Представлен алгоритм органосохраняющего лечения миомы матки в зависимости от размеров узлов. Патогенетически и клинически обоснована эффективность внутриматочной левоноргестрел-рилизинг системы Мирена в самостоятельном лечении маленьких узлов миомы и в качестве противорецидивной терапии после миомэктомий и курса гормональной аблационной терапии. Предложенные лечебные подходы направлены на расширение возможности проведения органосохраняющего лечения больных миомой матки.
The algorithm of the complex conservative treatment of uterine myoma depending on the units sizes is represented. The effectiveness of the intrauterine levonorgestrel-releasing system Mirena is pathogenetically and clinically substantiated in the independent treatment of the small units of myoma and as the anti-relapse therapy after miomectomy and hormonal-ablation therapy. Proposed therapeutic approaches are directed to the expansion of the possibility of using the conservative treatment of patients with uterine myoma.
Key words: uterine myoma, adenomyosis, hyperplasia of endometrium, the algorithm of treatment, intrauterine levonorgestrel-releasing system Mirena.
1. Вихляева Е.М. О стратегии и тактике ведения больных с миомой матки. Вестн. рос. ассоц. акушеров-гинекологов. 1997; 3: 21–3.
2. Сидорова И.С. Миома матки. М.: Медицинское информационное агентство, 2005.
3. Тихомиров А.Л., Залеева Е.В. Роль левоноргестрел-рилизинг системы в комплексном лечении миомы матки. Актуальные вопросы клинической транспортной медицины, 2006.
4. Тихомиров А.Л., Лубнин Д.М. Контрацепция у больных миомой матки. Рус. мед. журн. 2002; 10 (4): 212–15.
5. Тихомиров А.Л., Лубнин Д.М. Миома матки. М.: Медицинское информационное агентство, 2006.
6. Тихомиров А.Л., Лубнин Д.М. Новый принцип лечения миомы матки. Методическое руководство для врачей акушеров-гинекологов. М., 2006.
7. Тихомиров А.Л., Тускаев К.С., Залеева Е.В. Применение внутриматочной гормональной рилизинг-системы в комплексном органосохраняющем лечении миомы матки. Методическое руководство для врачей акушеров-гинекологов. М., 2005.
8. Bahamondes, Ribeiro-Huguet. Levonorgestrel-releasing intrauterine system (Mirena) as a therapy for endometrial hyperplasia and carcinoma. Acta Obstet Gynecol Scand 2003; 82 (6): 580–2.
9. Baldaszti E, Wimmer-Puchinger B. Acceptability of the long-term contraceptive levonorgestrel-releasing intrauterine system (Mirena): a 3-year follow-up study. Contraception 2003; 67 (2): 87–91.
10. Fedele L, Bianchi S, Raffaelli R et al. Treatment of adenomyosis-associated menorrhagia with a levonorgestrel-releasing intrauterine device. Fertil Steril 1997; 68: 426–29.
11. Fedele L, Bianchi S, Zanconato G et al. Use of a levonorgestrel-releasing intrauterine device in the treatment of recto- vaginal endometriosis. Fertil Steril 2001; 75: 485–88.
12. French RS, Cowan FM, Mansour D et al. Levonorgestrel-releasing (20 microgram/day) intrauterine systems (Mirena) compared with other methods of reversible contraceptives. Bjog 2000; 107 (10): 1218–25.
13. Giannopoulos T, Butler-Manuel S et al. Levonorgestrel-releasing intrauterine system (LNG-IUS) as a therapy for endometrial carcinoma. Gynecol Oncol 2004; 95 (3): 762–4.
14. Laoag-Fernandez JB, Maruo T et al. Effects of levonorgestrel-releasing intra-uterine system on the expression of vascular endothelial growth factor and adrenomedullin in the endometrium in adenomyosis. Hum Reprod 2003; 18 (4): 694–9.
15. Levy BS. Management of uterine fibroids. Acta Obstet Gynecol Scand 2008; 87 (8): 812–23.
16. Maia H, Maltez A. Insertion of mirena after endometrial resection in patients with adenomyosis. J Am Assoc Gynecol Laparosc 2003; 10 (4): 512–6.
17. Perino A, Quartararo P, Catinella E et al. Тreatment of endometrial hyperplasis with levonorgestrel-releasing intrauterine devices. Acta Fertil 1987.
18. Rachev E. Mirena – the first intrauterine contraceptive rherapeutic system. Akush Ginekol (Sofiia) 2001; 40 (Suppl. 6): 3–6.
19. Rein MS. Advances in uterine leiomyoma research: the progesterone hypothesis. Environ. Health Perspect 2000; 108 (5): 791–3.
20. Searselli G, Tantini C, Colafranceschi M et al. Levonorgestrel-releasing intrauterine devices and precancerous lesious of the endometrium. Eur J Gynaecol Oncol 1988; 9 (4): 284–86.
21. Tiltman AJ. Smooth muscle neoplasms of the uterus. Curr Opin Obstet Gynecol 1997; 9 (1): 48–51.
22. Vercellini P, Aimi G, Panazza S et al. A levonorgestrel-releasing intrauterine system for the treatment of dysmenorrhea associated with endometriosis: a pilot study. Fertil Steril 1999; 72 (3): 505–8.
23. Vollenboven BJ, Lawrence AS, Healy DL. Uterine fibroids 1997; 97: 285–98.
24. Wang S, Su Q. Clonality of multiple uterine leiomyomas. Zhonghua Bing Li Xue Za Zhi 2002; 31 (2): 107–11.
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1. Вихляева Е.М. О стратегии и тактике ведения больных с миомой матки. Вестн. рос. ассоц. акушеров-гинекологов. 1997; 3: 21–3.
2. Сидорова И.С. Миома матки. М.: Медицинское информационное агентство, 2005.
3. Тихомиров А.Л., Залеева Е.В. Роль левоноргестрел-рилизинг системы в комплексном лечении миомы матки. Актуальные вопросы клинической транспортной медицины, 2006.
4. Тихомиров А.Л., Лубнин Д.М. Контрацепция у больных миомой матки. Рус. мед. журн. 2002; 10 (4): 212–15.
5. Тихомиров А.Л., Лубнин Д.М. Миома матки. М.: Медицинское информационное агентство, 2006.
6. Тихомиров А.Л., Лубнин Д.М. Новый принцип лечения миомы матки. Методическое руководство для врачей акушеров-гинекологов. М., 2006.
7. Тихомиров А.Л., Тускаев К.С., Залеева Е.В. Применение внутриматочной гормональной рилизинг-системы в комплексном органосохраняющем лечении миомы матки. Методическое руководство для врачей акушеров-гинекологов. М., 2005.
8. Bahamondes, Ribeiro-Huguet. Levonorgestrel-releasing intrauterine system (Mirena) as a therapy for endometrial hyperplasia and carcinoma. Acta Obstet Gynecol Scand 2003; 82 (6): 580–2.
9. Baldaszti E, Wimmer-Puchinger B. Acceptability of the long-term contraceptive levonorgestrel-releasing intrauterine system (Mirena): a 3-year follow-up study. Contraception 2003; 67 (2): 87–91.
10. Fedele L, Bianchi S, Raffaelli R et al. Treatment of adenomyosis-associated menorrhagia with a levonorgestrel-releasing intrauterine device. Fertil Steril 1997; 68: 426–29.
11. Fedele L, Bianchi S, Zanconato G et al. Use of a levonorgestrel-releasing intrauterine device in the treatment of recto- vaginal endometriosis. Fertil Steril 2001; 75: 485–88.
12. French RS, Cowan FM, Mansour D et al. Levonorgestrel-releasing (20 microgram/day) intrauterine systems (Mirena) compared with other methods of reversible contraceptives. Bjog 2000; 107 (10): 1218–25.
13. Giannopoulos T, Butler-Manuel S et al. Levonorgestrel-releasing intrauterine system (LNG-IUS) as a therapy for endometrial carcinoma. Gynecol Oncol 2004; 95 (3): 762–4.
14. Laoag-Fernandez JB, Maruo T et al. Effects of levonorgestrel-releasing intra-uterine system on the expression of vascular endothelial growth factor and adrenomedullin in the endometrium in adenomyosis. Hum Reprod 2003; 18 (4): 694–9.
15. Levy BS. Management of uterine fibroids. Acta Obstet Gynecol Scand 2008; 87 (8): 812–23.
16. Maia H, Maltez A. Insertion of mirena after endometrial resection in patients with adenomyosis. J Am Assoc Gynecol Laparosc 2003; 10 (4): 512–6.
17. Perino A, Quartararo P, Catinella E et al. Тreatment of endometrial hyperplasis with levonorgestrel-releasing intrauterine devices. Acta Fertil 1987.
18. Rachev E. Mirena – the first intrauterine contraceptive rherapeutic system. Akush Ginekol (Sofiia) 2001; 40 (Suppl. 6): 3–6.
19. Rein MS. Advances in uterine leiomyoma research: the progesterone hypothesis. Environ. Health Perspect 2000; 108 (5): 791–3.
20. Searselli G, Tantini C, Colafranceschi M et al. Levonorgestrel-releasing intrauterine devices and precancerous lesious of the endometrium. Eur J Gynaecol Oncol 1988; 9 (4): 284–86.
21. Tiltman AJ. Smooth muscle neoplasms of the uterus. Curr Opin Obstet Gynecol 1997; 9 (1): 48–51.
22. Vercellini P, Aimi G, Panazza S et al. A levonorgestrel-releasing intrauterine system for the treatment of dysmenorrhea associated with endometriosis: a pilot study. Fertil Steril 1999; 72 (3): 505–8.
23. Vollenboven BJ, Lawrence AS, Healy DL. Uterine fibroids 1997; 97: 285–98.
24. Wang S, Su Q. Clonality of multiple uterine leiomyomas. Zhonghua Bing Li Xue Za Zhi 2002; 31 (2): 107–11.
Авторы
А.Л.Тихомиров, А.А.Леденкова
Московский государственный медико-стоматологический университет