disease, foci of \nendometriosis were localized on the peritoneum \nsacroiliac ligaments and in the ovaries, and less \nfrequently localized in the retro-peritoneum space \nand broad uterine ligaments. Identified relapses \nof endometrioid ovarian cyst shad not exceed \nthe diameter of 3 cm and were always unilateral. \nIt should be noted that the localization of foci of \nendometriosis is not dependant on the presence or \nabsence of undifferentiated dysplasia of connective \ntissue.\nWhen performed a re-laparoscopy presence \nof an adhesive process was detected in 15 \n(42.9±8.4 %) patients of main group and in 10 \n(28.6±7.4 %) patients in the comparison group.\nConclusion.  Summarizing the data obtained, \nit can be argued that while conducting the same \ncomplex therapy for endometrioid ovarian cysts \nwith the presence of undifferentiated dysplasia of \nconnective tissue, return rate of the pain syndrome \nafter treatment is 1.5 times higher than in the \ncomparison group (34.3±8.0 and 22.9±7.1 % of \npatients, respectively). A similar pattern was seen \nin the study of the content of serum CA-125 blood: \nincrease of more than 35 IU/ml a year after completion \nof treatment is 2 times more frequently observed in \npatients with undifferentiated dysplasia of connective \ntissue than in patients in the comparison group \n(22.9±7,1 % and 11.4±5.4 % of patients, respectively).  \nAt the same time, studying the frequency of pregnancy \nin women with endometrioid ovarian cysts, it was \nfound that when the number of phenotypic traits \nofundifferentiated dysplasia of connective tissue \nwere less than 6 the pregnancy rate was 1.4 times \nhigher than in the patients with the phenotypic traits \nof undifferentiated dysplasia of connective tissue \nmore than 6 (58.3±14.2 and 38.5±13.5 %).\nIt should be noted that according to the \nlaparoscopy, recurrence of external genital \nendometriosis was observed in almost one third \nof patient with endometrioid ovarian cysts. While \nin the group of patients with undifferentiated \ndysplasia of connective tissue endometriosis \nrecurrence rate was 2 times higher than in patients \nwithout undifferentiated dysplasia of connective \ntissue (40.0±8,3 and 22.9±7.1 %, respectively), \nand the frequency of adhesion processesin the \npelvic were 1.5 times (42.9±8.4 and 28.6±7.4 %, \nrespectively).\nFig. 4.  Pregnancy rate in patients with infertility associated  \nwith endometrioid ovarian cysts depending on the presence  \nor absence of undifferentiated dysplasia of connective tissue \none year after completion of therapy\nIn accordance with the developed research \nProtocol 12 months after completion of treatment \nof all non-pregnant women with endometrioid \novarian cysts, a second laparoscopy was performed \n(30 patients of main group and 28 patients of \ncomparison group).\nWhen performed a re-laparoscopy foci of \nendometriosis in the pelvic peritoneum or ovaries \nwere found in 14 patients with undifferentiated \ndysplasia of connective tissue (40.0 ± 8.3 %) and \n7 (20.0 ± 7.1 %) patients without undifferentiated \ndysplasia of connective tissue.\nReferences \n1.  Adamyan L. V ., Kulakov V . I., Andreeva E. N. Endometriosis: \na Guide for physicians. M; 2006. P . 416.\n2.  Vereshchagin G. N. Systemic dysplasia of connective \ntissue. Guidelines for physicians. Novosibirsk; 2008. P . 35.\n3.  Gromov O. A., Torshin I. Y . Dysplasia of connective \ntissue, cell biology and molecular mechanisms and the \ninfluence of magnesium. Russian journal of medicine . \n2008;16(1):110.\n4.  Zemcovskis E. V . Century Dysplastic phenotypes. \nDisplastice heart. 2007. P . 80.\n5.  Klemenov A. V ., Tkachev O. N., Vertkin A. L. Connective \ntissue dysplasia and pregnancy (review). Therapeutic \narchives . 2004;11:80-83.\n6.  Krasnopolsky V . I., Buyanova S. N. Conservative surgical \ntreatment of the external-internal endometriosis. Journal \nof obstetric and gynecological diseases . 2002;LI(3):113-\n116.\n7.  Linde V . A., Whaling, Nahalkova, Nesibaigia O. I. \nGrishanin Epidemiological aspects of genital \nendometriosis. Problems of reproduction . \n2008;14(3):68-72.\n8.  Savelyeva G. M. et al. External endometriosis. \nEfficacy of laparoscopic surgery. Journal of obstetrics \nand gynecological diseases . 2002;LI(3):32-34.  \n9. Mahavolkna et al. Prevention of recurrence of external \ngenital endometriosis Problems of reproduction . \n2008;1:78-80.\n\n\n140140140\nORIGINAL  RESEARCH\n Obstetrios  and  gynecology\nОРИГИНАЛЬНЫЕ  ИССЛЕДОВАНИЯ\nАкушерство и гинекология140\n10.  Makolkin V . I. et al. A variety of clinical symptoms \nof connective tissue dysplasia. Ter. the archive . \n2004;76(11):77-80.\n11.  Shorohova M. A., Burlev V . A. Pathogenetic substantiation \nand modern principles of treatment for patients with \nendometriosis. Herald of the Russian obstetrician-\ngynecologist.  2008;8(4):23-30.\n12.  Berry A. Century, Smooth N. N. Evaluation of a range of \nexternal phenotypic traits to identify small anomalies of \nthe heart. Klin. honey . 2004;82(7):30-33.\n13. Missmer S. A., Cramer D. W. The epidemiology of \nendometriosis. Obstet. Gynecol. Clin. North.Am . \n2003;30(1):1-19.\nЭФФЕКТИВНОСТЬ\tКОМПЛЕКСНОЙ\t\nТЕРАПИИ\tЭНДОМЕТРИОИДНЫХ\tКИСТ\t\nЯИЧНИКОВ\tВ\tЗАВИСИМОСТИ\tОТ\tНАЛИЧИЯ\t\nНЕДИФФЕРЕНЦИРОВАННОЙ\tДИСПЛАЗИИ\t\nСОЕДИНИТЕЛЬНОЙ\tТКАНИ\t\nЕ. М. АЛЕКСАНОВА, В. А. АКСЕНЕНКО\nПроведена оценка эффективности ком -\nплексной терапии эндометриоидных кист яич-\nников в зависимости от наличия недифферен -\nцированной дисплазии соединительной ткани. \nУстановлено, что при проведении одинаковой \nтерапии частота возврата болевого синдрома \nпосле завершения лечения в 1,5 раза выше у \nпациенток с эндометриозными кистами яични-\nков (ЭКЯ) при наличии недифференцирован -\nной дисплазии соединительной ткани (НДСТ), \nчем у женщин без признаков НДСТ . Повышение \nуровня СА-125 в сыворотке крови спустя год по -\nсле завершения лечения наблюдалось в 2 раза \nчаще у пациенток с НДСТ , чем у больных группы \nсравнения. В то же время при изучении часто -\nты наступления беременности у пациенток с \nЭКЯ было установлено, что при числе феноти -\nпических признаков НДСТ менее 6 частота на -\nступления беременности была в 1,4 раза выше, \nчем у пациенток, число фенотипических при -\nзнаков НДСТ у которых превышало 6. В группе \nбольных с НДСТ частота спаечного процесса \nмалого таза в 1,5 раза выше, а частота рециди -\nвов эндометриоза – в 2 раза выше, чем у паци -\nенток без НДСТ . \nКлючевые слова:  эндометриоидные кисты \nяичников, дисплазия соединительной ткани, эн-\nдометриоз\n14. Pyeritz R. E. Small molecule for a large disease. N. Engl. \nJ. Med . 2008;358(26):2829- 2831.\n15. Schroder A. K., Diedrich K., Ludwig M. Medical \nmanagement of endometriosis: a systematic review. I. \nDrugs . 2004;7(5):451-463. \n16. Vigano P ., Parazzini F ., Somigliana E. Endometriosis: \nepidemiology and etiological factors. Best. Pract. Res. \nClin. Obstet. Gynecol . 2004;18(2):177-200.\n17. Weijenborg P . T ., Kuile M. M., Jansen F . W. Intraobserver \nand interobserver reliability of videotaped laparoscopy \nevaluations for endometriosis and adhesions. Fertil. \nSteril . 2007;87(2):373-380. \nEFFECTIVENESS OF COMPLEX THERAPY  \nFOR ENDOMETRIOID OVARIAN CYSTS  \nDEPENDING ON THE PRESENCE OR ABSENCE  \nOF UNDIFFERENTIATED DYSPLASIA \nOF CONNECTIVE TISSUE\nALEKSANOVA E. M., AKSENENKO V. A. \nIt is established, that by carrying out the same \ntherapy the frequency of pain syndrome returning \nafter treatment is 1.5 times higher in patients with \nundifferentiated dysplasia of connective tissue \nthan women without evidence of undifferentiated \ndysplasia of connective tissue. Increase in the le-\nvel of CA-125 in blood serum, a year after the end \nof treatment was observed to be 2 times more fre -\nquent in patients with undifferentiated dysplasia \nof connective tissue than the patients in the com -\nparison group. At the same time, studying the fre -\nquency of pregnancy in women with endometrioid \novarian cysts, it was found that when the number \nof phenotypic traits of undifferentiated dysplasia of \nconnective tissue were less than 6 the pregnancy \nrate was 1.4 times higher than in the patients with \nthe phenotypic traits of undifferentiated dysplasia \nof connective tissue more than 6. In the group of \npatients with undifferentiated dysplasia of connec -\ntive tissue frequency of adhesion processes in the \npelvic was– 1.5 times higher and endometriosis re -\ncurrence rate was 2 times higher than in patients \nwithout undifferentiated dysplasia of connective \ntissue.\nKey words:  endometrioid ovarian cysts, dyspla -\nsia of connective tissue, endometriosis","source_license":"CC0","license_restricted":false}