Naslov (srp)

Uticaj laparoskopske cistektomije endometrioma na rezervu jajnika : doktorska disertacija

Autor

Kovačević, Vera, 1973-

Doprinosi

Mitrović-Jovanović, Ana, 1971-
Kastratović-Kotlica, Biljana, 1962-
Vasiljević, Mladenko, 1958-
Vejnović, Tihomir, 1958-

Opis (srp)

Cilj: Laparaskopska cistektomija primenom tehnike „ljušćenja“ kapsule dovodi doklinički značajnog smanjenja rezerve jajnika.Proceniti rezervu jajnika kod žena sa endometriotičnom cistom jajnika prečnika ≥ 4 cm,pre i nakon laparoskopskog uklanjanja endometriotične ciste, primenom tkz. tehnike „ljuštenja“kapsule uz korišćenje bipolarne struje za uspostavljanje hemostaze. Ispitati oštećenje rezervejajnika kroz određivanje vrednosti Antimilerovog hormona (AMH) u serumu pre sameoperacije, kao i 6, 12 meseci nakon operacije. Ispitati uticaj cistektomije na endokrinološkufunkciju jajnika procenjeno kroz određivanje koncentracije Folikulostimulirajućeg hormona(FSH) i Estradiola (E2) u serumu pre operacije, kao i 6, 12 meseci nakon laparoskopskeoperacije.Metodologija: Ispitivanje po tipu prospektivne, kohortne studije, koje je sprovedeno naOdeljenju za ginekologiju i akušerstvo Opšte bolnice u Subotici, od februara 2013. donovembra 2016. godine. Studija je uključila 54 pacijentkinje reproduktivne životne dobi između18 i 42 godine, sa redovnim menstrualnim ciklusima između 25-35 dana. Kod svih pacijentkinjaje preoperativno, ultrazvučno ustanovljeno postojanje cistične formacije koja izgledomodgovara endometriotičnoj cisti prečnika ≥ 4 cm, kod 37 pacijentkinja (n=37) na jednom a kod17 pacijentkinja (n=17) na oba jajnika. Laparoskopskim i histopatološkim pregledom je kodsvih pacijentkinja potvrđena dijagnoza endometriotične ciste. Rezerva jajnika procenjivana jepreoperativno od 3-5 dana menstrualnog ciklusa, kroz određivanje vrednostiFolikulostimulirajućeg hormona (FSH), Estradiola (E2) i Antimullerovog hormona (AMH) izuzorka krvi kao i 6 i 12 meseci postoperativno. Laparoskopska cistektomija je rađena u opštojanesteziji u kasnoj folikularnoj fazi menstrualnog ciklusa. Laparoskopska cistektomija jerađena na sledeći način: nakon identifikacije ravni klivaža, zid ciste je odvojen tehnikom„ljušćenja“ od okolnog zdravog, okružujućeg tkiva jajnika uz upotrebu dva atraumatskazupčasta forcepsa primenom pokreta trakcije i kontra-trakcije uz očuvanje hilusa jajnika.Dobijen materijal je poslat na histopatološki pregled. Hemostaza je uspostavljana primenomstruje snage oko 25 W, uz upotrebu bipolarnog forcepsa na ležište ciste...

Opis (srp)

Medicina - Humana reprodukcija sa perinatologijom i neonatologijom / Medicine- Human reproduction, perinatology and neonatology Datum odbrane: 14.09.2022.

Opis (eng)

significant decrease in ovarian reserve To investigate the ovarian reserve in women withendometrioma ≥4 cm before and after laparoscopic endometrioma „stripping“ surgery usingbipolar current to achieve hemostasis. Damage to the ovarian reserve will be examined bymeasuring AMH concentration, before the operation and 6 and 12 months after the operation.To investigate the effect of cystectomy of endometrioma on endocrine function assessed bymeasuring concentration of Follicle-stimulating hormone (FSH) and estradiol (E2) in serumbefore and 6- and 12 months after the operation.Methods and matherials: This prospective cohort study was conducted in the GeneralHospital, Subotica, Serbia, from February 2013. to November 2016. Study included 54 patientsof reproductive age from 18 - 42 years of age, with regular menstrual periods ranging from 25to 35 days. In all of these patients endometrioma in total diameter ≥ 4 cm was diagnosed bytransvaginal ultrasound examination, in 37 patients (n=37) unilateral and in 17 patients (n=17)bilateral endometriomas. The ovarian reserve of the patients was determined by measuringserum levels of AMH, FSH and estradiol in the early follicular phase of their spontaneousmenstrual cycle from the 3rd to the 5th day before surgery, as well as 6 and 12 months afterlaparoscopic endometrioma stripping surgery using bipolar current to achieve haemostasis. Alloperations were performed during the late follicular phase of the menstrual cycle. Laparoscopiccystectomy was performed as follows: We performed a diagnostic inspection of the pelvis andabdomen to assess the extend of the disease. Then we lysed the adhaesions and liberated theovary from its adhaesions and from adhaesions with surrounding organs, if present.Subsequently, if the endometrioma remained unruptured during adhaesion-lysis, we performedan incision of endometrioma at the animesenteric site of the affected ovary using bipolarcautery, and the endometrioma was drained by means of aspiration of the chocolate content andfurther extension of the incision into the antemesenteric edge. After idenification the cleavageplane, the pseudocapsule was stripped from the healthy surrounding normal ovarian tissue withthe use of two atraumatic grasping forceps by means of traction and countertraction. In somecases, the identification of the cleavage plane was difficult because the reactive tissue of theendometrioma was strongly adhered during ovarian-lysis and adhaesion-lysis, the rupture siteon the ovaries was the starting point for cyst enucleaion. When necessary, haemostasis wasachieved by application of a 25-W current with the use of bipolar current on the cyst bed. Nosuures were placed after endometrioma cystectomy...

Jezik

srpski

Datum

2022

Licenca

Ovo delo je licencirano pod uslovima licence
Creative Commons CC BY-NC-ND 3.0 AT - Creative Commons Autorstvo - Nekomercijalno - Bez prerada 3.0 Austria License.

http://creativecommons.org/licenses/by-nc-nd/3.0/at/legalcode

Predmet

OSNO - Opšta sistematizacija naučnih oblasti, Ginekologija

Endometriotična cista, laparoskopija, ovarijalna rezerva, Anti-Mullerov hormon

618.14-089(043.3)

OSNO - Opšta sistematizacija naučnih oblasti, Ginekologija

Endometrioma, laparoscopy, ovarian reserve, antimullerian hormone