Сучасний погляд на етіологію, діагностику, лікування та профілактику спайкового процесу органів малого таза у жінок репродуктивного віку
DOI:
https://doi.org/10.15574/HW.2020.155-156.91Ключові слова:
перитонеальні спайки, спайкова хвороба, етіологія, патогенез, профілактика, лікування, репродуктивний вікАнотація
У статті представлено огляд літератури останніх років з проблеми перитонеальних тазових спайок у жінок репродуктивного віку. Висвітлено основні питання етіології та патогенезу перитонеальних тазових спайок як однієї з провідних причин порушення репродуктивної функції, хронічного тазового болю і хірургічних ускладнень у пацієнток репродуктивного віку.
Зазначено, що основними етіологічними передумовами утворення спайок є травма очеревини, кровотеча у черевну порожнину, наявність інфекції і вплив різних агресивних субстанцій, місцева антибактеріальна терапія, регіонарна ішемізація тканин тощо. Визначена висока медико-соціальна значущість проблеми у зв’язку з широким колом оперативних втручань, пов’язаних з травматизацією очеревини, високою частотою розвитку спайкового процесу.
Перитонеальні спайки – це диференційована динамічна клітинна васкуляризована структура. Розвиток активного запального процесу за участю клітин і прозапальних медіаторів може переходити у стадію тканинного ремоделювання, формування позатканинного колагену, тобто початкових ознак спайок. Виникнення хибного кола і каскаду взаємопідтримувальних змін з рештою призводить до спайкової хвороби та інвалідизації хворих.
Незалежно від факторів виникнення спайкового процесу перитонеальні спайки є основною причиною тазового болю, безпліддя і недостатності функції яєчників. Незважаючи на тривале вивчення патофізіологічних механізмів розвитку спайкового процесу, численні спроби визначення ефективних методів їхньої профілактики не дають очікуваних результатів.
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