Endometrial pathology is increasingly common today. Specialists attribute this trend to an increase in the number of obese, endocrine disorders and a decrease in the immunity of women. In most cases, the pathology of the endometrium is accompanied by an imbalance in the hormonal system, metabolic processes. Of great importance is the increase in the number of somatic diseases of the chronic course.
Today, approximately 30-40% of all gynecological diseases reveal hyperplastic processes in the endometrium. Such conditions include fibro-endometrial, glandular-fibrous, glandular polyps, adenomatosis. Hyperplasia (glandular-cystic, diffuse or focal, glandular) is becoming more common.
Most experts agree that the cause of the processes is a hormonal malfunction in the body of a woman. The endometrium becomes a target for sex hormones, due to the presence of specific receptors in it. A disorder in the hormonal background of a woman leads to changes in the differentiation and growth of cellular elements. As a result, the pathology of the endometrium of a neoplastic or hyperplastic nature develops. Of particular importance in the formation of processes is hyperestrogenia. In many ways, an increase in estrogen levels is affected by a metabolic disorder that accompanies various therapeutic diseases.
The most common complaints of patients with hyperplastic processes are blood contact discharge, uterine bleeding (mostly acyclic). Bleeding in reproductive age is manifested by prolonged and heavy periods (according to the type of menometer) in the premenopausal period - acyclic, in postmenopausal women - with bloody discharge of varying intensity.
Diagnosis of endometrial hyperplasia is carried out by transvaginal ultrasound in the pelvic organs, histroscopy (diagnostic, with separate curettage, histological study of the material obtained).
One of the most important gynecological tasks today remains the treatment of hyperplastic processes. Endometrial pathology involves the use of conservative methods of therapy. These include hormonal treatment with estrogen-progestogen drugs, progestogen drugs. In addition, there are surgical procedures, including modern minimally invasive ones, with relatively fast recovery times.
An operative method includes resection (ablation) of the endometrium.
The purpose of this surgical intervention is to eliminate the clinical manifestations of existing hyperplastic processes. In addition, this method is used as a prophylaxis of endometrial cancer, to increase the chances of conception in women of childbearing age.
By ablation (ablation) of the endometrium is meant curettage, removal, destruction of the uterine cavity. Until today, gynecologists have not come to the same opinion on what to consider as a resection. There is no clarity about when to apply the definition of “ablation”.
The destruction of the entire endometrium (ablation) can be carried out by the electrosurgical and laser methods. At the same time, it is impossible to take tissue for histological examination.
Excision (resection) of the thickness of the endometrium is carried out only by the electrosurgical method. At the same time, the cutting loop cuts out the entire uterine mucosa in the form of chips . When carrying out this surgical intervention, it is possible later to take the excised tissue for histological examination.
As a rule, surgery is performed under epidural analgesia or general intravenous anesthesia. With simultaneous laparoscopy, endotracheal anesthesia is used.