Characteristics of blood supply to uterine fibroids after laparoscopic myomectomy in history

封面

如何引用文章

全文:

开放存取 开放存取
受限制的访问 ##reader.subscriptionAccessGranted##
受限制的访问 订阅存取

详细

Modern ultrasound technologies, including dynamic perfusion assessment, can deepen our understanding of the mechanisms that activate growth of residual uterine fibroids after myomectomy.

Objective: To evaluate the dynamics of blood supply to uterine fibroids remaining after laparoscopic myomectomy during 6 months of follow-up.

Materials and methods: A prospective cohort longitudinal study included 30 patients with a single uterine fibroid of intramural, intramural-subserous localization (FIGO type 4–5) that remained after laparoscopic myomectomy. We conducted a dynamic monitoring at 1, 3, and 6 months postoperatively, with the ultrasound assessment of biometry parameters and vascular morphology, as well as Doppler blood flow velocimetry. Three-dimensional ultrasound reconstruction with the VOCAL software was used to evaluate fibroid volume, echogenicity, as well as its vascularization indices (VI), flow index (FI), and perfusion index (VFI).

Results: We observed a decrease in uterine volume and restoration of endometrial thickness, accompanied by changes in the vascular architecture of the remaining uterine fibroids. The resistance index of the central fibroid vessels remained stable, while that of the peripheral vessels gradually increased. Small fibroids showed signs of angiogenic activity, while larger ones featured reduced perfusion. The perfusion index of uterine fibroids, both intramural (FIGO type 4) and intramural-subserosal (FIGO type 5), increased toward the end of the follow-up period; in type 4 nodules the enhancement of perfusion and flow index occurred earlier and was more pronounced than in intramural-subserosal nodules. Surgical factors had an impact on the perfusion indices of the residual uterine fibroids after myomectomy.

Conclusion: Size, location and type of the fibroid according to FIGO, as well as its surgical characteristics (number of removed fibroids, opening of the uterine cavity) were associated with differences in the perfusion indices of the residual uterine fibroids in postoperative observation. These data confirm that the combination of ultrasound features can be used for more substantiated planning of the frequency and extent of postoperative monitoring, but their prognostic role requires further study.

作者简介

Maria Dolgikh

D.O. Ott Research Institute for Obstetrics, Gynecology and Reproductology

编辑信件的主要联系方式.
Email: mariadolgikh1@gmail.com
ORCID iD: 0000-0002-9910-9668
SPIN 代码: 3879-7773

MD, Junior Researcher at the Department of Gynecology and Endocrinology

俄罗斯联邦, St. Petersburg

Nikolay Polenov

D.O. Ott Research Institute for Obstetrics, Gynecology and Reproductology

Email: polenovdoc@mail.ru
ORCID iD: 0000-0001-8575-7026
SPIN 代码: 9387-1703

MD, PhD, Senior Researcher at the Department of Gynecology and Endocrinology

俄罗斯联邦, St. Petersburg

Maria Yarmolinskaya

D.O. Ott Research Institute for Obstetrics, Gynecology and Reproductology

Email: m.yarmolinskaya@gmail.com
ORCID iD: 0000-0002-6551-4147
SPIN 代码: 3686-3605
Scopus 作者 ID: 7801562649
Researcher ID: P-2183-2014

Honored Scientist of the Russian Federation, Dr. Med. Sci., Professor of the Russian Academy of Sciences, Head of the Department of Gynecology and Endocrinology, Head of the Center of Diagnostics and Treatment of Endometriosis

俄罗斯联邦, St. Petersburg

Igor Kogan

D.O. Ott Research Institute for Obstetrics, Gynecology and Reproductology

Email: ikogan@mail.ru
ORCID iD: 0000-0002-7351-6900
SPIN 代码: 6572-6450
Scopus 作者 ID: 56895765600
Researcher ID: P-4357-2017

Dr. Med. Sci., Professor, Corresponding Member of the Russian Academy of Sciences, Director

俄罗斯联邦, St. Petersburg

参考

  1. Аганезова Н.В., Аганезов С.С., Шило М.М. Миома матки: современные практические аспекты заболевания. Проблемы репродукции. 2022; 28(4): 97-105. [Aganezova N.V., Aganezov S.S., Shilo M.M. Uterine fibroids: modern practical aspects of the disease. Russian Journal of Human Reproduction. 2022; 28(4): 97-105 (in Russian)]. https://dx.doi.org/10.17116/repro20222804197
  2. Ящук А.Г., Мусин И.И., Гумерова И.А. Современные аспекты в изучении этиологии миомы матки. Российский вестник акушера-гинеколога. 2019; 19(3): 49-56. [Iashchuk A.G., Musin I.I., Gumerova I.A. Current aspects of the study of uterine myoma etiology. Russian Bulletin of Obstetrician-Gynecologist. 2019; 19(3): 49-56 (in Russian)]. https://dx.doi.org/10.17116/rosakush20191903149
  3. Беженарь В.Ф., Линде В.А., Аракелян Б.В., Садыхова Э.Э., Резник М.В., Тарасенкова В.А. Миома матки и фертильность: современный взгляд на проблему (обзор литературы). Журнал акушерства и женских болезней. 2022; 71(2): 79-86. [Bezhenar V.F., Linda V.A., Arakelyan B.V., Sadykhova E.E., Reznik M.V., Tarasenkova V.A. Uterine fibroids and fertility: a modern view of the problem (literature review). Journal of Obstetrics and Women's Diseases. 2022; 71(2): 79-86 (in Russian)]. https://dx.doi.org/10.17816/JOWD78831
  4. Yang Q., Ciebiera M., Bariani M.V., Ali M., Elkafas H., Boyer T.G. et al. Comprehensive review of uterine fibroids: developmental origin, pathogenesis, and treatment. Endocr. Rev. 2022; 43(4): 678-719. https://dx.doi.org/10.1210/endrev/bnab039
  5. Donnez J., Dolmans M.M. Uterine fibroid management: from the present to the future. Hum. Reprod. Update. 2016; 22(6): 665-86. https://dx.doi.org/10.1093/humupd/dmw023
  6. Li B., Wang F., Chen L., Tong H. Global epidemiological characteristics of uterine fibroids. Arch. Med. Sci. 2023; 19(6): 1802-10. https://dx.doi.org/10.5114/aoms/171786
  7. Stewart E.A. Uterine fibroids. Lancet. 2001; 357(9252): 293-8. https://dx.doi.org/10.1016/S0140-6736(00)03622-9
  8. Bulun S.E. Uterine fibroids. N. Engl. J. Med. 2013; 369(14): 1344-55. https://dx.doi.org/10.1056/NEJMra1209993
  9. Giuliani E., As-Sanie S., Marsh E.E. Epidemiology and management of uterine fibroids. Int. J. Gynaecol. Obstet. 2020; 149(1): 3-9. https://dx.doi.org/10.1002/ijgo.13102
  10. Kirschen G.W., AlAshqar A., Miyashita-Ishiwata M., Reschke L., El Sabeh M., Borahay M.A. Vascular biology of uterine fibroids: connecting fibroids and vascular disorders. Reproduction. 2021; 162(2): R1-18. https://dx.doi.org/10.1530/REP-21-0087
  11. Dolmans M.M., Petraglia F., Catherino W.H., Donnez J. Pathogenesis of uterine fibroids: current understanding and future directions. Fertil. Steril. 2024; 122(1): 6-11. https://dx.doi.org/10.1016/j.fertnstert.2024.02.048
  12. Testa A.C., Di Legge A., Bonatti M., Manfredi R., Scambia G. Imaging techniques for evaluation of uterine myomas. Best Pract. Res. Clin. Obstet. Gynaecol. 2016; 34: 37-53. https://dx.doi.org/10.1016/j.bpobgyn.2015.11.014
  13. Frijlingh M., Juffermans L., de Leeuw R., de Bruyn C., Timmerman D., van den Bosch T. et al. How to use power Doppler ultrasound in transvaginal assessment of uterine fibroids. Ultrasound Obstet. Gynecol. 2022; 60(2): 277-83. https://dx.doi.org/10.1002/uog.24879
  14. Idowu B.M., Ibitoye B.O. Doppler sonography of perifibroid and intrafibroid arteries of uterine leiomyomas. Obstet. Gynecol. Sci. 2018; 61(3): 395-403. https://dx.doi.org/10.5468/ogs.2018.61.3.395
  15. Nieuwenhuis L.L., Keizer A.L., Stoelinga B., Twisk J., Hehenkamp W., Brölmann H. et al. Fibroid vascularisation assessed with three-dimensional power Doppler ultrasound is a predictor for uterine fibroid growth: a prospective cohort study. BJOG. 2018; 125(5): 577-584. https://dx.doi.org/10.1111/1471-0528.14608
  16. Mavrelos D., Ben-Nagi J., Holland T., Hoo W., Naftalin J., Jurkovic D. The natural history of fibroids. Ultrasound Obstet. Gynecol. 2010; 35(2): 238-42. https://dx.doi.org/10.1002/uog.7482
  17. Беженарь В.Ф., Цыпурдеева А.А., Долинский А.К., Поленов Н.И., Байлюк Е.Н., Русина Е.И., Кахиани М.И. Опыт применения стандартизированной методики лапароскопической миомэктомии. Журнал акушерства и женских болезней. 2012; 61(4): 23-32. [Bezhenar V.F., Tsypurdeeva A.A., Dolinskiy A.K., Polenov N.I., Bayluk E.N., Rusina E.I., Kakhiani M.I. The experience of a standardized technique of laparoscopic myomectomy. Journal of Obstetrics and Women's Diseases. 2012; 61(4): 23-32 (in Russian)]. https://dx.doi.org/10.17816/JOWD61423-32
  18. Поленов Н.И., Долгих М.С., Ярмолинская М.И. Анализ эффективности миомэктомии лапароскопическим доступом при использовании стандартизированной методики. Журнал акушерства и женских болезней. 2024; 73(5): 76-83. [Polenov N.I., Dolgikh M.S., Yarmolinskaya M.I. Analysis of the effectiveness of myomectomy performed by laparoscopic access using a standardized technique. Journal of Obstetrics and Women's Diseases. 2024; 73(5): 76-83 (in Russian)]. https://dx.doi.org/10.17816/JOWD634591
  19. Долгих М.С., Поленов Н.И., Ярмолинская М.И., Коган И.Ю. Описание особенностей кровоснабжения интрамуральных и интрамурально-субсерозных миоматозных узлов различных размеров с применением Virtual Organ Computer-aided Analysis (VOCAL). Журнал акушерства и женских болезней. 2024; 73(6): 44-52. [Dolgikh M.S., Polenov N.I., Yarmolinskaya M.I., Kogan I.Yu. Description of the features of blood supply to intramural and intramural-subserous myomatous nodes of various sizes using Virtual Organ Computer-aided Analysis (VOCAL). Journal of Obstetrics and Women's Diseases. 2024; 73(6): 44-52 (in Russian)]. https://dx.doi.org/10.17816/jowd636413
  20. Malik N., Ranjan R., Khatri R., Kumari S., Malik V., Singh U.K. et al. A study of fibroid vascularization and vascular indices with three-dimensional power Doppler and superb microvascular imaging and the correlation with heavy menstrual bleeding. Cureus. 2024; 16(10): e71246. https://dx.doi.org/10.7759/cureus.71246
  21. Pritts E.A., Parker W.H., Olive D.L. Fibroids and infertility: an updated systematic review of the evidence. Fertil. Steril. 2009; 91(4): 1215-23. https://dx.doi.org/10.1016/j.fertnstert.2008.01.051
  22. Elkattan E., Kamel R., Elghazaly H., ElAriki E. Can three-dimensional power Doppler and uterine artery Doppler differentiate between fibroids and adenomyomas? Middle East Fertil. Soc. J. 2016; 21(1): 4651. https://dx.doi.org/10.1016/j.mefs.2015.07.004
  23. Stępniak A., Czuczwar P. 3D power Doppler vascular indices as a novel technique in assessing the outcome of minimally invasive techniques in uterine fibroids treatment. Prz. Menopauzalny. 2017; 16(4): 118121. https://dx.doi.org/10.5114/pm.2017.72755
  24. Ciarmela P., Delli Carpini G., Greco S., Zannotti A., Montik N., Giannella L. et al. Uterine fibroid vascularization: from morphological evidence to clinical implications. Reprod. Biomed. Online. 2022; 44(2): 281-94. https:// dx.doi.org/10.1016/j.rbmo.2021.09.005
  25. Miyashita-Ishiwata M., El Sabeh M., Afrin S., Borahay M.A., Hopkins J. Hypoxia induces angiogenesis and proliferation in uterine fibroid cells. Fertil. Steril. 2021; 116(3): 740-8. https://dx.doi.org/10.1016/j.fertnstert.2021.07.041
  26. Olson S.L., Akbar R.J., Gorniak A., Fuhr L.I., Borahay M.A. Hypoxia in uterine fibroids: role in pathobiology and therapeutic opportunities. Oxygen. 2024; 4(2): 236-52. https://dx.doi.org/10.3390/oxygen4020013
  27. Fedotova M., Barysheva E., Bushueva O. Pathways of hypoxia-inducible factor (HIF) in the orchestration of uterine fibroids development. Life (Basel). 2023; 13(8): 1740. https://dx.doi.org/10.3390/life13081740
  28. AlAshqar A., Lulseged B., Mason-Otey A., Liang J., Begum U.A.M., Afrin S. et al. Oxidative stress and antioxidants in uterine fibroids: pathophysiology and clinical implications. Antioxidants (Basel). 2023; 12(4): 807. https://dx.doi.org/10.3390/antiox12040807
  29. Alcázar J.L. Three-dimensional power Doppler-derived vascular indices: what are we measuring and how are we doing it? Ultrasound Obstet. Gynecol. 2008; 32(4): 485-7. https://dx.doi.org/10.1002/uog.6144
  30. Russo C., Camilli S., Martire F.G., Di Giovanni A., Lazzeri L., Malzoni M. et al. Ultrasound features of highly vascularized uterine myomas (uterine smooth muscle tumors) and correlation with histopathology. Ultrasound Obstet. Gynecol. 2022; 60(2): 269-76. https://dx.doi.org/10.1002/uog.24855
  31. Хворостухина Н.Ф., Островская А.Е., Рогожина И.Е., Новичков Д.А., Степанова Н.Н. Особенности маточной гемодинамики и системы гемостаза при миоме, осложненной геморрагическим синдромом. Акушерство и гинекология. 2016; 6: 87-93. [Khvorostukhina N.F., Ostrovskaya A.E., Rogozhina I.E., Novichkov D.A., Stepanova N.N. The specific features of uterine hemodynamics and hemostatic system in myoma complicated by hemorrhagic syndrome. Obstetrics and Gynecology. 2016; (6): 87-93 (in Russian)]. https://dx.doi.org/10.18565/aig.2016.6.87-93
  32. Буянoва С.Н., Щукина Н.А., Чечнева М.А., Бабунашвили Е.Л. Ультразвуковая диагностика при планировании органосберегающих операций по поводу миомы матки. Российский вестник акушера-гинеколога. 2018; 18(6): 83-7. [Buianova S.N., Shchukina N.A., Chechneva M.A., Babunashvili E.L. Ultrasound diagnosis in the planning of organ-sparing surgery for uterine myoma. Russian Bulletin of Obstetrician-Gynecologist. 2018; 18(6): 83-7 (in Russian)]. https://dx.doi.org/10.17116/rosakush20181806183
  33. Khan A.T., Shehmar M., Gupta J.K. Uterine fibroids: current perspectives. Int. J. Womens Health. 2014; 6: 95-114. https://dx.doi.org/10.2147/IJWH.S51083
  34. Munro M.G., Critchley H.O.D., Fraser I.S. The FIGO classification of causes of abnormal uterine bleeding in the reproductive years. Fertil. Steril. 2011; 95(7): 2204-8. https://dx.doi.org/10.1016/j.fertnstert.2011.03.079

补充文件

附件文件
动作
1. JATS XML
下载

Согласие на обработку персональных данных

 

Используя сайт https://journals.rcsi.science, я (далее – «Пользователь» или «Субъект персональных данных») даю согласие на обработку персональных данных на этом сайте (текст Согласия) и на обработку персональных данных с помощью сервиса «Яндекс.Метрика» (текст Согласия).