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Алгоритм консервативного лечения миомы матки
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.
Key words: uterine fibroids, treatment algorithm, the levonorgestrel-releasing intrauterine system Mirena.
Ключевые слова: миома матки, алгоритм лечения, внутриматочная левоноргестрел-рилизинг-система Мирена.
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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.
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.
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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