ARCHIVEOBSTETRICS AND GYNECOLOGY
International Medical Journal, Vol. 23., Iss. 3, 2017, P. 39−44.
MODERN METHODS OF HEMOSTASIS AND OVARIAN RESERVE DURING ORGAN-PRESERVING SURGERY ON THE OVARIES
M. I. Pyrogov Russian National Research University, Moscow, Russian Federation
At present organ−preserving ovarian surgery with video endosurgery is considered to be a routine intervention. If it is necessary to stop bleeding, various types of coagulation are used (bipolar, argon−plasma, ligature hemostasis), but their effect on the ovarian reserve has not been investigated in detail. With this end in view, the study of ovarian reserve parameters in patients with endometrioid and dermoid ovarian formations before and after operations using bipolar, argon−plasma coagulation, ligature hemostasis by imposing intraovarian suture was carried out. According to echography findings, the nature of the tumor and its size were determined at the preoperative stage. One year after the operation, the parameters of the ovarian reserve were investigated: the volume of the ovary, the number of antral follicles, intraovarian blood flow and folliculogenesis in the operated and intact ovaries. The analysis of the obtained findings showed that in all patients after surgical treatment, regardless of the nature of the formation and the type of hemostasis used, disorder of the morphofunctional state of the ovarian tissue was present when compared with the preoperative results. The level of the ovarian reserve reduction depended on the morphological nature of the formation in the ovary, its size and location, as well as the age of the patient. In patients of later reproductive age, the criteria studied were reduced to a greater extent regardless of the method of bleeding control. It was concluded that it is necessary to minimize any type of thermal effect on the tissues, especially in nulliparous patients. An individual approach and choice of hemostasis method are extremely important in women with diagnosed endometrioid formations, since endometriosis itself leads to reduction in the primordial pool.
Key words: argon−plasma and bipolar coagulation, mature teratomas of the ovaries, ligature hemostasis, ovarian reserve, ovarian endometrioid formations.