akusherstvoObstetrics, Gynecology and ReproductionАкушерство, Гинекология и Репродукция2313-73472500-3194IRBIS LLC10.17749/2313-7347/ob.gyn.rep.2024.575akusherstvo-2226Research ArticleОRIGINAL ARTICLESОРИГИНАЛЬНЫЕ СТАТЬИExternal genital endometriosis post-surgery hemostasis parametersПоказатели гемостаза после хирургического лечения наружного генитального эндометриозаhttps://orcid.org/0000-0003-0845-7550БайгалмааБ.BaigalmaaB.

Байгалмаа Балдансамбуу

Улан-Батор

Baldansambuu Baigalmaa, MD

Ulan Bator

baikala1011@gmail.comhttps://orcid.org/0000-0001-8404-1042БицадзеВ. О.BitsadzeV. O.

Бицадзе Виктория Омаровна, д.м.н., проф., профессор РАН

119991 Москва, ул. Трубецкая, д. 8, стр. 2

Scopus Author ID: 6506003478. WoS ResearcherID: F-8409-2017

Victoria O. Bitsadze, MD, Dr Sci Med, Prof., Professor of RAS

8 bldg. 2, Trubetskaya Str., Moscow 119991

Scopus Author ID: 6506003478. WoS ResearcherID: F-8409-2017

https://orcid.org/0000-0002-7456-2386СолоповаА. Г.SolopovaA. G.

Солопова Антонина Григорьевна, д.м.н., проф.

119991 Москва, ул. Трубецкая, д. 8, стр. 2

Scopus Author ID: 6505479504. WoS ResearcherID: Q-1385-2015

Antonina G. Solopova, MD, Dr Sci Med, Prof

8 bldg. 2, Trubetskaya Str., Moscow 119991

Scopus Author ID: 6505479504. WoS ResearcherID: Q-1385-2015

https://orcid.org/0009-0006-6130-2434ЕфановА. Е.EfanovA. E.

Ефанов Александр Евгеньевич

123423 Москва, ул. Саляма Адиля, д. 2/44

Alexander E. Efanov, MD

2/44 Salyama Adilya Str., Moscow 123423

https://orcid.org/0000-0003-4761-5793ВойновскийА. Е.VoynovskiyA. Е.

Войновский Александр Евгеньевич,  д.м.н.,  проф. 

123423 Москва, ул. Саляма Адиля, д. 2/44

WoS ResearcherID: S-6385-2016

Alexander Е. Voynovskiy, MD, Dr Sci Med, Prof

2/44 Salyama Adilya Str., Moscow 123423

WoS ResearcherID: S-6385-2016

 

Клиника «Амгалан»МонголияAmgalan ClinicMongoliaФГАОУ ВО Первый Московский государственный медицинский университет имени И.М. Сеченова Министерства здравоохранения Российской Федерации (Сеченовский Университет)РоссияSechenov UniversityRussian FederationГБУЗ «Городская клиническая больница № 67 имени Л.А. Ворохобова Департамента здравоохранения города Москвы»РоссияVorokhobov City Clinical Hospital № 67, Moscow Healthcare DepartmentRussian Federation202404112024185648–657Copyright © Baigalmaa B., Bitsadze V.O., Solopova A.G., Efanov A.E., Voynovskiy A.Е., 20242024Байгалмаа Б., Бицадзе В.О., Солопова А.Г., Ефанов А.Е., Войновский А.Е.Baigalmaa B., Bitsadze V.O., Solopova A.G., Efanov A.E., Voynovskiy A.Е.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.gynecology.su/jour/article/view/2226Introduction

Introduction. Endometriosis is one of the common diseases with poorly elucidated underlying nature and pathogenetic mechanisms. Clinical trials suggest that women suffering from it have hemostasis disorders. However, the severity of relevant changes and their origin remain debated.

Aim

Aim: to study the dynamics of hemostasis system parameters in patients underwent surgical treatment of external genital endometriosis (EGE).

Materials and Methods

Materials and Methods. A total of 120 women were enrolled into the prospective interventional comparative controlled study: 40 patients with EGE scheduled for surgical treatment (main group), 40 patients with other benign gynecological diseases requiring surgical intervention (comparison group), and 40 apparently healthy women (control group). Нemostasis system status was assessed based on the results of 3 visits during 3 month-follow-up by assessing the following biomarkers: metalloproteinase ADAMTS-13 (a disintegrin and metalloproteinase with thrombospondin type 1 motif, member 13), von Willebrand factor (vWF), D-dimer, protein C, antithrombin III (AT-III), activated partial thromboplastin time (APTT) and Рarus-test values.

Results

Results. Prior to surgery, among EGE women a subclinical but significant increase in procoagulant biomarkers was observed compared to other groups: vWF – 1.24 [1.17–1.35] U/ml, D-dimer – 173.5 [73.5–221.23] ng/ml. Evaluation of the remaining parameters showed no clinical significance of the observed changes. The endometriosis-related surgical intervention was accompanied by increase in specific procoagulant factors a week post-treatment apparently associated with surgical manipulations. However, 3 months later, hemostasis system status partially normalized as revealed by lower biomarkers examined, which in some cases were significantly decreased compared to those observed before surgery. At the same time, differences between the study groups remained statistically significant.

Conclusion

Conclusion. Patients with EGE were noted to have a subclinical risk of thrombogenesis. Upon this, surgical treatment and rehabilitation during recovery period allowed to improve overall state of the hemostasis system, thereby reducing a thrombogenesis risk.

Введение

Введение. Эндометриоз является одним из распространенных заболеваний с не до конца проясненными природой возникновения и патогенетическими механизмами. Исследования указывают на наличие нарушений в системе гемостаза у женщин с этим заболеванием. При этом характер выраженности данных изменений и их природа остаются предметом дискуссии.

Цель

Цель: изучить особенности динамики отдельных показателей системы гемостаза у пациенток, перенесших хирургическое лечение наружного генитального эндометриоза (НГЭ).

Материалы и методы

Материалы и методы. В проспективное интервенционное сравнительное контролируемое исследование были включены в общей сложности 120 участниц: 40 пациенток с НГЭ, которым назначено хирургическое лечение (основная группа), 40 пациенток с другими доброкачественными гинекологическими заболеваниями, требующих хирургического вмешательства (группа сравнения), и 40 практически здоровых женщин (контрольная группа). Диапазон возраста участниц исследования составил 18–45 лет. Оценку состояния системы гемостаза проводили по результатам трех визитов в течение 3 месяцев наблюдения с помощью следующих биомаркеров: содержание металлопротеиназы ADAMTS-13 (англ. a disintegrin and metalloproteinase with thrombospondin type 1 motif, member 13), фактора фон Виллебранда (англ. von Willebrand factor, vWF), D-димера, протеина С, антитромбина III (АТ-III), значения активированного частичного тромбопластинового времени (АЧТВ) и Парус-теста.

Результаты

Результаты. У женщин с НГЭ до проведения хирургического лечения наблюдали субклиническое, но статистически значимое по сравнению с другими группами увеличение концентраций прокоагуляционных биомаркеров: vWF – 1,24 [1,17–1,35] ЕД/мл и D-димера – 173,5 [73,5–221,23] нг/мл. Оценка остальных показателей не показала существенной клинической значимости наблюдаемых изменений. Проведенное хирургическое вмешательство сопровождалось повышением уровня отдельных прокоагуляционных факторов спустя одну неделю после лечения, что, по всей видимости, связано с хирургическими манипуляциями. Спустя 3 месяца состояние системы гемостаза частично нормализовалось, на что указывало снижение содержания изучаемых биомаркеров, которое в отдельных случаях было статистически значимо ниже по отношению к значениям в той же группе до хирургического вмешательства. В то же время различия между исследуемыми группами оставались статистически значимыми.

Заключение

Заключение. У больных с НГЭ отмечен риск тромбообразования, носящий субклинический характер. При этом хирургическое лечение и реабилитация в восстановительном периоде позволили в целом улучшить состояние системы гемостаза, тем самым снизив риск тромбообразования.

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The authors declare that there are no conflicts of interest present.