Method of ovary thecomatosis diagnostics during menopause

FIELD: medicine.

SUBSTANCE: invention refers to medicine, particularly to obstetrics and gynecology, and is intended for diagnostics of ovary thecomatosis during menopause. For patients with recurrent hyperplastyic endometrium process, number of hyperplastic process events is determined by ultrasonic endometrium scanning and urethra scrape. If there are three or more events of hyperplastic process of endometrium during menopause, then ovary thecomatosis is diagnosed.

EFFECT: increased accuracy of ovary thecomatosis diagnostics.

4 ex

 

The invention relates to medicine, namely to obstetrics and gynecology, and can be used to diagnose Takamatsu ovaries at menopause in women with recurrent hyperplastic process of the endometrium.

Known ultrasonic diagnostic method of Takamatsu ovaries (TAN). Spend transvaginal ultrasound examination of the ovaries. Determine the volume of the ovary and the amount of stroma. Compute their ratio. When it is 3.2 and less diagnose stromal hyperplasia. The method improves the accuracy of diagnosis (Kuzmina S. Patent RF №2201141 from 10.07.2000).

The prototype disadvantages: lack of sensitivity and specificity, there are no reliable markers THEE. Ultrasound helper method studies and is an adjunct to clinical examination. Only on the basis of ultrasound diagnosis THEE not valid.

Technical result: early diagnosis of the disease, improving the accuracy of the method.

This result is achieved by the fact that patients with recurrent hyperplastic process of the endometrium in a menopause determine the number of cases of endometrial hyperplasia by ultrasound of the endometrium and the scraping of the uterine cavity. If three or more cases of endometrial hyperplasia establish the diagnosis of Takamatsu ovary.

The method is carried out following the way.

Examined patients with recurrent hyperplastic process endometrial menopausal period (from 47 to 60 years). Comprehensive, full diagnostics:

- Ultrasound of the endometrium;

the scraping of the uterine cavity.

An ultrasound determine hyperplasia of the endometrium by the nature of the echoes (endometrial thickness, the presence of rounded or elongated oval formations of endometrial polyps and/or the cervical canal).

In the presence of hyperplastic process produce a scraping of the uterine cavity under the hysteroscope, which allows to determine the nature of the morphological changes. Appreciate various forms of endometrial hyperplastic processes with different benign histological picture on the basis of laboratory findings (adenofibrosis polyp, glandular polyp, glandular hyperplasia, glandular-cystic hyperplasia). When relapse hyperplastic process (based on ultrasound) again produce a biopsy under the control of the hysteroscope.

The result is evaluated as follows.

If three or more cases of hyperplastic process endometrium during menopause confirm the presence of Takamatsu ovary.

Examples of specific applications

Example 1. A patient, 54 years old, was observed in the gynecology Department KKB Perm Ds: set the state interstitielle-subserous myoma of the small sizes. Hyperplastic process of the endometrium in menopause.

Menopause 2 years. Uterine fibroids within 3 years. 1 case of hyperplastic process endometrium - fibrous polyp of endometrium. Treatment is not received.

Ultrasound: uterus 74×76×80 mm Interstitielle subserous uterine fibroids from 50 to 80 mm 3 knots. M-echo 2 mm Ovaries without features.

Volume of surgery - laparotomy. Hysterectomy with appendages.

Results histological findings uterine fibroids, endometriosis.

Diagnosis after surgery: interstitielle-subserous myoma of the small sizes. Growth. Hyperplastic process of the endometrium in menopause. No Takamatsu ovaries. No recurrence hyperplasia.

Example 2. Patient T., aged 54, was observed in the gynecology Department KKB Perm Ds: recurrent hyperplastic process of the endometrium. Hysteromyoma of the small sizes in combination with endometriosis.

Menopause 2 years. Myoma of the uterus for 10 years.

2 cases of hyperplastic process of the endometrium of the uterus during 1 year. Treatment: norcolut.

Data ultrasound: uterus 58×44×55 mm, M-echo 3 mm, the boundary clear. Ovaries 24×20×15 mm increased echogenicity.

CA 125; LH; FSH; progesterone; testosterone; DHEA-s - normal Volume of surgery - laparotomy. Hysterectomy with appendages.

Results the ATA histological findings uterine fibroids, endometriosis.

Diagnosis after surgery: recurrent hyperplastic process of the endometrium. Hysteromyoma of the small sizes in combination with endometriosis. No Takamatsu ovary.

Example 3. Patient, 54 years, was observed in the gynecology Department KKB Perm Ds: recurrent hyperplastic process of the endometrium in menopause. Hysteromyoma of the small sizes. The state after the combined treatment of disease of the left breast in 2003 Menopause 5 years. 3 cases of hyperplastic process endometrium during 1 year. Treatment is not received.

Data ultrasound: uterus 53×43×53 mm M-echo 11 mm Ovaries melkoporistoj structure.

Volume of surgery - laparotomy. Hysterectomy with appendages.

Results histological findings uterine fibroids, tecomates ovary.

Diagnosis after surgery: recurrent hyperplastic process of the endometrium in menopause. Uterine fibroids. Tecomates ovary.

Example 4. A patient, 55 years of age, was observed in the gynecology Department KKB Perm Ds: recurrent hyperplastic process of the endometrium in menopause.

Menopause 3 years. 4 cases of hyperplastic process endometrium during 1 year. Treatment is not received. Objective: redundant power supply. Data ultrasound: uterus 67×44×62 mm Interstitielle-subserous m & e is and uterus, M-echo 5 mm Ovaries without features.

Volume of surgery - laparotomy. Hysterectomy with appendages. The results of the pathology report - tecomates ovaries. Diagnosis after surgery: recurrent hyperplastic process of the endometrium. Tecomates ovary.

In this way were examined 60 patients menopausal age with recurrent hyperplastic process of the endometrium. The age of women ranged from 46 to 60 years. The following results are obtained: 60 surveyed (100%) patients with uterine bleeding were histologically verified various forms of hyperplastic processes. The 52 surveyed (86,6%) as a result of histological examination of ovarian tissue revealed the presence of luteinizing stromal cells in hyperplastic ovarian cortical layer without any connection to the follicles, otherwise tecomates ovary.

The positive effect of the claimed method consists in the following: the method is highly specific and sensitive; allows you to diagnose the presence of Takamatsu ovaries, thereby allowing selection of the appropriate therapeutic strategy.

The way to diagnose Takamatsu ovaries at menopause using pelvic ultrasound, characterized in that in patients with recurrent hyperplastic process endometrium reveal the number of Sluch the EB hyperplastic process of the endometrium by ultrasound of the endometrium and the scraping of the uterine cavity, and in the presence of 3 or more cases of endometrial hyperplasia different localization in the cavity of the uterus establish the presence of Takamatsu ovaries during menopause.



 

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