Ендометріоз післяопераційного рубця: актуальність сьогодення

Рostoperative scar endometriosis (РSE) is extragenital endometriosis, develops in 0.03-1.5% of women after surgical interventions. Aim - studying the problem of РSE and evaluating the tactics of managing this pathology in women for 5 years to improve and implement comprehensive treatment. Materials and methods. An analysis of anamnestic and clinical data, examination and treatment of 46 women with РSE was carried out during 2020-2024. Results. There was a 5-fold increase in the frequency of РSE from 2020 to 2024. Tumor-like formation was observed in the scar area in 46 (100%) women, pain in the scar area in 42 (91.3%) women; scar induration in 20 (43.5%) women; abnormal uterine bleeding in 11 (23.9%) women. 21 (45.7%) women with РSE had a hereditary predisposition; a high infectious index in 42 (91.3%) women and concomitant extragenital pathology in 17 (36.9%) women. 32 (69.6%) women had a history of artificial abortions, 7 (15.2%) had spontaneous abortions (electrovacuum aspiration 48.3%); 43 (93.4%) had a cesarean section. Among gynecological diseases: inflammation of the uterus and appendages in 19 (41.3%); cervical pathology in 15 (32.6%); infertility II in 8 (17.3%); appendage operations in 12 (26%) women. Clinical symptoms appeared after previous operations on average 3.2 years. 60.9% of women with РSE were operated on 2-4 years after the onset of complaints, which indicates untimely referral to a medical institution and late diagnosis. In 37% of women, the level of the tumor marker CA 125 is elevated (38.4 U/ml). The complexity of the operation depended on the duration of the appearance of РSE by the time of surgery. The longer the clinical manifestations of РSE, the more widespread the pathological process, which required the involvement of surgeons and urologists. Conclusions. Predictors of РSE were identified: intrauterine operations, complicated heredity, chronic inflammation of the uterus and appendages, cervical pathology, induced abortions. A woman after surgery and histological confirmation of endometriosis of the scar requires observation by a gynecologist and therapy to prevent relapse. The study was conducted in accordance with principles of the Declaration of Helsinki. Research protocol was approved by local ethics committee of the participating institution. Informed consent was obtained. The authors declare no conflict of interest.