Прогнозирование характера образований и профилактика осложнений доброкачественных эпителиальных опухолей яичников

Аннотация

Topicality and demand of the subject of dissertation. Pelvic masses - one of the most frequent pathologies occurring in women of reproductive, premenopausal and postmenopausal age. Absence of symptoms not only at early, but in the later stages of the disease in many cases leads to untimely identification of pathological process. Adnexal masses in the general structure of their morbidity consist of 14% of pelvic masses, and TFO (tumor formation of ovary) and BEOT (benign epithelial ovarian tumors) - up to 80% of all ovarian tumors. Despite of the fact that benign ovarian tumors and OTF arc in one code in ICD-10 (International classification of diseases) - D27 “Ovarian Tumors”, their pathogenesis is different, and they make a different contribution to the process of neoplastic transformation and structure of mortality from pelvic cancer. In light of this fact, the most dangerous arc benign epithelial ovarian tumors (BEOT), the frequency of their cancer transformation is quite high, and patients admit mainly in neglected stages. Demonstrated ability to relapse of ovarian tumors, rapid growth, malignancy, lack of clear understanding of the etiology and pathogenesis and poor diagnosis in the early stages dictate the introduction of additional methods of research and rehabilitation treatment options for patients to relapse, restore fertility and improve quality of life. In terms of malignancy, the most dangerous arc epithelial ovarian tumors, which in consequence may develop into cancer. TFO and ВОТ transform into ovarian malignancy in 17% of cases, due to untimely diagnosis, which arc associated with high morbidity and mortality, public spending for inpatient treatment that is not only medical and social, but also economic importance for all countries. Mortality from ovarian cancer for ten years in a number of countries increased by 36.8%, i.e. it is every second or third woman with ovarian tumors. The research work carried out within the framework of the achievement of the set by the Decree of the President of Republic of Uzbekistan "Program on measures for further intensification and increase of efficiency of work held on strengthening of reproductive health of the population, birth of healthy child" 01.07.2009, № PD-1144. In connection with listed above, problems of identification the causes and searching for new sensitive markers for the diagnosis and prediction of ovarian tumors, including TFO, ВОТ and malignant tumors arc one of the most pressing in fundamental and applied modem gynecology and gynecological oncology for today. Differential diagnosis of type BEOT and TFO especially prediction of these diseases before surgery remain one of the most important and unsolved problems in modern gynecology and one of the important criteria demand the dissertation topic. Purpose of research is to determine the role and nature of disorders of the immune system in the development of benign epithelial ovarian tumors and according to the results of research to work out methods for prediction nature of tumor before surgery and according to pathogenesis work out rehabilitation treatment, and prevention complications. Scientific novelty of dissertational research of the thesis research arc following: comprehensive examination of patients with benign ovarian tumors prior to surgery is carried out for the first time, allowing a high degree of probability to predict the nature of the formation of the ovary for avoiding diagnostic errors in the selection of treatment methods; results of the study facilitate to determine the role of immune system in development of the tumor process, to examine the nature of immunological imbalance parameters (cytokines), molecular biology (VEGF), and apoptosis factors (P53 and Bcl-2) in the development of BEOT; it was shown that all kinds of benign ovarian tumors had significantly higher levels of IL-6 and TNF-a as compared with the control group, but they have a lower content than in malignant tumors. A clear correlation had revealed between increasing of an ovarian neoangiogenesis factors VEGFR-1 and VEGFR-2 and P53/Bcl-2 apoptosis factors ration in scrum and tumor tissue. Application of modem ultrasound Doppler studies to examine blood flow in the ovarian formation capsule and identify neoangiogenesis allows predicting the nature of education. high rates of sensitivity, specificity, the coefficient of asymmetry indices assessment of risk (AR), odds ratio (OR), informative and rank coefficient allow us to recommend the definition of VEGFR-1 and VEGFR-2, p53 and bcl-2 and their ratio P53 / bcl-2 in blood and ovarian cancer as markers for predicting the nature of formations and possible recurrence of BETO and TFO; rehabilitation program of operated patients for relapse prevention of formation in the operated ovary developed and scientifically validated. Conclusion 1. Gynecological operations in the structure of interventions frequency for benign ovarian tumors arc one-third. More than 90% of benign ovarian tumors removed by laparoscopy in gynecological hospitals, which equipped with a laparoscope, allows for conserving therapy. 2. During the last 12 years have seen a "rejuvenation" of the age of patients with benign tumors of the ovaries, which ranges from 20 to 40 years (73.8%). Frequency of BEOT is 32.1% among all benign tumors of the ovary. It is known that epithelial ovarian carcinomas arc at risk of ovarian cancer, so it is necessary to predict type of tumor before surgery. 3. Among the risk factors for benign ovarian tumors in an important place is dysfunction of immune system that indicate the importance of their pathogenetic role in the progression of cancer. All kinds of benign ovarian tumors had significantly higher levels of IL-6 and TNF-a as compared with the control group, but they arc characterized by low levels of proinflammatory interleukin than in malignant tumors. High levels of IL-6 and TNF-a in malignant tumor of the ovaries allow us to consider them as a marker of malignancy and aggressiveness of the dis ease. 4. Among women with benign tumors of the ovaries increased apoptotic protein p53 and antiapoptotic bcl-2 protein, however, changes in these apoptotic markers disproportionate in scrum and tissues in TFO and BEOT. Changes in apoptosis markers ratio indicates on violation of immunological control and improving the processes of proliferation, contributing to the development of cancer. Increasing the parameters of apoptosis (p53 and bcl-2) in the blood and tumor tissues, and differences in the rate of growth of these indicators in women, especially with BEOT, allow us to recommend them for the differential diagnosis and prediction of complications and recurrence of ovarian tumors. 5. Forecast of the disease is determined by the integral index - the ratio of p53/bcl-2. In this high integral gain characteristic of TFO development, and vice versa, low integral factor for the development of characteristic of BEOT. To develop BEOT also characterized by the presence of high index of VEGFR-2. 6. Determination of intratumoral blood flow and neovascularization in the ovarian tumor capsule by Doppler mapping allows a high degree of probability to predict benign (specificity 92%) or malignant nature of tumor (specificity 100%). Identification of neovascularization in ovarian capsule tumor worsens the prognosis, which may be a sign of malignancy of tumor and indicates preference of laparotomy access to surgery compared with laparoscopy. Determination of tumor marker CA-125 can be used only in combination with other methods of prcopcra-tive examination. 7. Comprehensive examination, including determination of tumor marker CA-125, ultrasound Doppler velocimetry of blood in tumor capsule, determination of VEGF and its receptors VEGFR-1, VEGFR-2, p53 and bcl-2, the definition of interleukins IL-6 and TNF-a) can be prediction of tumor type (benign or malignant) before the operation and make a decision on the method of surgical treatment and its volume. In identifying elevated prcopcrativc indicators CA-125, p53 and bcl-2 and the absence of reduction of their levels after the operation is necessary consult of oncologist, to know the probability of recurrence and further observation and treatment. 8. Rehabilitation treatment after surgery helps to reduce relapse rates of masses of remaining ovary. Removal of benign ovarian tumor and conducting rehabilitation therapy helps to restore reproductive function. The cost effectiveness of minimally invasive laparoscopic surgical treatment of organ compared with the traditional is an average of 180 000 sum per patient.