ARCHIVEOBSTETRICS AND GYNECOLOGY
International Medical Journal, Vol. 22., Iss. 1, 2016, P. 51−55.
THE CHARACTERISTICS OF POSTOPERATIVE ADHESION FORMATION IN PATIENTS WITH TUBAL PREGNANCY
Kharkiv Medical Academy of Postgraduate Education, Ukraine
The frequency of abdominal pregnancy in Europe amounts to 1 % of all pregnancies, and in Ukraine it amounts to 15.4 per 1,000 pregnancies. The ratio of uterine and ectopic pregnancies is 1: 100. 25−47 % of all patients admitted to the hospital are patients with tubal pregnancy. The main etiological factors of ectopic pregnancy are structural changes in the fallopian tubes (sexually transmitted genital infections, tubal sterilization, operations on the fallopian tubes including surgical treatment of tubal pregnancy); hormonal (IVF, ovulation induction, delay of ovulation, hormonal contraceptives), intrauterine contraceptives; other factors (hypoplasia of the corpus luteum, endometriosis, congenital anomalies of the uterus, cross−migration of ovule, oxidative stress). Etiological factors of the adhesion formation which patients with tubal pregnancy suffer from in the postoperative period consist of the urgency of surgery, the presence of blood in the abdominal cavity, the use of carboxyperitoneum during laparoscopic surgery, mechanical, chemical, physical, infectious effect on the peritoneum. The traumatic effects caused by the above factors lead to peritoneum ischemia resulting in deterioration of the local fibrinolytic activity of the tissue (inhibition of fibrinolysis by inhibitors of plasminogen activator PAI1, PAI2, which are formed as a result of a surgical trauma), followed by an inflammatory reaction and endothelial dysfunction. During re−laparoscopy 94−100 % of patients have adhesion formation after laparotomy surgeries and 81 % of patients after laparoscopic surgeries, which leads to repeated tubal pregnancy that have 7−27 % of patients. Application of Ringer's lactate, seprafilm, adept, mesogel, SprayGel, sodium hyaluronate, SURGIFLO matrix for prevention of adhesion formation intraoperatively and Distreptaza in the early postoperative period without affecting all parts of the pathogenesis does not provide 100 % anti−commissural effect but reduces the frequency of development of postoperative adhesions in 31.3 % −− 40 % of cases and restores reproductive function in 51−67.5 % of patients, due to which reproductive function of 32.5−49 % of patients can be restored using TAA, which efficiency does not exceed 30 %. The research of new approaches to the prevention of adhesion which have patients with tubal pregnancy in the postoperative period should include the use of minimally invasive methods of surgical treatment and modern anti−commissural medicines with antioxidant effect, which will help to reduce adhesion development, to enhance the demographic measures in Ukraine and the quality of life of patients.
Key words: tubal pregnancy, pathogenesis of postoperative adhesions, anticommissural remedies.