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Objective: To assess the diagnostic value of biomarkers: microbiological, molecular and biological, immunological biomarkers, characteristic of various types of recurrent myoma-associated growth.Materials and Methods: Seventy women of reproductive age with recurrent uterine myoma and its combination with adenomyosis after conservative treatment in the Clinic of Kuban State Medical University were examined. Methods: microbiological examination, sonography, Doppler sonography, histology, immunohistochemistry, morphometry.Results: The type of recurrent myoma-associated growth was proved to be dependent on molecular and biological characteristics of tumors, the presence of infection and blood perfusion. It was indicated that women with recurrence of myoma-associated growth of a “false” type were characterized by high rates of infections (the presence of reproductive losses, chronic inflammatory diseases of the pelvic organs) and significant bacterial contamination of the genital tract biotopes. Blood perfusion features were identified for true and “false” types of recurrent myoma-associated growth based on Doppler sonography data, which were consistent with features of tumor vessel morphometry. Analysis of uterine myoma histological types and their vascularization features showed correlation of forms with a high proliferative potential of a tumor on a molecular and cellular level to moderate and high expression of steroid hormone receptors in combination with Ki67, a significant diameter of the lumen of the vessels with the highest VI and VFI values.Conclusions: A comprehensive study of women with uterine hyperplasia determines the possibility of prediction of pathogenetic variants of recurrent myoma-associated tissue growth and adequate choice of treatment options and rehabilitation course.

Aim. The aim of the study: to compare the effectiveness of traditional laparoscopic myomectomy to the one with an additional stage based on the analysis of echographic scar monitoring among fertile-interested patients.Materials and methods. A prospective analysis of 96 surgical interventions was performed (laparoscopic myomectomy among reproductive-aged patients with uterine fibroids (UF).Results. Echographic scar monitoring showed a lower incidence of adverse sonographic stigma after laparoscopic occlusion of the ascending branches of the uterine artery (UA AB LSO) during three months’ time observation and a leveling of differences – during half a year.Conclusions. UA AB LSO improves the quality of myomectomy and the probability of morphologically substantiated scar formation on the uterus.

Purpose: to evaluate the impact of a comprehensive rehabilitation therapy on the results of organ-preserving UF treatment technology being based on the study of adaptation reactions nature and cytokine profile. Materials and methods: the study involved 265 women with uterine fibroids after laparoscopic myomectomy, laparotomic myomectomy and UAE (with and without complex rehabilitation after surgery). Adaptation reactions after different treatment technologies and cytokine profile after UAE (TNF-α, IL-1β, IL-2, IL-6, IL-4, IFN-γ, Fas-L) were under thorough study. Results: myoma growth relapses during the observation period were distinguished among 12 patients after LSM, 16 – after LTM, 11 – after UAE. Molecular mechanisms of disease recurrence were clarified, especially in the absence of rehabilitation: long-term proinflammatory shift characteristic of an early postoperative period, destructive processes aggravation in the injured myometrial tissue with the increase in the dynamics of anti-apoptotic activity (Fas-L lack), Th1-cell factors depletion and immunosuppression development. Summary: the profile of adaptation reactions is shown to be not only the predictor of disease recurrence but also the criterion of a full-course rehabilitation. Cytokine profile study after UAE contributes to the prediction of treatment technology ineffectiveness.

Within our study we compared the effectiveness of laparoscopic myomectomy with bed unit closure with individual sutures and a monofilament self-locking thread. Depending on the way of the uterine wall closure during laparoscopic myomectomy 2 groups were formed among 40 women: in group I (n = 20) a monofilament synthetic thread of poliglecaprone (Monocryl Plus 0) was used by individual Z-shaped sutures; in group II (n = 20) a node-free uninterrupted suture was used with the thread with a serrated design and a fixing loop (V-lock 180 «0»). Using a node-free suture in laparoscopic myomectomy helped to reduce the duration of suturing the myometrium defect, the intraoperative blood loss, general surgical risks and the complexity of the intervention. Certain clinical benefits in using barbed suture V-lock were identified: the formation of a well-fixed uterine scar due to full recovery of the uterus anatomy after laparoscopic myomectomy while minimizing intra- and postoperative complications.

Purpose: To evaluate the clinical response and quality of life of patients with uterine myoma on the basis of the analysis of outcomes after organ-preserving interventions and depending on existence of complex rehabilitation.Materials and Methods: This prospective study included 265 patients with symptomatic uterine myoma. Data on health-related quality of life and severity of symptoms before and after UAE and organ-preserving interventions and existence of complex rehabilitation were obtained by the standardized «Uterine Fibroid Symptom and Quality of Life» (UFS-QOL) questionnaire. Treatment failure was defined as the need for a second invasive procedure because of recurrent symptoms or persistent symptoms after interventions.Results: At 6 months after treatment, all three leiomyoma therapies resulted in substantial symptom relief, to near normal levels, with the greatest improvement after complex rehabilitation.Summary: It is shown that the assessment of quality of life not only a prediсtor of the complicated current of the postoperative period and the remote recurrence of a disease, but also criterion of full value of a carried-out course of rehabilitation. The complex rehabilitation makes it possible to reduce the frequency of postoperative complications and relapses of diseases.

In research it is shown that the profile of adaptable reactions acts not only a predictor of the complicated current of the postoperative period and the remote recurrence of a disease, but also criterion of full value of a carried-out course of rehabilitation. Preference of UAE and a laparoscopic myomectomy at the uterine myoma in view of their less traumatic impact on uterine tissue of proves more favorable profile of adaptable reactions.