4 курс / Акушерство и гинекология / Оптимизация_хирургического_метода_лечения_миомы_матки

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a reliable method to identify high and low risk groups for uterine rupture. According to M.A. Chechneva [61], US examination with linear measurements, color Doppler mapping of the scar and surrounding myometrium is sufficient to diagnose a dehiscent uterine scar [145]. E.A. Gallardo et al. consider how objectivity is sonographic data on soft tissue scarring deformity (2001) [97]. A comparative analysis of sonography and

V.I. Krasnopolsky, V.E. Radzinsky, L.S. Logutova et al. (1997) [26] assess the effect of various suture materials on post-op reparative processes. The used a sophisticated US examination. A thin rubber balloon was introduced into the uterine cavity, filled with furacillin solution through a catheter until the uterine cavity was completely stretched. As a result, the anterior uterine wall turned out to be located between two hypodense areas – the full bladder and balloon. Under these conditions, the inner and outer surfaces

of the uterine wall in the suture area were clearly contoured, allowing see evidence

of niches and defects. In addition, internal structures of the myometrium were better visualized, and sometimes ligatures were visible in the thickness of the myometrium. The authors consider it appropriate to use bicontrast echoscopy and hysteroscopy in early postoperative period. A similar opinion has been expressed in other publications [14]. The method allows you to determine the conditions in which the initial processes of scar regeneration occur. In cases where they were unfavorable, therapeutic measures were carried out with the help of hysteroscopy. According to Yu.P. Titchenko et

al. (2006) [53], the coincidence of ultrasound assessment and the actual condition

of the scar on the uterus was confirmed during surgery in 69% of cases, false positive results were obtained in 7% of cases, false negative in 19%. O. Drouin et al. (2004)

[138] used energy doppler to study blood flow in uterine arteries and vessels

of myometrium in post-op uterine scar area early after C-section. Uterine arteries

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in the examination of a scar on the uterus after CS, while the frequency of detection of an untenable scar was 24-70% with transvaginal ultrasound and 56-84% with

hydrosonography [36].

The discovery of the phenomenon of magnetic resonance in 1944 belongs

to Professor E.K. Zavoysky of Kazan State University, who laid the first theoretical

foundations of NMR. In the 50s of the twentieth century, R. Purcell, A. Carr and

P.A. Rinkk [46] continued their research in this area and developed the basics of nuclear magnetic spectroscopy, while NMR combined with specific signal processing methods allowed for MR imaging. In the last few years, despite the high cost, MRI has been widely used and is becoming one of the leading methods for diagnosing pathology of the uterus and appendages [24]. The interest in MPT is due to its great capabilities:

chemical composition, and perform dynamic control [52]. New fields of application and technical innovations are discussed: 3D-imaging, dynamic and fast spin echo sequences,

the use of contrast agents, cavity methods. The clinical significance of MRI and

ultrasound in the study of obstetric and gynecological pathology is compared [37]. Recent publications show the superiority of MRI over ultrasound both in the diagnosis of gynecological diseases and in obstetrics [101]. A.V. Shatov (2006) showed a high informative value of MRI and believes that it has advantages over other radiation methods and proves greater specificity in assessing uterine pathology than ultrasound. The same data are given in other publications [59]. The use of contrast agents allows you to get additional information [90]. There are reports of the use of MRI to assess the condition of the scar on the uterus after myomectomy [118]. Thus, the methods used today to assess the condition of the scar on the uterus after myomectomy have both advantages and disadvantages. Some of them are invasive, require hospitalization and appropriate anesthesia, which increases the risk of various complications, carry a radiation load, have a high cost or are unavailable for other reasons.

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of normal myometrial cells, is necessary to maintain normal cell activity [99]. At

the same time Wu C. et al. [78] used histochemical methods and immunoblotting and nevertheless failed to detect differences in the apoptotic index between leiomyomas and

normal myometrium, as well as between myometrium at different stages

of the menstrual cycle. At the same time, both leiomyomas and the control myometrium showed a negative immunohistochemical reaction when using antibodies to p53. The results of the immunohistochemical study were confirmed by Western blot [78]. Similar results were obtained by Gao Z. et al. [117], who also failed to identify differences in the level of p53 expression between leiomyomas and neighboring sites with normal myometrium.

There is evidence in the literature that immunophenotypes of myometrial tumor cells may have specific features for different types of tumors. In particular, it was shown that in the case of cellular leiomyomas, the immunophenotype was characterized by a low level of p53 expression, whereas for atypical leiomyomas and leiomyosarcomas, on the contrary, the level of p53 expression was increased compared to control samples [128].

Proliferating cell nuclear antigen (PCNA) is a nuclear protein with a molecular weight of 36 kDa, which is present in the nuclei of proliferating cells only and is involved in many aspects of DNA replication. The level of PCNA expression increases during the late G1 phase, reaches a maximum in the S phase, and then decreases during the G2 phase. To date, the possibility of PCNA to participate in several metabolic pathways, as well as in such processes as processing of Okazaki fragments, DNA repair, DNA synthesis, DNA methylation, chromatin remodeling and cell cycle regulation has been revealed [111].

Using immunohistochemical methods and Western blotting, it was shown that leiomyoma is characterized by a higher level of PCNA expression than intact myometrium [92;139]. Similar data were obtained in experiments on mice, where the average PCNA tagging index for uterine leiomyosarcomas (7.40%) was significantly higher than for leiomyomas (0.29%) and control uterine myometrium

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particular, the study of cytogenetic uterine leiomyomas with clonal anomaly t (12:14)

(q14-15; q23-24) did not reveal any changes in expression for the COL2A1 gene [114].

As for collagens of other types, it is currently believed that the change in their

expression in the case of leiomyoma is due to a decrease in the level of some

microRNAs, in particular miR-29. It was found that the level of miR-29b, the main

types by binding to the 3-untranslated portion of their mRNA. The data accumulated

to date on the association of disorders in the regulation of miR-29 microRNA

expression with fibrotic pathology in the liver, lungs, kidneys and cardiovascular system

of collagens can be considered as a potential marker of leiomyoma, however, it is more appropriate to pay special attention to the expression of collagen I, since a change in the expression of collagen of this type is shown in most studies performed to date.

Vascular endothelial growth factors (VEGF) are powerful regulators

of vascular functions such as angiogenesis, vasculogenesis, vascular permeability and lymphangiogenesis. This family of proteins includes VEGFA, VEGFB, VEGFC, VEGFD and placental growth factor (PlGF). The biological activity of the VEGFA factor is mediated by its binding to the VEGFR1 and VEGFR2 membrane receptors. VEGFB and PlGF factors bind exclusively to VEGFR1. The VEGFR1 receptor also has a soluble form (sVEGFR1), in which intracellular and transmembrane domains are absent, but the ligand-binding domain, which actually determines its affinity for ligands, is preserved. The sVEGFR1 receptor is considered to be the main modulator of the biological activity of VEGF, and VEGF family proteins play a critical angiogenic role in the uterus during the implantation process in various animal and human species [132].

examination of samples obtained as a result of hysterectomy showed that in the case

of leiomyoma, there is indeed a less developed vascular network, a decrease in

microvascular density and an increase in vascular lumen areas, but these changes were not associated with VEGF expression [94]. In a later study by Wolanski et al. [87], conducted using immunoblotting, enzyme immunoassay and RT-PCR methods, no significant differences were found in the expression of VEGF, as well as their receptors

Thus, although by now the link between the pathogenesis of leiomyoma and disorders of angiogenesis is considered unambiguously proven, data on the expression

Thus, obtaining new data in this direction will have not only practical, but also theoretical significance.

the lower segment of the uterus compared to the control group was higher in women 3 years and earlier after C-section and, conversely, lower compared to the control group 7-9 years after surgery [144]. Biochemical studies of samples obtained from women

with repeated pregnancy after a previous C-section showed that in the case

of a violation of the integrity of the scar during repeated pregnancy, a higher collagen content and a slight increase in VEGF expression are detected compared to patients with a normal repeated pregnancy [140]. Data on the importance of VEGF for restoring the integrity of the uterus after C-section were confirmed in experiments on rats. The introduction to animals after removal of a part of the uterine horn of a genetically engineered structure obtained by fusion of the collagen-binding domain with the N-end