medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/2079-701X-2018-7-146-151medsovet-2422Research ArticleПрактикаPracticeВнутриматочные синехии: особенности хирургического лечения и профилактика рецидивовIntrauterine sinechia: features of surgical treatment and prevention of recurrenceМакаренкоТ. А.MakarenkoT. A.

д.м.н.

MD

НикифороваД. Е.NikiforovaD. E.УльяноваИ. О.UlyanovaI. O.

к.м.н.

PhD in medicine

Красноярский государственный медицинский университет им. проф. В.Ф. Войно-Ясенецкого Минздрава РоссииРоссияVoino-Yasenetsky Krasnoyarsk State Medical University of the Ministry of Health of RussiaRussian Federation20181804201807146151Copyright © Макаренко Т.А., Никифорова Д.Е., Ульянова И.О., 20182018Макаренко Т.А., Никифорова Д.Е., Ульянова И.О.Makarenko T.A., Nikiforova D.E., Ulyanova I.O.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/2422

Статья посвящена проблеме хирургического лечения и профилактики рецидивов внутриматочных синехий (ВС) и крайней их формы – синдрома Ашермана. Актуальность ВС характеризуется высокой частотой бесплодия, привычного невынашивания, аменореи и гипоменструального синдрома. В статье описаны принципы ведения больных с ВС, особенности их хирургического лечения и профилактики рецидивов заболевания. Приведены собственные клинические данные, обобщающие опыт лечения 64 женщин с ВС. Всем больным был выполнен гистероскопический адгезиолизис. В послеоперационном периоде 48 женщинам (I группа) в полость матки вводился противоспаечный барьер на основе гиалуроновой кислоты и карбоксиметилцеллюлозы – Антиадгезин. Группу контроля (II группа) составили 16 женщин, которым Антиадгезин не вводили. В результате проведенного исследования было выявлено, что среди пациенток I группы констатированы значимо меньшее количество рецидивов ВС, а также достоверно большее число случаев наступившей беременности. Таким образом, для комплексного лечения пациенток с ВС решающее значение имеют не только бережное и полное рассечение спаек, но и активный послеоперационный реабилитационный период, включающий профилактику рецидива адгезиогенеза при помощи внутриматочного введения противоспаечных барьеров.

 

The article is devoted to the issues of surgical treatment and prevention of recurrence of intrauterine sinechia (IUS) and its severe condition Asherman syndrome. The topicality of the IUS is characterized by a high incidence of infertility, common miscarriage, amenorrhea and hypomenstrual syndrome. The article describes the principles for management of patients with IUS, the features of surgical treatment and the prevention of recurrence of the disease. The authors present their own clinical data summarizing the experience in treating 64 women with IUS. All patients underwent a hysteroscopic adhesiolysis. In the postoperative period, 48 women (group 1) received an adhesion barrier based on hyaluronic acid and carboxymethylcellulose – Antiadhesin injected into the cavity of the uterus. 16 women (control group 2) did not receive Antiadgesin. The study showed that significantly fewer relapses and a significant increase in commenced pregnancy were detected among patients in group 1. As can be seen from the above, not only the careful and complete dissection of the adhesions, but also the active postoperative rehabilitation period, which includes the prevention of relapsing adhesiogenesis using intrauterine injections of adhesion barriers, is crucial for the comprehensive treatment of patients with IUS.

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The authors declare that there are no conflicts of interest present.