{"paper_id":"d0c4fe81-af21-41b7-a7e3-3205c106dedd","body_text":"476 A journal of the AMERICAN Journal of Pediatric Medicine and Health Sciences www. grnjournal.us \n \n \nAMERICAN Journal of Pediatric Medicine and \nHealth Sciences \nVolume 01, Issue 09, 2023 ISSN (E): 2993-2149 \n \n \n \nModern Views About Genital Endometriosis \n \nSharafy Tamina Floridovna \nBukhara State Medical Institute \n \nAnnotation: Genital endometriosis is one of the most common diseases in women. \nEpidemiological studies indicate. that in 90-99% of patients, endometriotic lesions are detected \nbetween the ages of 20 and 50 years, most often during the reproductive period. The review is \ndevoted to modern ideas about genital endometriosis. \nKey words: genital endometriosis, myometrium, gynecology, diagnosis. \n \nRelevance. Endometriosis is a benign hormone-dependent disease that develops against the \nbackground of hormonal and immune imbalance in the presence of a genetic predisposition and \nis characterized by the appearance of tissue identical in structure and function to the \nendometrium outside the normal localization of the mucous membrane of the uterine body [1]. \nGenital endometriosis is one of the most common diseases in women. It ranks third in the \nstructure of gynecological diseases after inflammatory diseases and uterine fibroids [1;6]. \nAccording to various authors, for example [1], from 12 to 50% of all diseases in women of \nreproductive age; according to [6] up to 10% of women, according to [1] from 6 to 44% of \nwomen suffering from infertility and undergoing laparoscopy and laparotomy. In the structure of \npersistent pelvic pain syndrome, endometriosis occupies 80%; among patients with infertility, \nendometriosis occurs in 30% [4]. Epidemiological studies indicate. that in 90-99% of patients, \nendometriotic lesions are detected between the ages of 20 and 50 years. and most often in the \nreproductive period, regardless of ethnicity and socio-economic conditions [7; 14]. Risk factors \nfor the development of endometriosis are [1;15]: disturbances in the number and function of \nestrogen-sensitive, progesterone-sensitive receptors of myometrial cells, disturbance of the \nhormone-producing function of the ovaries; inflammatory processes of the internal genital \norgans; violation of pelvic thermodynamics; infertility due to anovulation; hereditary factor; late \nonset of menarche. According to modern ideas about the nature of endometriosis, it should be \nconsidered as a benign, genetically determined, dishormonal and immune-dependent disease. \nMost researchers believe that endometriosis is a disease with a chronic, relapsing course; \ntherefore, a number of concepts of its occurrence continue to be discussed in the literature, but \nnone of them is able to explain all aspects of its pathogenesis [2;6;9;12] : 1. The metaplastic \nconcept focuses on metaplasia of the embryonic peritoneum or coelomic epithelium under the \ninfluence of chronic inflammation, hormonal and immunological imbalance, mechanical trauma \nand other influences. 2. Transport theory (implantation, transplantation) which was first \nproposed by J.A. Sampson in 1921. The theory considers the possibility of endometriosis \ndeveloping from viable endometrial cells displaced into the thickness of the uterine wall or \ntransferred retrograde, through the fallopian tubes, into the abdominal cavity during \n\n477 A journal of the AMERICAN Journal of Pediatric Medicine and Health Sciences www. grnjournal.us \n \n \nmenstruation. 3. The dysontogenic (embryonic) concept provides for the emergence of \nendometriosis from abnormally located embryonic rudiments, in particular the Müllerian duct. 4. \nImmunological theory - suggests that congenital and acquired immunity disorders may underlie \nthe development of endometrioid disease. It has been established that endometriosis develops T-\ncell immunodeficiency and suppression of the function of T-suppressors. decreased NK cell \nfunction, activation of B lymphocytes, peritoneal macrophages, and delayed-type \nhypersensitivity reactions [3]. 5. Genetic theory - the relationship between HLA antigen and \nendometriosis has been established. Quantitative and structural changes in chromosomes were \nfound in endometrial heterotopia cells; it is possible that the presence of one or more gene \ndefects causes a predisposition to endometriosis. Endometriosis with genital localization of foci \naccounts for about 95% of all cases of the disease. Extragenital endometriosis occurs many times \nless often than genital endometriosis in approximately 5% of cases [1]. Histological \nclassification of internal endometriosis [15]. 1. Glandular - occurs 16 times more often than \nstromal; 2. Stromal: a) adenomyosis - endometriosis, accompanied by hyperplasia and \nhypertrophy of the muscle fibers of the uterus; c) adenomyoma - unlike adenomyosis, this form \nof the disease is characterized by a clearer limitation of the nodes with the surrounding tissue, \nwith the absence of clusters of glandular inclusions of the endometrial stroma around the \nclusters. \nAn important role in timely diagnosis and making a correct diagnosis has a purposefully \ncollected anamnesis, knowledge of the main symptoms, the ability to identify their relationship \nwith the menstrual cycle, generative function, correct interpretation of pain syndrome, \nidentification and assessment of provoking factors in... Vaginal and rectovaginal examination are \nquite informative, examination of the cervix and vaginal walls in the speculum. Of the additional \ndiagnostic research methods, the most commonly used are: ultrasound, colposcopy; \nhysteroscopy, laparoscopy, cervical biopsy, less often NMR and x-ray methods are used. General \nobjective examination: body features, height, obesity, nature of hair growth, degree of ane mia. \nThe examination begins with examination of the external genitalia and vulva. Rarely, but still \nsometimes it is possible to detect a focus of endometriosis in the form of a bluish compaction in \nthe area of the scar after perineotomy. It is clearly visible during menstruation. When examined \nin speculums on the vaginal part of the cervix, you can see endometrioid lesions ranging in size \nfrom 1-2 to 5-7 mm of red or dark purple color. During menstruation, the lesions enlarge and \nsometimes empty. In the posterior fornix, at the border with the cervix, you can see brown or \ndark blue foci of retrocervical endometriosis in the form of small tuberous formations. Bimanual \nexamination - with adenomyosis, an enlarged uterus is palpated (70% of patients), especially in \nthe anteroposterior size, often fixed in the posterior fornix, its shape can be spherical (diffuse \nversion of adenomyosis) or tuberous (nodular version). At the same time, the size of the uterus \nchanges cyclically: during menstruation it increases, and during the intermenstrual period it \ndecreases, sometimes to its original size. A fine nodular roughness of the surface of the uterus \nand the pain of these nodules on palpation can be determined. An attempt to displace the uterus \nanteriorly causes sharp pain. Hormonal studies can reveal the dysfunction of the hypothalamic-\npituitary-ovarian system inherent in endometriosis with the development of an imbalance of sex \nhormones. The concentrations of FSH, LH, estradiol, and progesterone are determined over time. \nCharacteristics of endometriosis are: the absence of a peak in the levels of FSH and LH in the \nblood in the middle of the menstrual cycle; an increase in the concentration of estradiol in the \nblood in the second phase of the menstrual cycle. Ultrasonography. For a detailed assessment of \nstructural changes in the endometrium and myometrium, ultrasound using transvaginal sensors is \n\n478 A journal of the AMERICAN Journal of Pediatric Medicine and Health Sciences www. grnjournal.us \n \n \nused; The accuracy of diagnosing endometriosis exceeds 90-95%. The most informative \nultrasound is in the second phase of the menstrual cycle (on the 23-25th day of the menstrual \ncycle). Signs of adenomyosis: Hysteroscopy - diagnostic value ranges from 30 to 92%. carrie d \nout if internal endometriosis of the uterine body is suspected no later than 5-7 days of the cycle. \nEndometrioid ducts are found in the form of dark red pinholes against the background of a pale \nSLQN\u0003WLQW\u0003RI\u0003WKH\u0003FHUYLFDO\u0003PXFRVD\u000f\u0003IURP\u0003ZKLFK\u0003EORRG\u0003IORZV\u0003\u000bWKH\u0003³KRQH\\FRPE´\u0003V\\PSWRP\f\u0011\u0003'LIIXVH\u0003\nform of adenomyosis: expansion of the uterine cavity and the appearance of folding and uneven \ncontour of the surface of the basal layer of the endometrium. Nodular form of adenomyosis: \nenlargement and deformation of the uterine cavity due to local bulging, its affected walls, and the \nDSSHDUDQFH\u0003RI\u0003HQGRPHWULRWLF\u0003³H\\HV´\u0003RQ\u0003WKHP\u0003>\u0014\u0016@\u0011\u0003+\\VWHURVDOSLQJRJUDSK\\\u0011\u00037KL s method has not \nlost its importance in the diagnosis of adenomyis. Information content reaches up to 85% of \ncases. The study is carried out on the 5-7th day of the menstrual cycle with water-soluble \ncontrast, so that the racing mucous membrane of the beginning of the proliferation stage does not \ninterfere with the penetration of the contrast agent into the endometrioid lesions. Laparoscopy \nfollowed by biopsy. It is the most accurate instrumental method for diagnosing peritoneal \nendometriosis. The endoscopic picture is determined by the degree of spread of the pathological \nprocess, the duration of its existence and the characteristics of the macroscopic structure of the \nimplants. The high resolution of optical technology makes it possible to examine foci of \nendometriosis in the early stages of development and carry out differentiated treatment with \nGLIIHUHQW\u0003 W\\SHV\u0003 RI\u0003 HQHUJLHV\u0003 GHSHQGLQJ\u0003 RQ\u0003 WKH\u0003 IRUP\u0003 RI\u0003 WKH\u0003 GLVHDVH\u0003 >\u0019@\u0011\u0003 7KHUH\u0003 DUH\u0003 ³W\\SLFDO´\u0003\n(classical) and mild (atypical) laparoscopic signs of the disease [2]: Typical signs: black, bluish-\npurple, dark red spots on the surface of the peritoneum; scar tissue surrounding endometrioid \nimplants; white, opaque plaques surrounded by scar tissue; ovarian formations with a dense dark \nblue capsule with blue-purple fragments; adhesive process in the pelvis (between the posterior \nlayers of the broad uterine uterus and the ovaries, the immobile part of the sigmoid colon and the \nSRVWHULRU\u0003ZDOO\u0003RI\u0003WKH\u0003YDJLQD\f\u0011\u0003$W\\SLFDO\u0003VLJQV\u001d\u0003DUHDV\u0003RI\u0003ZKLWH\u0003RSDTXH\u0003SHULWRQHXP\u001e\u0003UHG\u0003³IODPH -OLNH´\u0003\nspots; subovarian adhesions; yellow-brown spots on the surface of the peritoneum; circular \ndefects of the peritoneum; petechial peritoneum; glandular neoplasms on the surface of the \nSHULWRQHXP\u001e\u0003K\\SHUYDVFXODU\u0003]RQHV\u0011\u00036LJQV\u0003RI\u0003DGHQRP\\RVLV\u001d\u0003³PDUEOHG´\u0003DQG\u0003SDOH\u0003VHU ous lining of the \nuterus; uniform increase in the size of the uterus; sharp thickening of the anterior or posterior \nwall of the uterus (with focal and nodular forms); wall deformation due to adenomyosis; \nmyometrial hyperplasia. \nLiterature \n1. 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GZ\\jmah\\\u0003J\u0011\u0003J\u0011\u000f\u0003Hqbeh\\\u0003D\u0011\u0003J\u0011\u0003FHJNHNMGDPBHG:EVGU?\u0003HKH;?GGHKLB\u0003\nEBFNHB>GUO\u0003KLJMDLMJ\u0003LHEKLHC\u0003DBRDB\u0003IJB\u0003EMQ?JBC\u0003I?Q?GB\u0003DJUK\u0003IJB\u0003HLJ: