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Endometrioid cysts were first described by Rüssel (1899) and Pick (1905), who called them the «chocolate» or «tar» cysts [16]. Considering the frequency of lesions of the genital system, endometrioid ovarian cysts occupy the second place [1, 7, 13]. Despite the studies of over a century years there is still no consensus about the mechanisms of pathogenesis, occurrence and recurrence. Such as therapy for endometrioid formations of the ovaries which are also ambiguous. According to modern concepts, the most positive effects in treatment were shown when using a three-phase approach, including a surgical stage, an antirelapse hormonal therapy and a re-laparoscopy [6, 8]. The main criterion for the effectiveness of therapy, regardless of method or combinations, show no recurrence of the disease [8, 11, 17]. Relapses of endometrioid ovarian cysts for 5 years after laparoscopic treatment (cystectomy, resection of the ovary, adnexectomy) occur in 10–25 % of cases, and significantly more frequently in patients not treated with hormonal therapy in the postoperative period [9, 15]. Undifferentiated dysplasia of connective tissues – genetically determined developmental disorder of connective tissue, resulting in the change of its structure, functions and properties which cause organ manifestations flowing with human immunity, contributing to the progression of pathological changes in the genital organs. In modern gynecology many studies confirm the impact of undifferentiated dysplasia of connective tissues in the development of gynecological diseases [2, 3, 4, 5, 10, 14]. Despite the interest of researchers about undifferentiated dysplasia of connective tissues, so far there are no research on the effectiveness of standard therapy for endometrioid ovarian cysts, depending on the degree of concomitant undifferentiated dysplasia of connective tissues. Objective: evaluation of effectiveness of complex therapy of endometrioid ovarian cysts depending on the availability of undifferentiated dysplasia of connective tissues. Material and Мethods. Under our supervision there were 70 patients aged from 18 to 40 years, depending on the presence or absence of undifferentiated dysplasia of connective tissue they were divided into 2 groups: I study group consisted of 35 patients with endometrioid ovarian cysts, who wereidentified to have more than 6 external phenotypic traits of undifferentiated dysplasia of connective tissues, II a comparison group consisted of 35 patients with endometrioid ovarian cysts with 6 and less phenotypic traits of undifferentiated dysplasia of connective tissues. To externally establish the phenotype a modified phenotypic map was used, including 63 metric units [12]. Patients of the main group and comparison group did not differ in age, complaints, reproductive and somatic factors, gynecological pathologies and the state of endometriosis. All the patients had not received specific therapy of endometriosis before the surgery. All patients diagnosed for endometrioid ovarian cysts were confirmed histologically. for all the patients after a complete observation a laparoscopy was performed, followed by theremoval of cysts in healthy tissues, separation of adhesions, hydrotubation. After surgery the patient of both groups within 6 months received an agonist Gonadotropin releasing hormone «Buserelindepot» («pharmsintez», Russia): intramuscularly in a dose of 3.75 mg once every 28 days for 6 months. For the comparative evaluation of the clinical effect of complex therapy for endometrioid ovarian cysts, the patients were observed and monitored the frequency of detection of pain syndrome, menstrual function, the level of CA-125 (through 1, 3, 6 and 12 months after completion of treatment), as well as infertility within 12 months after the treatment. In the absence of pregnancy after 12 months after completion of treatment, a second-look laparoscopy was performed to estimating the frequency of possible recurrence of endometrioid ovarian cysts. laparoscopy evaluated the state of organs of the pelvis area and abdomen, in case of endometriosis taking into account their size, color, location, extent, and depth of invasion, the severity of adhesions and patency of the fallopian tubes. After which a standard volume of operative Aleksanova Ekaterina, Assistant of obstetrics and gynecology department, Stavropol State Medical University; tel.: +79280069003; e-mail: alexanova@mail.ru

medicinskij vestnik severnogo kavkaza

Effectiveness of complex therapy for endometrioid ovarian cysts depending on the presence or absence of undifferentiated dysplasia of connective tissue