medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/ms2023-088medsovet-7454Research ArticleРЕПРОДУКТИВНОЕ ЗДОРОВЬЕ И ВРТREPRODUCTIVE HEALTH AND ARTВнутриматочные спайки: от патогенеза к эффективным технологиям преодоленияIntrauterine adhesions: from pathogenesis to effective coping technologieshttps://orcid.org/0000-0002-1767-5536ОразовМ. Р.OrazovM. R.

Оразов Мекан Рахимбердыевич, д.м.н., профессор кафедры акушерства и гинекологии с курсом перинатологии Медицинского института,

117198, Москва, ул. Миклухо-Маклая, д. 6

Mekan R. Orazov, Dr. Sci. (Med.), Professor of the Department of Obstetrics and Gynecology with a Perinatology Course of the Medical Institute,

6, Miklukho-Maklai St., Moscow, 117198

omekan@mail.ruhttps://orcid.org/0000-0003-2052-914XМихалеваЛ. М.MikhalevaL. M.

Михалева Людмила Михайловна, заслуженный деятель науки РФ, член-корр. РАН, д.м.н., профессор, директор Института морфологии,

117418, Москва, ул.  Цюрупы, д.  3

Liudmila M. Mikhaleva, Honored Worker of Science of the Russian Federation, Corr. Member RAS, Dr. Sci. (Med.), Professor, Director of the Institute of Morphology,

3, Tsyurupa St., Moscow, 117418

mikhalevam@yandex.ruhttps://orcid.org/0000-0003-1940-4534ХамошинаМ. Б.KhamoshinaM. B.

Хамошина Марина Борисовна, д.м.н., профессор, профессор кафедры акушерства и гинекологии с курсом перинатологии Медицинского института,

117198, Москва, ул. Миклухо-Маклая, д. 6

Marina B. Khamoshina, Dr. Sci. (Med.), Professor, Professor of the Department of Obstetrics and Gynecology with a Perinatology Course of the Medical Institute,

6, Miklukho-Maklai St., Moscow, 117198

khamoshina@mail.ruhttps://orcid.org/0000-0002-7428-0469ИсмаилзадеС. Я.IsmayilzadeS. Ya.

Исмаилзаде Севиндж Ядулла кызы, аспирант кафедры акушерства и гинекологии с курсом перинатологии Медицинского института,

117198, Москва, ул. Миклухо-Маклая, д. 6

Sevinc Ya. Ismayilzade, Postgraduate Student of the Department of Obstetrics and Gynecology with a Perinatology Course of the Medical Institute,

6, Miklukho-Maklai St., Moscow, 117198

sevka_monika@mail.ruРоссийский университет дружбы народовРоссияPeoples’ Friendship University of RussiaRussian FederationНаучно-исследовательский институт морфологии человека имени академика А.П. АвцынаРоссияResearch Institute of Human Morphology named after Academician A.P. AvtsynRussian Federation202319042023057280Copyright © Оразов М.Р., Михалева Л.М., Хамошина М.Б., Исмаилзаде С.Я., 20232023Оразов М.Р., Михалева Л.М., Хамошина М.Б., Исмаилзаде С.Я.Orazov M.R., Mikhaleva L.M., Khamoshina M.B., Ismayilzade S.Y.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/7454

Внутриматочные спайки  (ВМС) являются одной из  нерешенных и  нерешаемых проблем современной репродуктивной медицины во всем мире. Адгезивное поражение приводит к частичной либо полной облитерации полости матки и (или) цервикального канала. Основные клинические проявления при ВМС  – нарушения менструального цикла, циклические боли, инфертильность и другие различные репродуктивные нарушения. Репродуктивные исходы у женщин с ВМС остаются малоизученными и трудно верифицируемыми. При этом на сегодняшний день отсутствует понимание основных механизмов развития ВМС, в том числе и процессов, объясняющих неудачи указанных осложнений. Остается далекой от окончательного решения проблема преодоления рецидивов ВМС после адгезиолизиса. Золотым стандартом лечения ВМС является гистероскопический адгезиолизис, однако он ассоциирован с высокой частотой осложнений и рецидивов, что свидетельствует о необходимости превентивных подходов в преодолении ВМС. В числе препаратов с ферментативной активностью против аномальной соединительной ткани следует отметить бовгиалуронидазу азоксимер, созданный российскими разработчиками еще в 2005 г. Препарат состоит из двух компонентов – гиалуронидазы и азоксимера бромида. Если первый – это фермент, то второй – стабилизатор, пролонгирующий действие гиалуронидазы. В ряде исследований было показано, что бовгиалуронидаза азоксимер вызывает деструкцию внутриматочных спаек и восстанавливает состояние эндометрия при воспалительных заболеваниях органов малого таза. Благодаря пролонгированному противофиброзному действию бовгиалуронидаза азоксимер может применяться для лечения женщин с ВМС с целью снижения риска последующего формирования адгезивного процесса в полости матки. 

Intrauterine adhesions (IUDs) are one of the unresolved and unsolved problems of modern reproductive medicine worldwide. Adhesive lesions lead to partial or complete obliteration of the uterine cavity and/or cervical canal. The main clinical manifestations of IUDs are menstrual irregularities, cyclical pain, infertility and other various reproductive disorders. Reproductive outcomes in women with IUDs remain poorly understood and difficult to verify. At the same time, there is currently no understanding of the basic mechanisms of IUD development, including the processes explaining the failures of the above complications. The problem of overcoming IUD recurrences after adhesiolysis remains far from being finally resolved. The gold-standard treatment for IUD is hysteroscopic adhesiolysis, which, however, is associated with a high frequency of complications and relapses, highlighting the need for preventive approaches to the management of IUD. The drugs with enzymatic activity inhibiting abnormal connective tissue include bovhyaluronidase azoximer created by the Russian developers back in 2005. The drug consists of two components – hyaluronidase and azoximer bromide. The former is an enzyme, and the latter is a stabilizer that prolongs the action of hyaluronidase. Several studies have shown that bovhyaluronidase azoximer causes the destruction of intrauterine adhesions and restores the endometrium status in inflammatory pelvic diseases. Due to prolonged antifibrotic effect of bovhyaluronidase, azoximer can be used to treat women with IUDs to reduce the risk of the subsequent development of adhesive process in the uterine cavity.

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