Comparative analysis of the effectiveness of hysteromyoma relapse medicinal prevention in patients after myomectomy
The aim of the research is to compare the effectiveness of various methods of hysteromyoma relapse drug prevention in patients of reproductive age after myomectomy. Material and methods. During a prospective comparative study, 149 patients of reproductive age were examined in 3, 6, and 12 months after myomectomy surgery. All the patients were divided into 3 groups: in the 1st group the patients (n = 30) were prescribed a drug from the group of selective progesterone receptor modulators (SPRM); in the 2nd group (n = 30) a drug from the group of gonadotropin releasing agonists hormone (GnRH) was prescribed; in the 3rd group (n = 30) - combined oral contraceptives (COC) were prescribed. Results. During the dynamic observation by means of ultrasound study, the minimum number of hysteromyoma relapses was detected in the 1 st group of patients compared with the 2nd and the 3rd groups. The relapse in the first group was observed in 19.6% (n = 10) of patients in 3 months; in 21.6% (n = 11) and 23.5% (n = 12) of patients, respectively in 6 and 12 months. In the 2nd group of the study compared with the 1st group, the increase in hysteromyoma frequency relapses was observed: in 3 months since the start of treatment, hysteromyoma relapses was in 36.7% (n = 18) of patients; in 6 months the relapse rate did not change and amounted 36.7 % (n = 18); in 12 months it was in 40.8% (n = 20) of females. The 3rd group showed the highest number of hysteromyoma relapses: in 3 months the relapse rate was 42.9% (n = 21); in 6 and 12 months the data obtained remained unchanged and also amounted 42.9% (n = 21) cases. According to the results of IHC study, the main prognostic markers in our study were Ki-67 (marker of tumor cells proliferative activity), BCL-2 (marker of apoptosis inhibitor), TGF (transforming growth factor), VEGF (vascular endothelial growth factor), ER (estrogen receptors) and PR (progesterone receptors). Conclusion. It was found that the use of SPRM in the early postoperative period significantly reduces the hysteromyoma relapses frequency, thereby reducing the risk of repeated surgical intervention.