Laser conversion express diagnostics and high-volume photoactive therapy of endometrial hyperplastic processes

Gynecology, Obstetrics and Perinatology - Gynecology, Obstetrics and Perinatology - 2017 volume 16 issue 2 Laser conversion express diagnostics and high-volume photoactive therapy of endometrial hyperplastic processes Authors / Institutions Vladimir M. Zuev / M.T.Aleksandrov / Yu.I.Pimancheva / Elena A. Kalinina / Thea A. Dzhibladze / The objective. Assessment of the effectiveness of laser fluorescence conversion spectroscopy and high-volume photo-active (photodynamic and photo-immune) therapy in diagnosis and treatment of endometrial hyperplastic processes (EHP) in infertile women on the programmes of assisted reproductive technologies (ART). Patients and methods. A clinical-laboratory examination and treatment of 68 female patients aged 35–47 (41.15 ± 2.18) years with primary and secondary infertility, CE and various forms of EHP was performed. All women underwent planned routine examination before an IFV programme. The control group consisted of 10 healthy women, who were preparing for ART. Ultrasound examination of the pelvic organs was performed in all patients using colour Doppler mapping with assessment of flow rate curves in vessels of the small pelvis. Also, bacteriological and cytological examinations were performed. The main monitoring method of assessment of the morphofunctional state of the endometrium was laser fluorescence conversion diagnostics of the endometrium. High-volume complex photo-active therapy (PAT) was performed under the control of laser conversion diagnostics (LCD) (fluorescent constituent) on a certified device «EnSpectr M» with the use of chlorophyll-containing preparation for oral use 0.5–3.0 ml daily with preliminary processing by laser radiation with wavelength 0.63 μm in the dose 20–40 J/cm2 for 4–6 wks. Results. Fluorescence of a normal endometrium (proliferative activity) was 6–8 х 107–108 RFU. The aerobicity index in women with CE before treatment was 0.7–1.08 (0.92 ± 0.04) RU, after – 1.1–1.7 (1.58 ± 0.08) RU, which practically corresponded to the norm. The structure of endometrial tissues in the norm (metabolic aerobicity and morphometric – the level of proliferative activity of the endometrium in three examined endometrial zones) was well expressed. Signs of EHP are characterized by an enhanced intensity of fluorescent signal by 2–10 times at its different parts (fundus, body, internal orifice), some shift of the peak fluorescence signal by 5–10 nm to the right (in 25–30% of patients), impairment of the spectral structure in practically all patients. This was associated with a high proliferative activity of epithelial cells. The values of aerobicity and microcirculation in the endometrium were decreased in practically all uterine regions by 25–55%. During rehabilitation measures, all the above parameters normalized. Analysis of clinical data after PAT has shown that in most patients (59 = 86.76%) the character of menses changed – the period became longer by 2 to 3.5–4 days, the previously scanty volume of menstural blood loss increased, the colour menogramme changed for physiological one. Complaints of pathological discharge and discomfort in the vagina stopped. Ultrasonography showed the correspondence of the echographic picture of the endometrium to the menstrual cycle phase in 54 (79.4%) women. Morphological examination has not found EHP signs in any patient. Conclusion. The results of the study are indicative of a high diagnostic value of non-invasive laser express diagnostics of inflammatory and hyperplastic processes in the endometrium, a marked therapeutic effect of high-volume PAT in treatment of women with EHP in combination with CE. Key words: assisted reproductive technologies, endometrial hyperplastic processes, laser conversion diagnostics, photo-active therapy, chronic endometritis. For citation: Zuev V.M., Aleksandrov M.T., Pimancheva Yu.I., Kalinina E.A., Dzhibladze T.A., Grineva A.M., Bagramova G.E. Laser conversion express diagnostics and high-volume photoactive therapy of endometrial hyperplastic processes. Vopr. ginekol. akus. perinatol. (Gynecology, Obstetrics and Perinatology). 2017; 16(2): 5–11. (In Russian). DOI: 10.20953/1726-1678-2017-2-5-11 Patients and methods. A clinical-laboratory examination and treatment of 68 female patients aged 35–47 (41.15 ± 2.18) years with primary and secondary infertility, CE and various forms of EHP was performed. All women underwent planned routine examination before an IFV programme. The control group consisted of 10 healthy women, who were preparing for ART. Ultrasound examination of the pelvic organs was performed in all patients using colour Doppler mapping with assessment of flow rate curves in vessels of the small pelvis. Also, bacteriological and cytological examinations were performed. The main monitoring method of assessment of the morphofunctional state of the endometrium was laser fluorescence conversion diagnostics of the endometrium. High-volume complex photo-active therapy (PAT) was performed under the control of laser conversion diagnostics (LCD) (fluorescent constituent) on a certified device «EnSpectr M» with the use of chlorophyll-containing preparation for oral use 0.5–3.0 ml daily with preliminary processing by laser radiation with wavelength 0.63 μm in the dose 20–40 J/cm2 for 4–6 wks. Results. Fluorescence of a normal endometrium (proliferative activity) was 6–8 х 107–108 RFU. The aerobicity index in women with CE before treatment was 0.7–1.08 (0.92 ± 0.04) RU, after – 1.1–1.7 (1.58 ± 0.08) RU, which practically corresponded to the norm. The structure of endometrial tissues in the norm (metabolic aerobicity and morphometric – the level of proliferative activity of the endometrium in three examined endometrial zones) was well expressed. Signs of EHP are characterized by an enhanced intensity of fluorescent signal by 2–10 times at its different parts (fundus, body, internal orifice), some shift of the peak fluorescence signal by 5–10 nm to the right (in 25–30% of patients), impairment of the spectral structure in practically all patients. This was associated with a high proliferative activity of epithelial cells. The values of aerobicity and microcirculation in the endometrium were decreased in practically all uterine regions by 25–55%. During rehabilitation measures, all the above parameters normalized. Analysis of clinical data after PAT has shown that in most patients (59 = 86.76%) the character of menses changed – the period became longer by 2 to 3.5–4 days, the previously scanty volume of menstural blood loss increased, the colour menogramme changed for physiological one. Complaints of pathological discharge and discomfort in the vagina stopped. Ultrasonography showed the correspondence of the echographic picture of the endometrium to the menstrual cycle phase in 54 (79.4%) women. Morphological examination has not found EHP signs in any patient. Conclusion. The results of the study are indicative of a high diagnostic value of non-invasive laser express diagnostics of inflammatory and hyperplastic processes in the endometrium, a marked therapeutic effect of high-volume PAT in treatment of women with EHP in combination with CE. Key words: assisted reproductive technologies, endometrial hyperplastic processes, laser conversion diagnostics, photo-active therapy, chronic endometritis. For citation: Zuev V.M., Aleksandrov M.T., Pimancheva Yu.I., Kalinina E.A., Dzhibladze T.A., Grineva A.M., Bagramova G.E. Laser conversion express diagnostics and high-volume photoactive therapy of endometrial hyperplastic processes. Vopr. ginekol. akus. perinatol. (Gynecology, Obstetrics and Perinatology). 2017; 16(2): 5–11. (In Russian). DOI: 10.20953/1726-1678-2017-2-5-11