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Алгоритм консервативного лечения миомы матки
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Аннотация
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 с миомой матки.
Ключевые слова: миома матки, алгоритм лечения, внутриматочная левоноргестрел-рилизинг-система Мирена.
Ключевые слова: миома матки, алгоритм лечения, внутриматочная левоноргестрел-рилизинг-система Мирена.
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An algorithm for preserving therapy of uterine fibroids, depending on the size of nodes is presented in the following article. Pathogenetic and clinical efficacy of levonorgestrel -releasing intrauterine system Mirena in the self-treatment of small fibroids and as a preventive treatment after myomectomy and course of hormone ablation therapy is totally justified. The proposed therapeutic approaches aimed at increasing the possibility of organ preservation treatment of patients with uterine cancer.
Key words: uterine fibroids, treatment algorithm, the levonorgestrel-releasing intrauterine system Mirena.
Полный текст
Список литературы
1. Redwine DB, Wright JT. Laparoscopic treatment of complete obliteration of the cul-de-sac associated with endometriosis: long-term follow-up of en bloc resection. Fertil Steril 2001; 76: 358–65.
2. Вихляева Е.М. О стратегии и тактике ведения больных с миомой матки. Вестн. Рос. ассоциации акушеров-гинекологов. 1997; 3: 21–3.
3. 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.
4. Wang S, Su Q et al. Clonality of multiple uterine leiomyomas. Zhonghua Bing Li Xue Za Zhi 2002; 31 (2): 107–11.
5. Rachev E. Mirena – the first intrauterine contraceptive rherapeutic system. Akush Ginekol (Sofiia) 2001; 40 (Suppl. 6): 3–6.
6. Сидорова И.С. Миома матки. М.: Мед. информ. агентство, 2005.
7. 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.
8. Tiltman AJ. Smooth muscle neoplasms of the uterus. Curr Opin Obstet Gynecol 1997; 9 (1): 48–51.
9. 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.
10. Maia H Jr, Maltez A. Insertion of mirena after endometrial resection in patients with adenomyosis. J Am Assoc Gynecol Laparosc 2003; 10 (4): 512–6.
11. Levy BS. Management of uterine fibroids. Acta Obstet Gynecol Scand 2008; 87 (8): 812–23.
12. 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.
13. Perino A, Quartararo P, Catinella E et al. Тreatment of endometrial hyperplasis with levonorgestrel-releasing intrauterine devices. Acta Fertil 1987.
14. Rein MS. Advances in uterine leiomyoma research: the progesterone hypothesis. Environ Health Perspect 2000; 108 (5): 791–3.
15. 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.
16. Searselli G, Tantini C, Colafranceschi M et al. Levonorgestrel-releasing intrauterine devices and precancerous lesious of the endometrium. Eur J Gynecol Oncol 1988; 9 (4): 284–86.
17. Vollenboven BJ, Lawrence AS, Healy DL. Uterine Fibroids 1997; 97: 285–98.
18. Fedele L, Bianchi S, Zanconato G et al. Long-term follow-up after conservative surgery for rectovaginal endometriosis. Am J Obstet Gynecol 2004; 190: 1020–4.
19. Тихомиров А.Л., Залеева Е.В. Роль левоноргестрел-рилизинг системы в комплексном лечении миомы матки. Актуальные вопросы клинической транспортной медицины. 2006.
20. 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. 2005.
21. Bahamondes, Ribeiro-Huguet et al. Levonorgestrel-releasing intrauterine system (Mirena) as a therapy for endometrial hyperplasia and carcinoma. Acta Obstet Gynecol Scand 2003; 82 (6): 580–2.
22. Baldaszti E, Wimmer-Puchinger B et al. Acceptability of the long-term contraceptive levonorgestrel-releasing intrauterine system (Mirena): a 3-year follow-up study. Contraception 2003; 67 (2): 87–91.
23. 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.
2. Вихляева Е.М. О стратегии и тактике ведения больных с миомой матки. Вестн. Рос. ассоциации акушеров-гинекологов. 1997; 3: 21–3.
3. 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.
4. Wang S, Su Q et al. Clonality of multiple uterine leiomyomas. Zhonghua Bing Li Xue Za Zhi 2002; 31 (2): 107–11.
5. Rachev E. Mirena – the first intrauterine contraceptive rherapeutic system. Akush Ginekol (Sofiia) 2001; 40 (Suppl. 6): 3–6.
6. Сидорова И.С. Миома матки. М.: Мед. информ. агентство, 2005.
7. 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.
8. Tiltman AJ. Smooth muscle neoplasms of the uterus. Curr Opin Obstet Gynecol 1997; 9 (1): 48–51.
9. 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.
10. Maia H Jr, Maltez A. Insertion of mirena after endometrial resection in patients with adenomyosis. J Am Assoc Gynecol Laparosc 2003; 10 (4): 512–6.
11. Levy BS. Management of uterine fibroids. Acta Obstet Gynecol Scand 2008; 87 (8): 812–23.
12. 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.
13. Perino A, Quartararo P, Catinella E et al. Тreatment of endometrial hyperplasis with levonorgestrel-releasing intrauterine devices. Acta Fertil 1987.
14. Rein MS. Advances in uterine leiomyoma research: the progesterone hypothesis. Environ Health Perspect 2000; 108 (5): 791–3.
15. 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.
16. Searselli G, Tantini C, Colafranceschi M et al. Levonorgestrel-releasing intrauterine devices and precancerous lesious of the endometrium. Eur J Gynecol Oncol 1988; 9 (4): 284–86.
17. Vollenboven BJ, Lawrence AS, Healy DL. Uterine Fibroids 1997; 97: 285–98.
18. Fedele L, Bianchi S, Zanconato G et al. Long-term follow-up after conservative surgery for rectovaginal endometriosis. Am J Obstet Gynecol 2004; 190: 1020–4.
19. Тихомиров А.Л., Залеева Е.В. Роль левоноргестрел-рилизинг системы в комплексном лечении миомы матки. Актуальные вопросы клинической транспортной медицины. 2006.
20. 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. 2005.
21. Bahamondes, Ribeiro-Huguet et al. Levonorgestrel-releasing intrauterine system (Mirena) as a therapy for endometrial hyperplasia and carcinoma. Acta Obstet Gynecol Scand 2003; 82 (6): 580–2.
22. Baldaszti E, Wimmer-Puchinger B et al. Acceptability of the long-term contraceptive levonorgestrel-releasing intrauterine system (Mirena): a 3-year follow-up study. Contraception 2003; 67 (2): 87–91.
23. 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.
________________________________________________
1. Redwine DB, Wright JT. Laparoscopic treatment of complete obliteration of the cul-de-sac associated with endometriosis: long-term follow-up of en bloc resection. Fertil Steril 2001; 76: 358–65.
2. Вихляева Е.М. О стратегии и тактике ведения больных с миомой матки. Вестн. Рос. ассоциации акушеров-гинекологов. 1997; 3: 21–3.
3. 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.
4. Wang S, Su Q et al. Clonality of multiple uterine leiomyomas. Zhonghua Bing Li Xue Za Zhi 2002; 31 (2): 107–11.
5. Rachev E. Mirena – the first intrauterine contraceptive rherapeutic system. Akush Ginekol (Sofiia) 2001; 40 (Suppl. 6): 3–6.
6. Сидорова И.С. Миома матки. М.: Мед. информ. агентство, 2005.
7. 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.
8. Tiltman AJ. Smooth muscle neoplasms of the uterus. Curr Opin Obstet Gynecol 1997; 9 (1): 48–51.
9. 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.
10. Maia H Jr, Maltez A. Insertion of mirena after endometrial resection in patients with adenomyosis. J Am Assoc Gynecol Laparosc 2003; 10 (4): 512–6.
11. Levy BS. Management of uterine fibroids. Acta Obstet Gynecol Scand 2008; 87 (8): 812–23.
12. 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.
13. Perino A, Quartararo P, Catinella E et al. Тreatment of endometrial hyperplasis with levonorgestrel-releasing intrauterine devices. Acta Fertil 1987.
14. Rein MS. Advances in uterine leiomyoma research: the progesterone hypothesis. Environ Health Perspect 2000; 108 (5): 791–3.
15. 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.
16. Searselli G, Tantini C, Colafranceschi M et al. Levonorgestrel-releasing intrauterine devices and precancerous lesious of the endometrium. Eur J Gynecol Oncol 1988; 9 (4): 284–86.
17. Vollenboven BJ, Lawrence AS, Healy DL. Uterine Fibroids 1997; 97: 285–98.
18. Fedele L, Bianchi S, Zanconato G et al. Long-term follow-up after conservative surgery for rectovaginal endometriosis. Am J Obstet Gynecol 2004; 190: 1020–4.
19. Тихомиров А.Л., Залеева Е.В. Роль левоноргестрел-рилизинг системы в комплексном лечении миомы матки. Актуальные вопросы клинической транспортной медицины. 2006.
20. 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. 2005.
21. Bahamondes, Ribeiro-Huguet et al. Levonorgestrel-releasing intrauterine system (Mirena) as a therapy for endometrial hyperplasia and carcinoma. Acta Obstet Gynecol Scand 2003; 82 (6): 580–2.
22. Baldaszti E, Wimmer-Puchinger B et al. Acceptability of the long-term contraceptive levonorgestrel-releasing intrauterine system (Mirena): a 3-year follow-up study. Contraception 2003; 67 (2): 87–91.
23. 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.
Авторы
А.Л.Тихомиров
ГБОУ ВПО Московский государственный медико-стоматологический университет им. А.И.Евдокимова Минздрава России
ГБОУ ВПО Московский государственный медико-стоматологический университет им. А.И.Евдокимова Минздрава России
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A.L.Tikhomirov
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