Индивидуализация ведения пациенток с эндометриозом матки на основе использования левоноргестрелсодержащей внутриматочной системы и гистерорезектоскопической аблации эндометрия

Objective: to increase the efficiency of the treatment of uterine endometriosis complicated by uterine bleeding, based on the differential application of hysteroresectoscopic endometrial ablation, a levonorgestrel-containing intrauterine system, and gonadotropin-releasing hormone agonists. Material and methods: The study included 93 patients with uterine endometriosis complicated by uterine bleedings who were treated using the levonorgestrel-containing intrauterine system (31 patients), hysteroresectoscopic endometrial ablation (29 patients), and the combination of these methods (33 patients). The control group consisted of 23 patients without genital pathology. The treatment outcomes for the subgroups were analyzed based on studying clinical, anthropometric, sonographic, laboratory, immune-enzyme, endoscopic, immunohistochemical, morphological, and morphometrical parameters. Results. The levonorgestrel-containing intrauterine system is efficient (in 87.1% cases) for the treatment of patients with adenomyosis in cases when the size of the uterus does not exceed 250000 mm 3 , and possesses the main local and minimal systemic effect. It is comparable to hysteroresectoscopic endometrial ablation, whose efficiency in the elimination of uterine bleedings is 82.76 %. If the size of the uterus ranges from 150000 to 250000 mm 3 , the combined treatment strategy should be preferred (hysteroresectoscopic endometrial ablation, and the levonorgestrel-containing intrauterine system), which had 100 % efficiency in the corresponding group, and gonadotropin-releasing hormone agonists should be used. In the long-term follow-up study (1-5.3 years), the efficiency of the treatment with the use of the levonorgestrel-containing intrauterine system was 80.65 %, in the combined treatment - 100 %, in hysteroresectoscopic endometrial ablation - 72.41 %. Conclusion. The individualized use of the levonorgestrel-containing intrauterine system, hysteroresectoscopic endometrial ablation, the combination of these two treatment options as well as the application gonadotropin-releasing hormone agonists in the treatment of adenomyosis complicated by menorrhagia and other proliferative diseases of the endometrium and myometrium showed their high efficiency and reasonability.