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№2' 2019
OBSTETRICS AND GYNECOLOGYInternational Medical Journal, Vol. 25., Iss. 2, 2019, P. 32−36.
DIFFERENTIATED APPROACHES TO TREATMENT TACTICS IN PATIENTS WITH HYPERPLASTIC ENDOMETRY PROCESSES
Kharkiv National Medical University, Ukraine
In order to develop a differentiated approach to the choice of treatment tactics and methods for optimizing the management of patients with endometrial hyperplastic processes, 80 women with glandular and adenomatous forms of the disease were examined. A differentiated approach to the treatment of endometrial hyperplasia is based on the clinical and morphological features of its course and suggests a systemic effect on the endocrine and metabolic processes in the body. The approach to the tactics of treating the women's disease was carried out taking into account the ultrasound scan of the pelvic organs, determining the proliferation markers Ki−67 and p−53, the level of sex steroids and the expression of progesterone and estrogen receptors. With low expression of progesterone receptors, preserved expression level of estrogen receptors and low proliferative activity of the endometrium after the performed fractional curettage of uterus, the patients with unexpressed glandular endometrial hyperplasia are recommended to be treated with indol−3−carbinol. Patients with a pronounced glandular hyperplasia of the endometrium, but with a preserved level of expression of estrogen and progesterone receptors, and a moderate increase in the level of proliferation markers, the hormone therapy with synthetic progestins is needed for 3−6 months according to the standard technique. Patients with non−acute adenomatous hyperplasia of endometrium and decreased expression of estrogen and progesterone receptors, against the background of a moderate level of proliferation markers after curettage, the cryotreatment of the uterine cavity with liquid nitrogen is recommended. With a significant decrease in the expression of estrogen and progesterone receptors in patients with a pronounced adenomatous hyperplasia of the endometrium, and a high proliferative activity of proliferation markers, a surgical treatment is carried out. It was concluded that a differentiated approach to the treatment of hyperplastic processes of uterus, taking into account the receptor profile of the endometrium, the expression level of proliferation markers is important for a positive dynamics of the disease symptoms and the therapy results.
Key words: endometrial hyperplasia, treatment tactics, differentiated approach, expression of estrogen and progesterone receptors.