Analysis of the informativeness of perioperative visual diagnostics of uterine fibroids

Abstract

The aim. To analyze the methods of visual diagnosis used in reproductive age women with uterine fibroids. Materials and Methods. Retrospective analisys, information–analytical methods were used in the work. Sources of information were data from the scientific literature on the topic of the study, modern gadleins, a review of randomized controlled trials. Results. Depending on the types of visual diagnostics used in the preoperative examination were formed groups: I group (n=120) – patients were examined only by the sonographic method; II group (n=80) – patients were examined by MRI and ultrasound. Comparative analysis of the MRI and sonographic studies results determined the number of myomatous nodes inpatients of the II group (n=80 (100%): by ultrasound – solitary nodes in 52 (65%), multiple in 28 (35%), and by MRI – a solitary nodule in 37 women (according to FIGO classification – type SM0 – 16 women, SMI in 8 patients, SMII in 8 patients, O3–6 typein 5 women), two nodules in 27 people and three myomatous nodules in 16 women (among multiple myomas n=43 (100%) according to the FIGO classification, , were diagnosed: SM0/О3–4 type– 20 (47%), SM1/О3–4 type –13 (30%), SM2/ O3–4 type –10 (23%), and according to MP type: MP1 – 16 (37%), MP2 –11 (26%), MP3 –16 (37%), and among solitary nodes n=37 (100% ): MP1 – 27 (71%), MP2 –10 (29%). The frequency of cases of inconsistency the clinical situation with ultrasound data interms of the number and localization of myomatous nodes in multinodular UF, especially in SM0–2/О3–4 type combinations, was 39, 0%, and when was using MRI – 8.0% (p<0.05). The structure of organ–preserving surgical intervention in the scope of myomectomy is presented as follows: hysteroscopy – 118 (59%), a combination of laparoscopy and hysteroscopy – 50 (25%), in 28 (14%) a combination of laparoscopy and hysteroscopy was converted to laparoscopic–vaginal access and 2.0% were converted to laparoscopic laparotomy. In the 1st group (n=120(100%)) where only preoperative ultrasound was used, a higher specific weight of conversions from hysteroscopy to laparoscopy – 36 cases (30%), from a combination of laparoscopy and hysteroscopy to laparoscopic–vaginalaccess – 24 (20%) and from laparoscopy laparotomy – 12 (10%). Conclusions. Ultrasound in the perioperative period is unable to fully determine clear navigation for the operation, especially for multinodular UF and hard–to–reach UF localization for hysteroscopic myomectomy. This clinical problem can be solved by using MRI in the perioperative diagnostic and intraoperative sonography.