BACKGROUND
Myomectomy is often associated with technical difficulties, which can be minimized by drug pre-treatment aimed at reducing the size of fibroids, stopping heavy menstrual bleeding, preventing anemic syndrome.
OBJECTIVE
To substantiate the efficacy of drug preparation with the use of ulipristal acetate based on the results of organ preserving surgical treatment of patients of reproductive age with uterine myoma accompanied by heavy menstrual bleeding and anemia.
MATERIAL AND METHODS
The study involved 75 reproductive-age patients with leiomyoma, heavy menstrual bleeding and anemia. Group I — 40 women who underwent preoperative treatment of ulipristal acetate for 3 months, and then laparoscopic myomectomy. Group II — 35 patients who underwent surgery without pre-treatment. A prospective comparative analysis of clinical and laboratory data, intraoperative and postoperative parameters, pathomorphological changes in the nodes and endometrium was performed.
RESULTS
After ulipristal acetate treatment all group I patients stopped heavy menstrual bleeding, the size of myomatous nodes decreased by an average of 25% according to echography (p<0.05), the level of hemoglobin and ferritin reached normal values (p<0.01). In group I, there was a decrease in the duration of the operation (p=0.043) and the volume of blood loss (p=0.021), compared with group II. In the postoperative period, patients of group I showed a higher level of hemoglobin (p=0.038), and there was also a tendency to a decrease in the duration of hospitalization. In the distant postoperative period, most patients noted an improvement in their general condition, the absence of heavy menstruation, and a decrease in pain. Hemoglobin level 6 months after surgery corresponded to the norm in most patients. In endometrium of patients of group I after therapy, a drug pathomorphism was revealed, which was benign and reversible.
CONCLUSIONS
Management tactics for reproductive-age patients with uterine myoma, heavy menstrual bleeding and anemia, should include comprehensive preoperative diagnosis, pathogenetically substantiated preoperative preparation aimed at reducing the size of fibroids and correction of anemia, which creates favorable conditions for organ-preserving surgical intervantion.
