Сучасна концепція надання допомоги жінкам з апоплексією яєчника

Abstract

Вивчено надання медичної допомоги 888 жінкам з апоплексією яєчника з 2012 по 2020 рр. Залежно від об’єму гемоперитонеума пацієнтки були розділені на три групи: І група – 480 (54,0 %) пацієнток, у яких об’єм гемоперитонеума не перевищував 200 мл; ІІ група – 283 (31,8 %) жінки із внутрішньочеревною кровотечею об’ємом від 200 до 500 мл; ІІІ група – 125 (14,1 %) пацієнток з об’ємом гемоперитонеума більше 500 мл. Група І складалася з жінок, яким проводили консервативне лікування апоплексії яєчника, і пацієнток, у яких головним лікувально-діагностичним заходом була лапароскопія. Аналіз даних трансвагінальної ехографії дає можливість з високим ступенем точності кількісно визначити об’єм інтраабдомінальної кровотечі. Лапароскопія є «золотим стандартом» у діагностиці та лікуванні апоплексії яєчника.

The aim. Analysis of rendering the medical aid to women with apoplexy of the ovary, determination of the basic clinical, laboratory and ultrasonic criteria, which influence the choice of therapeutic management, the evaluation of the immediate and long-term results of treatment of ovarian hemorrhages. Materials and methods. There was studied medical aid to 888 women with apoplexy of the ovary from 2012 to 2020. Depending on the volume of hemoperitoneum patients were divided into three groups: І group – 480 (54.0%) patients whose volume of hemoperitoneum did not exceed 200 ml; ІІ group – 283 (31.8%) women with intraperitoneal hemorrhage with volume from 200 to 500 ml; ІІІ group – 125 (14.1%) patients with a volume of hemoperitoneum of more than 500 ml. The group І consisted of ІC group – 270 (30.4%) women who were given conservative treatment of apoplexy of the ovary (AO), and ІL group – 210 (23.6%) patients whose main diagnostic and treatment measure was laparoscopic intervention. Results of the study. The average age of the patients was (28.3±5.2) years. The pelvic pain was the leading clinical symptom in all patients. According to the data of the transvaginal US made in the saggital plane, a linear dependence was observed between the level of free liquid and the volume of hemoperitoneum (r=0.63, p<0.05). In 792 (89.2%) patients the diagnosis of apoplexy of the ovary and intraperitoneal hemorrhage was made to surgical intervention – on the basis of clinical picture and US data. In the remaining cases – 92 (10.4%) diagnostic laparoscopy was required for confirming the diagnosis. The average volume of hemoperitoneum discovered in patients with ovarian apoplexy, in absence of the adhesive process was (273.5±21.3) ml, whereas in patients with the expressed adhesive process of the small pelvis organs it was (141.4±35.5) ml. The cause of ovarian apoplexy was the corpus luteum or cyst of the corpus luteum in more than the half of the cases – 348 (56.3%). Conclusions. The manifestation of the clinical symptoms in apoplexy of the ovaries depends on the volume of intraperitoneal hemorrhage. The data analysis of transvaginal echography allows to determine quantitatively, with a high degree of accuracy the volume of intraabdominal hemorrhage and the morphological state of the affected ovary. Laparoscopy is not only a “gold standard” in diagnosis and treatment of ovarian apoplexy, but also contributes to the prevention of ovarian hemorrhages in future.