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Органосохраняющие методы лечения миомы матки: есть ли повод для дискуссии?
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Аннотация
За последние годы появились новые консервативные методы лечения миомы матки и малоинвазивные методики, позволяющие чаще проводить органосберегающие вмешательства. Накопленный опыт позволяет сравнить репродуктивные исходы, качество жизни в послеоперационном периоде и другие отдаленные результаты. На основании этих данных гинеколог может принять взвешенное решение об оптимальном алгоритме ведения пациенток с различными клиническими проявлениями миомы. В данном обзоре представлены современные данные о применении эмболизации маточных артерий, об использовании внутриматочного шейвера и возможных путях оптимизации лапароскопических миомэктомий с целью повышения безопасности и эффективности лечения.
Ключевые слова: миома матки, миомэктомия, эмболизация маточных артерий, лапароскопия, внутриматочный шейвер, самофиксирующиеся нити.
Ключевые слова: миома матки, миомэктомия, эмболизация маточных артерий, лапароскопия, внутриматочный шейвер, самофиксирующиеся нити.
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Over the past years, new conservative methods of treatment of uterine fibroids and minimally invasive techniques that allow more frequent organ preserving interventions to take place. Accumulated experience allows us to compare the reproductive outcomes, quality of life in the postoperative period and other long-term results. Based on these data a gynecologist can make an informative decision about the optimal algorithm of patients with different clinical manifestations of myomas. This review presents recent data on the use of uterine artery embolization, the use of intrauterine shaver and possible ways of optimizing the laparoscopic myomectomy in order to improve the safety and efficacy of treatment.
Key words: uterine fibroids, myomectomy, uterine artery embolization, laparoscopy, endometrial shaver, self-locking thread.
Полный текст
Список литературы
1. Банщиков В.М., Гуськов В.С., Мягков И.Ф. Медицинская психология. М.: Медицина, 1967.
2. Коренная В.В., Подзолкова Н.М. Улипристала ацетат в лечении миомы матки. Гинекология. 2013; 6: 20–4.
3. Мартынова А.Е., Смольникова В.Ю. Эффективность программы ЭКО у женщин с миомой матки. Проблемы репродукции. 2012; 6: 43–6.
4. Мейтина Е.Н. Особенности психотерапии у женщин с хроническими процессами генерационных органов, осложненных нервно-психическими нарушениями. Вопросы психотерапии (авторефераты докладов на Всесоюзном совещании по психотерапии 27–30 июня 1966 г.). М., 1966; с. 157–8.
5. Савельева Г.М., Курцер М.А., Бреусенко В.Г. и др. Эндоскопическая миомэктомия: за и против. Вопр. акуш. гинекол. и перинатол. 2007; 6 (1): 57–60.
6. Савицкий Г.А., Савицкий А. Г. Миома матки. СПб.: ЭЛБИ-СПб, 2000.
7. Пучков К.В., Коренная В.В., Пучков Д.К. Применение самофиксирующихся хирургических нитей в акушерстве и гинекологии. Эндоскопическая хирургия. 2014; 4: 46–51.
8. Пучков К.В., Коренная В.В., Добычина А.В., Дорофеева К.М. Временная окклюзия внутренних подвздошных артерий при лапароскопической миомэктомии. Эндоскопическая хирургия. 2013; 5: 16–9.
9. Bigatti G, Ferrario C, Rosales M et al. A 4-cm G2 cervical submucosal myoma removed with the IBSR Integrated Bigatti Shaver Springer Open Choice. 2012; 9 (4): 453.
10. Bosteels J, Kasius J, Weyers S et al. Hysteroscopy for treating subfertility associated with suspected major uterine cavity abnormalities. Cochrane Database of Systematic Reviews Issue 1. 2013. Art. No.:CD009461.
11. Bujold E, Bujold C, Hamilton EF et al. The impact of a single-layer or double-layer closure on uterine rupture. Am J Obstet Gynecol 2002; 186: 1326–30.
12. Cain-Nielsen Anne H, James MS, Moriarty P et al. Cost-Effectiveness of Uterine-Preserving Procedures for the Treatment of Uterine Fibroid Symptoms in the United States. J Comp Eff Res 2014; 3 (5): 503–14.
13. Carli F, Charlebois P, Baldini G et al. An integrated multidisciplinary approach to implementation of a fast-track program for laparoscopic colorectal surgery. Canadian J Anesthesia 2009; 56 (11): 837–42.
14. Carter J. Fast-Track Surgery in Gynaecology and Gynaecologic Oncology: а Review of a Rolling Clinical Audit. ISRN Surg 2012; 2012: 368014.
15. Kongnyuy Е, Wiysonge С. Interventions to reduce haemorrhage during myomectomy for fibroids, Editorial Group: Cochrane Menstrual Disorders and Subfertility Group, 2009.
16. Freed MM, Spies JB. Uterine artery embolization for fibroids: a review of current outcomes. Seminars in Reproductive Medicine 2010; 28 (3): 235–41.
17. Gupta Janesh K, Sinha Anju, Lumsden MA, Hickey Martha. Intervention Review: Uterine artery embolization for symptomatic uterine fibroids, Editorial Group: Cochrane Menstrual Disorders and Subfertility Group.
18. Hardi J. Психология работы с больным. Будапешт, 1972.
19. Homer H, Saridogan E. Uterine artery embolization for fibroids is associated with an increased risk of miscarriage. Fertil Steril 2010; 94 (1): 324–30.
20. Kaump GR, Spies JB. The impact of uterine artery embolization on ovarian function. J Vasc Interv Radiol 2013; 24 (4): 459–67.
21. Kehlet H. Fast-track colorectal surgery. Lancet 2008; 371 (9615): 791–3.
22. Mara M, Fucíkova Z, Maskova J et al. Midterm clinical and first reproductive results of a randomized controlled trial comparing uterine fibroid embolization and myomectomy. Cardiovasc Intervent Radiol 2008; 31 (1): 73–85.
23. Mara M, Horak P, Kubinova K et al. Hysteroscopy after uterine fibroid embolization: evaluation of intrauterine findings in 127 patients. J Obstet Gynaecol Res 2012; 38 (5): 823–31.
24. Mara М, Kubinova К. Embolization of uterine fibroids from the point of view of the gynecologist: pros and cons. Int J Womens Health 2014; 6: 623–9.
25. Memtsa М, Homer Н. Сomplications Associated with Uterine Artery Embolisation for Fibroids. Obstet Gynecol Int 2012; 2012. Article ID 290542.
26. Mitchell SR. Advances in uterine leiomyoma research: the progesterone hypothesis environmental health perspectives. 2000; 108 (Suppl. 5): 791–3.
27. Moss JG, Cooper KG, Khaund A et al. Randomised comparison of uterine artery embolisation (UAE) with surgical treatment in patients with symptomatic uterine fibroids (REST trial): 5-Year results. BJOG 2011; 118 (8): 936–44.
28. Somigliana Е,Vercellini Р, Daguati R et al. Fibroids and female reproduction: a critical analysis of the evidence. Hum Reprod Update 2007; p. 1–12.
29. Spies JB, Roth AR, Gonsalves SM, Murphy-Skrzyniarz KM. Ovarian function after uterine artery embolization for leiomyomata: assessment with use of serum follicle stimulating hormone assay. J Vasc Interv Radiol 2001; 12 (4): 437–42.
30. Torre A, Paillusson B, Fain V et al. Uterine artery embolization for severe symptomatic fibroids: effects on fertility and symptoms. Hum Reprod 2014; 29 (3): 490–501.
31. Tropeano G, di Stasi C, Litwicka K et al. Uterine artery embolization for fibroids does not have adverse effects on ovarian reserve in regularly cycling women younger than 40 years. Fertil Steril 2004; 81 (4): 1055–61.
32. Van der Kooij SM, Hehenkamp WJK, Volkers NA et al. Uterine artery embolization vs hysterectomy in the treatment of symptomatic uterine fibroids: 5-Year outcome from the randomized EMMY trial. Am J Obstet Gynecol 2010; 203 (2): 105–13.
33. Varadhan KK, Lobo DN, Ljungqvist O. Enhanced recovery after surgery: the future of improving surgical care. Critical Care Clinics 2010; 26 (3): 527–47.
34. Wamsteker K, Emanuel MH, Kruif JH. Transcervical hysteroscopic resection of submucous fibroids for abnormal uterine bleeding: result regarding the degree of intramural extension. Obstet Gynecol 1993; 82: 736–40.
35. Lethaby A, Vollenhoven B, Sowter M. Pre-operative GnRH analogue therapy before hysterectomy or myomectomy for uterine fibroids. Cochrane Database Syst Rev 2001; 2: CD000547.
2. Коренная В.В., Подзолкова Н.М. Улипристала ацетат в лечении миомы матки. Гинекология. 2013; 6: 20–4.
3. Мартынова А.Е., Смольникова В.Ю. Эффективность программы ЭКО у женщин с миомой матки. Проблемы репродукции. 2012; 6: 43–6.
4. Мейтина Е.Н. Особенности психотерапии у женщин с хроническими процессами генерационных органов, осложненных нервно-психическими нарушениями. Вопросы психотерапии (авторефераты докладов на Всесоюзном совещании по психотерапии 27–30 июня 1966 г.). М., 1966; с. 157–8.
5. Савельева Г.М., Курцер М.А., Бреусенко В.Г. и др. Эндоскопическая миомэктомия: за и против. Вопр. акуш. гинекол. и перинатол. 2007; 6 (1): 57–60.
6. Савицкий Г.А., Савицкий А. Г. Миома матки. СПб.: ЭЛБИ-СПб, 2000.
7. Пучков К.В., Коренная В.В., Пучков Д.К. Применение самофиксирующихся хирургических нитей в акушерстве и гинекологии. Эндоскопическая хирургия. 2014; 4: 46–51.
8. Пучков К.В., Коренная В.В., Добычина А.В., Дорофеева К.М. Временная окклюзия внутренних подвздошных артерий при лапароскопической миомэктомии. Эндоскопическая хирургия. 2013; 5: 16–9.
9. Bigatti G, Ferrario C, Rosales M et al. A 4-cm G2 cervical submucosal myoma removed with the IBSR Integrated Bigatti Shaver Springer Open Choice. 2012; 9 (4): 453.
10. Bosteels J, Kasius J, Weyers S et al. Hysteroscopy for treating subfertility associated with suspected major uterine cavity abnormalities. Cochrane Database of Systematic Reviews Issue 1. 2013. Art. No.:CD009461.
11. Bujold E, Bujold C, Hamilton EF et al. The impact of a single-layer or double-layer closure on uterine rupture. Am J Obstet Gynecol 2002; 186: 1326–30.
12. Cain-Nielsen Anne H, James MS, Moriarty P et al. Cost-Effectiveness of Uterine-Preserving Procedures for the Treatment of Uterine Fibroid Symptoms in the United States. J Comp Eff Res 2014; 3 (5): 503–14.
13. Carli F, Charlebois P, Baldini G et al. An integrated multidisciplinary approach to implementation of a fast-track program for laparoscopic colorectal surgery. Canadian J Anesthesia 2009; 56 (11): 837–42.
14. Carter J. Fast-Track Surgery in Gynaecology and Gynaecologic Oncology: а Review of a Rolling Clinical Audit. ISRN Surg 2012; 2012: 368014.
15. Kongnyuy Е, Wiysonge С. Interventions to reduce haemorrhage during myomectomy for fibroids, Editorial Group: Cochrane Menstrual Disorders and Subfertility Group, 2009.
16. Freed MM, Spies JB. Uterine artery embolization for fibroids: a review of current outcomes. Seminars in Reproductive Medicine 2010; 28 (3): 235–41.
17. Gupta Janesh K, Sinha Anju, Lumsden MA, Hickey Martha. Intervention Review: Uterine artery embolization for symptomatic uterine fibroids, Editorial Group: Cochrane Menstrual Disorders and Subfertility Group.
18. Hardi J. Психология работы с больным. Будапешт, 1972.
19. Homer H, Saridogan E. Uterine artery embolization for fibroids is associated with an increased risk of miscarriage. Fertil Steril 2010; 94 (1): 324–30.
20. Kaump GR, Spies JB. The impact of uterine artery embolization on ovarian function. J Vasc Interv Radiol 2013; 24 (4): 459–67.
21. Kehlet H. Fast-track colorectal surgery. Lancet 2008; 371 (9615): 791–3.
22. Mara M, Fucíkova Z, Maskova J et al. Midterm clinical and first reproductive results of a randomized controlled trial comparing uterine fibroid embolization and myomectomy. Cardiovasc Intervent Radiol 2008; 31 (1): 73–85.
23. Mara M, Horak P, Kubinova K et al. Hysteroscopy after uterine fibroid embolization: evaluation of intrauterine findings in 127 patients. J Obstet Gynaecol Res 2012; 38 (5): 823–31.
24. Mara М, Kubinova К. Embolization of uterine fibroids from the point of view of the gynecologist: pros and cons. Int J Womens Health 2014; 6: 623–9.
25. Memtsa М, Homer Н. Сomplications Associated with Uterine Artery Embolisation for Fibroids. Obstet Gynecol Int 2012; 2012. Article ID 290542.
26. Mitchell SR. Advances in uterine leiomyoma research: the progesterone hypothesis environmental health perspectives. 2000; 108 (Suppl. 5): 791–3.
27. Moss JG, Cooper KG, Khaund A et al. Randomised comparison of uterine artery embolisation (UAE) with surgical treatment in patients with symptomatic uterine fibroids (REST trial): 5-Year results. BJOG 2011; 118 (8): 936–44.
28. Somigliana Е,Vercellini Р, Daguati R et al. Fibroids and female reproduction: a critical analysis of the evidence. Hum Reprod Update 2007; p. 1–12.
29. Spies JB, Roth AR, Gonsalves SM, Murphy-Skrzyniarz KM. Ovarian function after uterine artery embolization for leiomyomata: assessment with use of serum follicle stimulating hormone assay. J Vasc Interv Radiol 2001; 12 (4): 437–42.
30. Torre A, Paillusson B, Fain V et al. Uterine artery embolization for severe symptomatic fibroids: effects on fertility and symptoms. Hum Reprod 2014; 29 (3): 490–501.
31. Tropeano G, di Stasi C, Litwicka K et al. Uterine artery embolization for fibroids does not have adverse effects on ovarian reserve in regularly cycling women younger than 40 years. Fertil Steril 2004; 81 (4): 1055–61.
32. Van der Kooij SM, Hehenkamp WJK, Volkers NA et al. Uterine artery embolization vs hysterectomy in the treatment of symptomatic uterine fibroids: 5-Year outcome from the randomized EMMY trial. Am J Obstet Gynecol 2010; 203 (2): 105–13.
33. Varadhan KK, Lobo DN, Ljungqvist O. Enhanced recovery after surgery: the future of improving surgical care. Critical Care Clinics 2010; 26 (3): 527–47.
34. Wamsteker K, Emanuel MH, Kruif JH. Transcervical hysteroscopic resection of submucous fibroids for abnormal uterine bleeding: result regarding the degree of intramural extension. Obstet Gynecol 1993; 82: 736–40.
35. Lethaby A, Vollenhoven B, Sowter M. Pre-operative GnRH analogue therapy before hysterectomy or myomectomy for uterine fibroids. Cochrane Database Syst Rev 2001; 2: CD000547.
________________________________________________
1. Банщиков В.М., Гуськов В.С., Мягков И.Ф. Медицинская психология. М.: Медицина, 1967.
2. Коренная В.В., Подзолкова Н.М. Улипристала ацетат в лечении миомы матки. Гинекология. 2013; 6: 20–4.
3. Мартынова А.Е., Смольникова В.Ю. Эффективность программы ЭКО у женщин с миомой матки. Проблемы репродукции. 2012; 6: 43–6.
4. Мейтина Е.Н. Особенности психотерапии у женщин с хроническими процессами генерационных органов, осложненных нервно-психическими нарушениями. Вопросы психотерапии (авторефераты докладов на Всесоюзном совещании по психотерапии 27–30 июня 1966 г.). М., 1966; с. 157–8.
5. Савельева Г.М., Курцер М.А., Бреусенко В.Г. и др. Эндоскопическая миомэктомия: за и против. Вопр. акуш. гинекол. и перинатол. 2007; 6 (1): 57–60.
6. Савицкий Г.А., Савицкий А. Г. Миома матки. СПб.: ЭЛБИ-СПб, 2000.
7. Пучков К.В., Коренная В.В., Пучков Д.К. Применение самофиксирующихся хирургических нитей в акушерстве и гинекологии. Эндоскопическая хирургия. 2014; 4: 46–51.
8. Пучков К.В., Коренная В.В., Добычина А.В., Дорофеева К.М. Временная окклюзия внутренних подвздошных артерий при лапароскопической миомэктомии. Эндоскопическая хирургия. 2013; 5: 16–9.
9. Bigatti G, Ferrario C, Rosales M et al. A 4-cm G2 cervical submucosal myoma removed with the IBSR Integrated Bigatti Shaver Springer Open Choice. 2012; 9 (4): 453.
10. Bosteels J, Kasius J, Weyers S et al. Hysteroscopy for treating subfertility associated with suspected major uterine cavity abnormalities. Cochrane Database of Systematic Reviews Issue 1. 2013. Art. No.:CD009461.
11. Bujold E, Bujold C, Hamilton EF et al. The impact of a single-layer or double-layer closure on uterine rupture. Am J Obstet Gynecol 2002; 186: 1326–30.
12. Cain-Nielsen Anne H, James MS, Moriarty P et al. Cost-Effectiveness of Uterine-Preserving Procedures for the Treatment of Uterine Fibroid Symptoms in the United States. J Comp Eff Res 2014; 3 (5): 503–14.
13. Carli F, Charlebois P, Baldini G et al. An integrated multidisciplinary approach to implementation of a fast-track program for laparoscopic colorectal surgery. Canadian J Anesthesia 2009; 56 (11): 837–42.
14. Carter J. Fast-Track Surgery in Gynaecology and Gynaecologic Oncology: а Review of a Rolling Clinical Audit. ISRN Surg 2012; 2012: 368014.
15. Kongnyuy Е, Wiysonge С. Interventions to reduce haemorrhage during myomectomy for fibroids, Editorial Group: Cochrane Menstrual Disorders and Subfertility Group, 2009.
16. Freed MM, Spies JB. Uterine artery embolization for fibroids: a review of current outcomes. Seminars in Reproductive Medicine 2010; 28 (3): 235–41.
17. Gupta Janesh K, Sinha Anju, Lumsden MA, Hickey Martha. Intervention Review: Uterine artery embolization for symptomatic uterine fibroids, Editorial Group: Cochrane Menstrual Disorders and Subfertility Group.
18. Hardi J. Психология работы с больным. Будапешт, 1972.
19. Homer H, Saridogan E. Uterine artery embolization for fibroids is associated with an increased risk of miscarriage. Fertil Steril 2010; 94 (1): 324–30.
20. Kaump GR, Spies JB. The impact of uterine artery embolization on ovarian function. J Vasc Interv Radiol 2013; 24 (4): 459–67.
21. Kehlet H. Fast-track colorectal surgery. Lancet 2008; 371 (9615): 791–3.
22. Mara M, Fucíkova Z, Maskova J et al. Midterm clinical and first reproductive results of a randomized controlled trial comparing uterine fibroid embolization and myomectomy. Cardiovasc Intervent Radiol 2008; 31 (1): 73–85.
23. Mara M, Horak P, Kubinova K et al. Hysteroscopy after uterine fibroid embolization: evaluation of intrauterine findings in 127 patients. J Obstet Gynaecol Res 2012; 38 (5): 823–31.
24. Mara М, Kubinova К. Embolization of uterine fibroids from the point of view of the gynecologist: pros and cons. Int J Womens Health 2014; 6: 623–9.
25. Memtsa М, Homer Н. Сomplications Associated with Uterine Artery Embolisation for Fibroids. Obstet Gynecol Int 2012; 2012. Article ID 290542.
26. Mitchell SR. Advances in uterine leiomyoma research: the progesterone hypothesis environmental health perspectives. 2000; 108 (Suppl. 5): 791–3.
27. Moss JG, Cooper KG, Khaund A et al. Randomised comparison of uterine artery embolisation (UAE) with surgical treatment in patients with symptomatic uterine fibroids (REST trial): 5-Year results. BJOG 2011; 118 (8): 936–44.
28. Somigliana Е,Vercellini Р, Daguati R et al. Fibroids and female reproduction: a critical analysis of the evidence. Hum Reprod Update 2007; p. 1–12.
29. Spies JB, Roth AR, Gonsalves SM, Murphy-Skrzyniarz KM. Ovarian function after uterine artery embolization for leiomyomata: assessment with use of serum follicle stimulating hormone assay. J Vasc Interv Radiol 2001; 12 (4): 437–42.
30. Torre A, Paillusson B, Fain V et al. Uterine artery embolization for severe symptomatic fibroids: effects on fertility and symptoms. Hum Reprod 2014; 29 (3): 490–501.
31. Tropeano G, di Stasi C, Litwicka K et al. Uterine artery embolization for fibroids does not have adverse effects on ovarian reserve in regularly cycling women younger than 40 years. Fertil Steril 2004; 81 (4): 1055–61.
32. Van der Kooij SM, Hehenkamp WJK, Volkers NA et al. Uterine artery embolization vs hysterectomy in the treatment of symptomatic uterine fibroids: 5-Year outcome from the randomized EMMY trial. Am J Obstet Gynecol 2010; 203 (2): 105–13.
33. Varadhan KK, Lobo DN, Ljungqvist O. Enhanced recovery after surgery: the future of improving surgical care. Critical Care Clinics 2010; 26 (3): 527–47.
34. Wamsteker K, Emanuel MH, Kruif JH. Transcervical hysteroscopic resection of submucous fibroids for abnormal uterine bleeding: result regarding the degree of intramural extension. Obstet Gynecol 1993; 82: 736–40.
35. Lethaby A, Vollenhoven B, Sowter M. Pre-operative GnRH analogue therapy before hysterectomy or myomectomy for uterine fibroids. Cochrane Database Syst Rev 2001; 2: CD000547.
Авторы
В.В.Коренная1, Н.М.Подзолкова1, К.В.Пучков2
1. ГБОУ ДПО Российская медицинская академия последипломного образования Минздрава России, Москва;
2. ГБОУ ВПО Рязанский государственный медицинский университет им. акад. И.П.Павлова Минздрава России
1. ГБОУ ДПО Российская медицинская академия последипломного образования Минздрава России, Москва;
2. ГБОУ ВПО Рязанский государственный медицинский университет им. акад. И.П.Павлова Минздрава России
________________________________________________
V.V.Korennaya, N.M.Podzolkova, K.V.Puchkov
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