Эндометриоз и спаечный процесс: что мы знаем и что можем

Дубровина С.О., Берлим Ю.Д., Александрина А.Д. и др. Эндометриоз и спаечный процесс: что мы знаем и что можем. Гинекология. 2020; 22 (6): 32–37. DOI: 10.26442/20795696.2020.6.200569

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Dubrovina S.O., Berlim Yu.D., Alexandrina A.D. et al. Endometriosis and adhesion process: what we know and what we can. Gynecology. 2020; 22 (6): 32–37. DOI: 10.26442/20795696.2020.6.200569

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Аннотация

Эндометриоз – заболевание, связанное с воспалительным процессом в брюшной полости, приводящим не только к хронической тазовой боли, но и к спаечному процессу. Частота спаек органов малого таза в первые несколько недель после операции составляет от 25 до 92%. На развитие спаечного процесса влияет ряд факторов, в перечень которых входят степень тяжести эндометриоза, выбор вида хирургического доступа, техника и объем оперативного вмешательства. Образование связанных с эндометриозом спаек может быть предотвращено с помощью совокупности мер, применяемых во время и после оперативного вмешательства. В обзоре литературы представлена оценка степени спаечного процесса, способов его лечения и профилактики у женщин с эндометриозом.

Ключевые слова: эндометриоз, спаечный процесс.

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Endometriosis is disease connected with inflammatory process in the peritoneum area, which leads to the development of the chronic pelvic pain and adhesion process. Frequency of small pelvic organs adhesion within several weeks following the operation makes up from 25 till 92%. A number of factors that influence the development of adhesion process, namely the degree of seriousness of endometriosis, decision on the type of surgery, technique and the amount of surgery. Formation of adhesions caused by endometriosis can be prevented through to joint measures taken in proper time and after the operation. In this literature review the estimation rate of adhesion is represented as well as the ways of its treatment and prevention at women with endometriosis.

Key words: endometriosis, adhesion process.

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Список литературы

1. Hirsch M, Begum MR, Paniz É еt al. Diagnosis and management of endometriosis: a systematic review of international and national guidelines. BJOG 2018; 125 (5): 556–64.
2. Vercellini P, Vigano P, Somigliana E, Fedele L. Endometriosis: pathogenesis and treatment. Nat Rev Endocrinol 2014; 10 (5): 261–75.
3. Jerman LF, Hey-Cunningham AJ. The role of the lymphatic system in endometriosis: a comprehensive review of the literature. Biol Reprod 2015; 92 (3): 64.
4. Yoshida K, Yoshihara K, Adachi S et al. Possible involvement of the E-cadherin gene in genetic susceptibility to endometriosis. Hum Reprod 2012; 27: 1685–9.
5. Li J, Dai Y, Zhu H et al. Endometriotic mesenchymal stem cells significantly promote fibrogenesis in ovarian endometrioma through the Wnt/b-catenin pathway by paracrine production of TGF-b1 and Wnt1. Hum Reprod 2016; 31 (6): 1224–35.
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[Dubrovina S.O., Berlim Yu.D., Gimbut V.S. et al. Potentsial'naia rol' stvolovykh kletok v patogeneze endometrioza. Problemy reproduktsii. 2017; 23 (2): 66–71 (in Russian).]
7. Liu Y, Liang S, Yang F еt al. Biological characteristics of endometriotic mesenchymal stem cells isolated from ectopic lesions of patients with endometriosis. Stem Cell Res Ther 2020; 11: 346. DOI: 10.1186/s13287-020-01856-8
8. Zondervan KT, Rahmioglu N, Morris AP еt al. Beyond Endometriosis Genome-Wide Association Study: From Genomics to Phenomics to the Patient. Semin Reprod Med 2016; 34: 242–54.
9. Sapkota Y, Low S-K, Attia J et al. Association between endometriosis and the interleukin 1A (IL1A) locus. Hum Reprod 2015; 30: 239–48.
10. Rahmioglu N, Banasik K, Christofidou P et al. Large-scale genome-wide association meta-analysis of endometriosis reveals 13 novel loci and genetically-associated comorbidity with other pain conditions. bioRxiv2018.
11. Li X-X, Gao S-Y, Wang P-Y et al. Reduced expression levels of let-7c in human breast cancer patients. Oncol Lett 2015; 9: 1207–12.
12. Tan M, Luo H, Lee S et al. Identification of 67 histone marks and histone lysine crotonylation as a new type of histone modification. Cell 2011; 146: 1016–28.
13. Koukoura O, Sifakis S, Spandidos DA. DNA methylation in endometriosis (Review). Mol Med Rep 2016; 13: 2939–48.
14. Zubrzycka А, Zubrzycki М, Perdas Е, Zubrzycka М. Genetic, Epigenetic, and Steroidogenic Modulation Mechanisms in Endometriosis. J Clin Med 2020; 9: 1309. DOI: 10.3390/jcm9051309
15. Albertsen HM, Ward K. Genes linked to endometriosis by GWAS are integral to cytoskeleton regulation and suggests that mesothelial barrier homeostasis is a factor in the pathogenesis of endometriosis. Reprod Sci 2017; 24 (6): 803–11. DOI: 10.1177/1933719116660847
16. Demir AY, Groothuis PG, Nap AW et al. Menstrual effluent induces epithelial-mesenchymal transitions in mesothelial cells. Hum Reprod 2004; 19 (1): 21–9.
17. Jin X, Ren S, Macarak E, Rosenbloom J. Pathobiological mechanisms of peritoneal adhesions: The mesenchymal transition of rat peritoneal mesothelial cells induced by TGF-beta1 and IL-6 requires activation of Erk1/2 and Smad2 linker region phosphorylation. Matrix Biol 2016; 51: 55–64.
18. Davis FM, Stewart TA, Thompson EW, Monteith GR. Targeting EMT in cancer: opportunities for pharmacological intervention. Trends Pharmacol Sci 2014; 35 (9): 479–88.
19. Somigliana E, Vigano P, Benaglia L еt al. Adhesion Prevention in Endometriosis: A Neglected Critical Challenge. J Minim Invasive Gynecol 2012; 19: 415–21.
20. Imai A, Suzuki N. Topical non-barrier agents for postoperative adhesion prevention in animal models. Eur J Obstet Gynecol Reprod Biol 2010; 149: 131–5.
21. Ahmad G, Kim K, Thompson M еt al. Barrier agents for adhesion prevention a er gynaecological surgery. Cochrane Database of Systematic Reviews 2020. Issue 3. Art. No.: CD000475. DOI: 10.1002/14651858.CD000475.pub4
22. Davey AK, Maher PJ. Surgical adhesions: a timely update, a great challenge for the future. J Minim Invasive Gynecol 2007; 14: 15–22.
23. Okabayashi K, Ashrafian H, Zacharakis E et al. Adhesions a er abdominal surgery: a systematic review of the incidence, distribution and severity. Surgery Today 2014; 44: 405–20. PUBMED: 23657643
24. Alborzi S, Motazedian S, Parsanezhad ME. Chance of adhesion formation after laparoscopic salpingo-ovariolysis: is there a place for second-look laparoscopy? J Am Assoc Gynecol Laparosc 2003; 10: 172–6.
25. Swank DJ, Swank-Bordewijk SC, Hop WC et al. Laparoscopic adhesiolysis in patients with chronic abdominal pain: a blinded randomised controlled multicentre trial. Lancet 2003; 361: 1247–51.
26. Дубровина С.О., Берлим Ю.Д. Гестагены в терапии эндометриоза. Акушерство и гинекология. 2018; 5: 150–4.
[Dubrovina S.O., Berlim Iu.D. Gestageny v terapii endometrioza. Akusherstvo i ginekologiia. 2018; 5: 150–4 (in Russian).]
27. Searchable R, Mabrouk M, Frasca C et al. Long-term oral contraceptive pills and postoperative pain management after laparoscopic excision of ovarian endometrioma: a randomized controlled trial. Fertil Steril 2010; 94: 464–71.
28. Seracchioli R, Mabrouk M, Frasca C et al. Long-term cyclic and continuous oral contraceptive therapy and endometrioma recurrence: a randomized controlled trial. Fertil Steril 2010; 93: 52–6.
29. Ichikawa М, Akira S, Kaseki H еt al. Accuracy and clinical value of an adhesion scoring system: A preoperative diagnostic method using transvaginal ultrasonography for endometriotic adhesion. J Obstet Gynaecol Res 2020. DOI: 10.1111/jog.14191
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[Dubrovina S.O., Berlim Yu.D., Gimbut V.S. et al. Management of endometriomas. Gynecology. 2017; 19 (4): 30–5 (in Russian).]
31. Di Paola V, Manfredi R, Castelli F еt al. Detection and localization of deep endometriosis by means of MRI and correlation with the ENZIAN score. Eur J Radiol 2015; 84: 568–74.
32. Dueholm M, Lundorf E. Transvaginal ultrasound or MRI for diagnosis of adenomyosis. Curr Opin Obstet Gynecol 2007; 19: 505–12.
33. Chapron C, Tosti C, Marcellin L et al. Relationship between the magnetic resonance imaging appearance of adenomyosis and endometriosis phenotypes. Hum Reprod 2017; 32: 1393–401.
34. Bazot M, Lafont C, Rouzier R еt al. Diagnostic accuracy of physical examination, transvaginal sonography, rectal endoscopic sonography, and magnetic resonance imaging to diagnose deep infiltrating endometriosis. Fertil Steril 2009; 92: 1825–33.
35. Manganaro L, Vittori G, Vinci V et al. Beyond laparoscopy: 3T magnetic resonance imaging in the evaluation of posterior cul-de-sac obliteration. Magn Reson Imaging 2012; 30: 1432–8.
36. Ahmad G, Thompson M, Kim K еt al. Fluid and pharmacological agents for adhesion prevention after gynaecological surgery. Cochrane Database of Systematic Reviews 2020. Issue 7. Art. No.: CD001298. DOI: 10.1002/14651858.CD001298.pub5
37. Leonardi M, Gibbons T, Armour M еt al. When to Do Surgery and When Not to Do Surgery for Endometriosis: A Systematic Review and Meta-analysis. J Minim Invasive Gynecol 2020; 27 (2): 390–407e3. DOI: 10.1016/j.jmig.2019.10.014
38. Дубровина С.О. Современные представления о спаечном процессе. Доктор.Ру. 2016; 3 (120): 34–8.
[Dubrovina S.O. Sovremennye predstavleniia o spaechnom protsesse. Doktor.Ru. 2016; 3 (120): 34–8 (in Russian).]
39. Ярмолинская М.И., Дурнева У.И., Сельков С.А. Иммуномодулятор Лонгидаза в комбинированном лечении наружного генитального эндометриоза. Журн. акушерства и женских болезней. 2016; 45: 76–7.
[Iarmolinskaia M.I., Durneva U.I., Sel'kov S.A. Immunomoduliator Longidaza v kombinirovannom lechenii naruzhnogo genital'nogo endometrioza. Zhurn. akusherstva i zhenskikh boleznei. 2016; 45: 76–7 (in Russian).]
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[Sulima A.N., Davydova A.A., Rybalka A.N. et al. Features of the prevention and treatment of adhesions in patients with chronic inflammatory diseases of the pelvic organs. Gynecology. 2018; 20 (1): 62–7 (in Russian).]

________________________________________________

1. Hirsch M, Begum MR, Paniz É еt al. Diagnosis and management of endometriosis: a systematic review of international and national guidelines. BJOG 2018; 125 (5): 556–64.
2. Vercellini P, Vigano P, Somigliana E, Fedele L. Endometriosis: pathogenesis and treatment. Nat Rev Endocrinol 2014; 10 (5): 261–75.
3. Jerman LF, Hey-Cunningham AJ. The role of the lymphatic system in endometriosis: a comprehensive review of the literature. Biol Reprod 2015; 92 (3): 64.
4. Yoshida K, Yoshihara K, Adachi S et al. Possible involvement of the E-cadherin gene in genetic susceptibility to endometriosis. Hum Reprod 2012; 27: 1685–9.
5. Li J, Dai Y, Zhu H et al. Endometriotic mesenchymal stem cells significantly promote fibrogenesis in ovarian endometrioma through the Wnt/b-catenin pathway by paracrine production of TGF-b1 and Wnt1. Hum Reprod 2016; 31 (6): 1224–35.
6. Dubrovina S.O., Berlim Yu.D., Gimbut V.S. et al. Potentsial'naia rol' stvolovykh kletok v patogeneze endometrioza. Problemy reproduktsii. 2017; 23 (2): 66–71 (in Russian).
7. Liu Y, Liang S, Yang F еt al. Biological characteristics of endometriotic mesenchymal stem cells isolated from ectopic lesions of patients with endometriosis. Stem Cell Res Ther 2020; 11: 346. DOI: 10.1186/s13287-020-01856-8
8. Zondervan KT, Rahmioglu N, Morris AP еt al. Beyond Endometriosis Genome-Wide Association Study: From Genomics to Phenomics to the Patient. Semin Reprod Med 2016; 34: 242–54.
9. Sapkota Y, Low S-K, Attia J et al. Association between endometriosis and the interleukin 1A (IL1A) locus. Hum Reprod 2015; 30: 239–48.
10. Rahmioglu N, Banasik K, Christofidou P et al. Large-scale genome-wide association meta-analysis of endometriosis reveals 13 novel loci and genetically-associated comorbidity with other pain conditions. bioRxiv2018.
11. Li X-X, Gao S-Y, Wang P-Y et al. Reduced expression levels of let-7c in human breast cancer patients. Oncol Lett 2015; 9: 1207–12.
12. Tan M, Luo H, Lee S et al. Identification of 67 histone marks and histone lysine crotonylation as a new type of histone modification. Cell 2011; 146: 1016–28.
13. Koukoura O, Sifakis S, Spandidos DA. DNA methylation in endometriosis (Review). Mol Med Rep 2016; 13: 2939–48.
14. Zubrzycka А, Zubrzycki М, Perdas Е, Zubrzycka М. Genetic, Epigenetic, and Steroidogenic Modulation Mechanisms in Endometriosis. J Clin Med 2020; 9: 1309. DOI: 10.3390/jcm9051309
15. Albertsen HM, Ward K. Genes linked to endometriosis by GWAS are integral to cytoskeleton regulation and suggests that mesothelial barrier homeostasis is a factor in the pathogenesis of endometriosis. Reprod Sci 2017; 24 (6): 803–11. DOI: 10.1177/1933719116660847
16. Demir AY, Groothuis PG, Nap AW et al. Menstrual effluent induces epithelial-mesenchymal transitions in mesothelial cells. Hum Reprod 2004; 19 (1): 21–9.
17. Jin X, Ren S, Macarak E, Rosenbloom J. Pathobiological mechanisms of peritoneal adhesions: The mesenchymal transition of rat peritoneal mesothelial cells induced by TGF-beta1 and IL-6 requires activation of Erk1/2 and Smad2 linker region phosphorylation. Matrix Biol 2016; 51: 55–64.
18. Davis FM, Stewart TA, Thompson EW, Monteith GR. Targeting EMT in cancer: opportunities for pharmacological intervention. Trends Pharmacol Sci 2014; 35 (9): 479–88.
19. Somigliana E, Vigano P, Benaglia L еt al. Adhesion Prevention in Endometriosis: A Neglected Critical Challenge. J Minim Invasive Gynecol 2012; 19: 415–21.
20. Imai A, Suzuki N. Topical non-barrier agents for postoperative adhesion prevention in animal models. Eur J Obstet Gynecol Reprod Biol 2010; 149: 131–5.
21. Ahmad G, Kim K, Thompson M еt al. Barrier agents for adhesion prevention a er gynaecological surgery. Cochrane Database of Systematic Reviews 2020. Issue 3. Art. No.: CD000475. DOI: 10.1002/14651858.CD000475.pub4
22. Davey AK, Maher PJ. Surgical adhesions: a timely update, a great challenge for the future. J Minim Invasive Gynecol 2007; 14: 15–22.
23. Okabayashi K, Ashrafian H, Zacharakis E et al. Adhesions a er abdominal surgery: a systematic review of the incidence, distribution and severity. Surgery Today 2014; 44: 405–20. PUBMED: 23657643
24. Alborzi S, Motazedian S, Parsanezhad ME. Chance of adhesion formation after laparoscopic salpingo-ovariolysis: is there a place for second-look laparoscopy? J Am Assoc Gynecol Laparosc 2003; 10: 172–6.
25. Swank DJ, Swank-Bordewijk SC, Hop WC et al. Laparoscopic adhesiolysis in patients with chronic abdominal pain: a blinded randomised controlled multicentre trial. Lancet 2003; 361: 1247–51.
26. Dubrovina S.O., Berlim Iu.D. Gestageny v terapii endometrioza. Akusherstvo i ginekologiia. 2018; 5: 150–4 (in Russian).
27. Searchable R, Mabrouk M, Frasca C et al. Long-term oral contraceptive pills and postoperative pain management after laparoscopic excision of ovarian endometrioma: a randomized controlled trial. Fertil Steril 2010; 94: 464–71.
28. Seracchioli R, Mabrouk M, Frasca C et al. Long-term cyclic and continuous oral contraceptive therapy and endometrioma recurrence: a randomized controlled trial. Fertil Steril 2010; 93: 52–6.
29. Ichikawa М, Akira S, Kaseki H еt al. Accuracy and clinical value of an adhesion scoring system: A preoperative diagnostic method using transvaginal ultrasonography for endometriotic adhesion. J Obstet Gynaecol Res 2020. DOI: 10.1111/jog.14191
30. Dubrovina S.O., Berlim Yu.D., Gimbut V.S. et al. Management of endometriomas. Gynecology. 2017; 19 (4): 30–5 (in Russian).
31. Di Paola V, Manfredi R, Castelli F еt al. Detection and localization of deep endometriosis by means of MRI and correlation with the ENZIAN score. Eur J Radiol 2015; 84: 568–74.
32. Dueholm M, Lundorf E. Transvaginal ultrasound or MRI for diagnosis of adenomyosis. Curr Opin Obstet Gynecol 2007; 19: 505–12.
33. Chapron C, Tosti C, Marcellin L et al. Relationship between the magnetic resonance imaging appearance of adenomyosis and endometriosis phenotypes. Hum Reprod 2017; 32: 1393–401.
34. Bazot M, Lafont C, Rouzier R еt al. Diagnostic accuracy of physical examination, transvaginal sonography, rectal endoscopic sonography, and magnetic resonance imaging to diagnose deep infiltrating endometriosis. Fertil Steril 2009; 92: 1825–33.
35. Manganaro L, Vittori G, Vinci V et al. Beyond laparoscopy: 3T magnetic resonance imaging in the evaluation of posterior cul-de-sac obliteration. Magn Reson Imaging 2012; 30: 1432–8.
36. Ahmad G, Thompson M, Kim K еt al. Fluid and pharmacological agents for adhesion prevention after gynaecological surgery. Cochrane Database of Systematic Reviews 2020. Issue 7. Art. No.: CD001298. DOI: 10.1002/14651858.CD001298.pub5
37. Leonardi M, Gibbons T, Armour M еt al. When to Do Surgery and When Not to Do Surgery for Endometriosis: A Systematic Review and Meta-analysis. J Minim Invasive Gynecol 2020; 27 (2): 390–407e3. DOI: 10.1016/j.jmig.2019.10.014
38. Dubrovina S.O. Sovremennye predstavleniia o spaechnom protsesse. Doktor.Ru. 2016; 3 (120): 34–8 (in Russian).
39. Iarmolinskaia M.I., Durneva U.I., Sel'kov S.A. Immunomoduliator Longidaza v kombinirovannom lechenii naruzhnogo genital'nogo endometrioza. Zhurn. akusherstva i zhenskikh boleznei. 2016; 45: 76–7 (in Russian).
40. Sulima A.N., Davydova A.A., Rybalka A.N. et al. Features of the prevention and treatment of adhesions in patients with chronic inflammatory diseases of the pelvic organs. Gynecology. 2018; 20 (1): 62–7 (in Russian).

Авторы

С.О. Дубровина*, Ю.Д. Берлим, А.Д. Александрина, Д.Ю. Богунова, М.Н. Лесной

ФГБОУ ВО «Ростовский государственный медицинский университет» Минздрава России, Ростов-на-Дону, Россия
*s.dubrovina@gmail.com

________________________________________________

Svetlana O. Dubrovina*, Yuliya D. Berlim, Anna D. Alexandrina, Diana U. Bogunova, Maxim N. Lesnoy

Rostov State Medical University, Rostov-on-Don, Russia
*s.dubrovina@gmail.com

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