Цель обзора — оценка диагностической ценности и клинической эффективности гистероскопии на современном этапе. Информационный поиск проведен с использованием библиометрического метода с помощью стандартных инструментов баз PubMed и EMBASE. Дополнительно выполнен анализ записей в базах IRBIS Национальной библиотеки им. Вернадского и Российской государственной библиотеки. Глубина поиска составила 5 лет. Из первоначального массива в 292 записи отобрано 12 с высоким уровнем доказательности (систематические обзоры,
метаанализы, контролируемые исследования). Дальнейший анализ полученного информационного массива проведен с использованием принципов квантификационной обработки текста с
последующей интерпретацией результатов в соответствии с постулатами Г. Лассвела. Показано, что гистероскопический метод является неотъемлемым элементом диагностических и
лечебно-профилактических алгоритмов в современной гинекологической практике, достаточно
безопасным и пригодным для лечения социально значимой патологии эндометрия.
The search strategy was conducted with bibliometric method in the databases PubMed and EMBASE. Advanced analysis wires entries in the IRBIS databases of the National Library n. a. Vernadsky and the Russian State Library. A search depth amounted to 5 years.
There were selected 12 sources from 292 entries with the preferences to high evidence publications (systematic review, meta analysis, controllable research). Further analysis of obtained information was conducted using the principles of quantification processing with following interpretation results in accordance with G. Lassvel’s tenets.
The main indications for use hysteroscopy detection and treatment of the pathology of the endometrium, myometrium and cervix, including those with congenital Mullerian anomalies, the presence of intrauterine contraceptive devices or other bodies of a foreign uterus, sterilization, treatment
of miscarriage, infertility and more. Diagnostic hysteroscopy is a safe method, complication rate when
it does not exceed 0.3%, while the application for therapeutic purposes hysteroscopy risk of complications increases to 0.95%. Hysteroscopy is the best method for the diagnosis and treatment of intrauterine synechiae, endometrial hyperplasia, submucous fibroids and pathological structures in the area of utero-tubular holes.
Different authors cite data showing high effectiveness of hysteroscopy for the diagnosis and treatment of infertility. Publications of the last years earlier refute widespread hypothesis that the irrigation
fluid uterus during hysteroscopy may facilitate dissemination of malignant cells in endometrial adenocarcinoma.
There are some limitations to the use of hysteroscopy. This procedure is contraindicated in the
presence of active inflammation in the pelvic organs, cervical cancer.
Recently gaining popularity for use hysteroscopic sterilization intervention.
A large amount of literature devoted to the improvement of tools and digital image processing,
obtained during hysteroscopy.
Another problem is that in recent years is the subject of scientific debate — defining the optimal
level of hysteroscopic interventions, including depth endometrial resection.
We know that the best results are observed intervention in cases where the endometrium is atrophic
or relatively thin as modern management carry out the procedure recommended resection of early
stage in postmenstrual perios when endometrial thickness not exceeding 4 mm. An alternative approach is to conduct data preoperative endometrial curettage, which eliminates the need to wait a few
days before that day cycle and hormonal therapy aimed at induction of endometrial thinning prior intervention. In the literature they are discussing the application of 3D-modeling image when performing hysteroscopic surgery and prospects robotics method actively. There is shown that hysteroscopic
method is the essential element of diagnostic, curative and preventive algorithms of the modern gynecological practices. This method is safe and could be used for the treatment for social important endometrium pathology.
