ABSTRACT
Benign ovarian pathology remains a significant disorder in women who are in reproductive age in the world. During the last decades laparoscopic treatment has been established as a routine method of benign ovarian masses. Adhesion prevention, less operative pain and cosmetic better results are some of the most important advantages of this proceed. Since 2010, laparoscopic surgery has been implemented in our hospital, and it is necessary to expand in the future. In 2014 total of 286 cystectomy were done and 50 cases from them were held by laparoscopy at First Maternity Hospital. In Mongolia laparoscopic surgery cases are few and there is no study relating to this situation. Purpose of this study was to investigate whether laparoscopy could replace safe and effective surgical treatment of benign ovarian pathology. 50 women with benign adnexal cysts, laparoscopically treated in the Department of Gynecologic surgery of First Maternity Hospital in 2014 were included. This is a prospective study which used questionnaire with 24 questions.The mean age of presentation was 31 years. Ovarian cysts were more commonly seen in the age group 18-35 years. The diagnosis in 28 (56%) cases was endometriosis of the ovary, 1 (2%) serous cystadenomas, 9 (18%) dermoid ovarian cyst, 9 (18%) follicular cysts and 6 (12%) paraovarian cysts. Serum level of CA-125 measured before the surgery : high- 7(14%), normal- 26(52%) and 17(34%)- cases not measured. Pain improvement after surgery- 90% of the patients had no pain, 4% were with wound pain, and 6% were with pelvic pain. It was proven the advantage of the laparoscopic surgery Patients hospital stay: 72%-1 day, 24%- 2 days and 4%- 3 days. Laparoscopic surgery seems to offer significant advantages such as reduced hospital stay, less adverse effects, better quality of life, and superior vision especially on surgical treatment of cases like endometriosis.
ABSTRACT
Hysterectomy is still the most common major operation performed by gynecologists. Having said that the incidence of hysterectomy has increased last 20 years with new minimally invasive technique. Laparoscopy assisted vaginal hysterectomy has advantage like small incision, less operative pain, quicker recovery, less hospital stay comparing to the abdominal open surgery. Objective: To compare the outcome of abdominal hysterectomy and laparoscopic vaginal hysterectomy.The study population comprised all patients who had LAVH and abdominal hysterectomy at First Maternity Hospital, from June 2013 to December 2014.The mean age of both group is same (46.2±5.3). Duration time of LAVH is approximately 2.30±-5.9minutes and of total abdominal hysterectomy is a 1.41±2.7 minute. The general blood loss during LAVH is 74.4±19 ml and during total abdominal hysterectomy is 185.2 ± 67 ml. After LAVH any patient had no complaints. After LAVH the patient stayed at the hospital for 3 days. LAVH took significantly longer operating time than TAH. Blood loss was jess during LAVH. Hospital stay after LAVH was less than TAH. Drug cost is more case LAVH.
ABSTRACT
Endometriosis is described as a chronic inflammatory disease, characterized by endometrial-like tissue, found outside the uterine cavity which cause chronic pelvic pain, infertility,dysmenorrhea. The prevalence of endometriosis is difficult to determine accurately but in asymptomatic women, the prevalence of endometriosis ranges from 2- 22 %, depending on the population studied , in infertile women 20-50 % and in those with pelvic pain, between 40-50% (Balasch, 1996; Eskenazi, 2001; Meuleman, 2009).Endometriosis is found 7-10% of reproductive agewomen and 20-90% in with chronic pelvic pain, infertility cases. Pathogenesis of endometriosis is not yet fully understood but one potential cause of the disease is retrograde menstruation which results in the deposition of endometrial tissue into the peritoneal cavity. Today a composite theory of retrograde menstruation with implantation of endometrial fragments in conjunction with peritoneal factors to stimulate cell growth is the most widely accepted explanation for peritoneal endometriosis. Susceptibility to endometriosis is thought to depend on the complex interaction of genetic, immunologic, hormonal and environmental factors. To determine prevalence and severity of clinical symptoms, compare meta-analysis to changes the clinical value of serum CA-125 and peritoneal fluid cytology in women with endometriosis of Ulaanbaatar city. We had selected total of 60 woman with endometriosis which were registered from January to December 2014 in gynecologic clinic of First Maternity Hospital. The research group registered in questionnaire with 28 questions. During the inspection laboratory analysis of serum CA-125, ultrasound analysis and peritoneal fluid cytology were done. Assessment of pelvic pain by means of a 10-point linear analog scale / pain score/ which provided by International Pain Association. The research result was worked out by prospective method. Average age of patients 33.4±8.9. Pain location: Chronic pelvic pain 30%; Dysmenorrhea 28.3%; Dysparunea 10%; Pain during defecation 6,7%; Without pain -25%. Average level of Serum СА125 was 38.13±20.6. Location of endometriosis: adenomyosis - 8.4%, endometrioma-15% endometriotic lesion at cul de suc 68.3%, rectal involment 1.7%, tubal lesion-3.3%, combined 3,3%. 76.7% of surgery for endometriosis have done by laparoscopy and 23.3% by laparotomy. Ultrasound examination result: endometrioma d=0-2cm-1.7%, d= 3-5cm-36.2%, d=6-8cm-10.3%, d=9cm<-12.1%. Cytology result: Peritoneal fluid contains 75% of erythrocytes, mesothelial cells and it needs to further study.CONCLUSION:Most of patient /58.3%/ had chronic pelvic pain and dysmenorrhea. The severity of pain was significantly improved after operative laparoscopy. /p<0.05%/51,7% of patient had infertility problem.Value of serum CA-125 was higher in study group with large sized and not clear content ovarian endometrioma by ultrasound examination. /p<0.05%/The local environment of peritoneal fluid surrounding the endometriotic implant is immunologically dynamic and links the reproductive and immune systems. Peritoneal factors to stimulate cell growth is the most widely accepted explanation for peritoneal endometriosis. Peritoneal fluid contains a variety of free floating cells, including macrophages, mesothelial cells, lymphocytes, erythrocytes, eosinophils and mast cells. In our cytology results: peritoneal fluid contains 75% of erythrocytes, mesothelial cells.