On the Endoscopic Criteria for Adenomyosis on the Background of Severe Chronic Pelvic Pain
Background. The problem of chronic pelvic pain is one of the most important, complex and far not solved problems in gynecology. More than 60 % of women each seeking help to the obstetrician-gynecologist of this problem. Chronic pelvic pain in women is most often a symptom of gynecological than extragenital diseases. Chronic pelvic pain in adenomyosis is secondary pain, having long, and like any visceral pain, rarely localized. Introduction into clinical practice of modern laparoscopic technologies, but also caused by the changes in the therapeutic tactics and technique of operations, have made it necessary to revise existing approaches to some aspects of the diagnosis of pelvic pain.
The aim of the study was to examine the role of endoscopic method in establishing Genesis pelvic pain syndrome in women with adenomyosis.
Material and methods. In the present study included 84 patients of reproductive age who received drug treatment with a diagnosis of adenomyosis. All patients were produced diagnostic laparoscopy main indication which was resistant to the drug therapy of pelvic pain caused by adenomyosis. Laparoscopy was performed under the endotracheal anesthesia at the Trendelenburg position using standard equipment company KARL STORZ. After the creation of pneumoperitoneum 3.0 litres of CO2 produced examination of pelvic organs.
The results of the study. Endoscopic criteria adenomyosis were: in 18 % of cases the uterus in position retroversio, congestive painting with a rough surface, dimensions up to 7–8 weeks of pregnancy, 76 % of detected marbling surface of the uterus, increasing its size to 12 weeks and uneven surface and only 6 % of cases of a body that had the correct round form, serous cover was cyanotic colors, has been reported endometrioidheterotopy on serous cover the cervix, with signs of adhesions.( on the back of the wall was fused sigmoid colon). Frequency of occurrence of adhesive process in the pelvic cavity of a various degree detected in 76 (90.4 %) of our patients, which is consistent with the results of the above researchers. 29 (34.5 %) patients found nodular form of adenomyosis, which was expressed by local swelling of the uterine wall, and without clear boundaries, dense and not palpation manipulator, and only 13 (15.4 %) of women nodular form was combined with cystic form, visually looked as education soft consistency. Intraoperative finding was the discovery of a subseros-interstitial myomatous nodes small size of 14 (16.6 %) of women against the background of a diffuse form of adenomyosis, and in 4 (4.7 %) women identified gaps wide uterine ligaments bilateral and unilateral damage sacroiliac ligaments — this videos copy picture verify how syndrome Allen-masters. These women through the rupture of the peritoneum in the field of trauma balls of varicose veins and twisted uterine arteries in addition to 19 (22.6 %) observations detected varicose change veins mezosalpinx and infundibulum-pelvic ligaments. Palpation endoscopic manipulator in the projection deep into Douglas space under outwardly normal брюшиной we found 11 (13.1 %) women tumor nature very similar to infiltrative a recto-vaginal endometriosis tissue, but evaluate the infiltration depth (losses) from the surrounding tissues and organs in laparoscopy examination, we could not. It should be emphasized that scientists Swanton et al., 2008, with a deep endometriosis noted that just as excision of endometrioid infiltration is possible to establish the depth of germination and degree of involving in pathological process of surrounding tissues.
Conclusion. Results of the research testify to the high diagnostic information and values of the laparoscopic method of research in establishing Genesis pelvic pain, and the need of possible revision in favor of endoscopic techniques in the diagnosis of patients with chronic pelvic pain syndrome caused by adenomyosis if not the efficiency of drug therapy.
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