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Postoperative scar endometriosis: optimization of diagnosis and treatment


Author: Zaharia Sergiu
Degree:doctor of medicine
Speciality: 14.00.27 - Surgery
Year:2020
Scientific advisers: Igor Mişin
doctor habilitat, professor, Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of Moldova
Ana Mişina
doctor habilitat
Institution: Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of Moldova

Status

The thesis was presented on the 18 November, 2020 at the meeting of the Scientific Council and now it is under consideration of the National Council.

Abstract

Adobe PDF document0.91 Mb / in english
Adobe PDF document1.01 Mb / in romanian

Thesis

CZU 616-089.84: 618.14-002

Adobe PDF document 16.00 Mb / in romanian
207 pages


Keywords

postoperative scar endometriosis (PSE), endometriosis of rectus abdominis muscle, perineal endometriosis, catamenial pain, cesarean section, immunohistochemistry profile

Summary

This research work comprises 120 pages, including introduction, 4 chapters, synthesis of the obtained results, conclusions, practical recommendations, 5 tables, 110 figures, and 274 bibliographic sources. The research findings were published with in 23 scientific works.

Research domain: 321.13 – surgery The purpose of the study: To provide optimal diagnostic and treatment management of the patients wit h PSE by assessing a range of clinical, imaging and morphological criteria, as well as surgical treatment outcomes.

The research objectives: (1) To study the clinical manifestations and localization features of PSE; (2) to determine the past surgery structure and define the causative risk factors for PSE; (3) to establish the imaging criteria (ultrasound, Doppler, CT, MRI scan) and the anatomical and topographical features of postoperative scar endometriosis; (4) to determine the optimal surgical volume in PSE based on the study of early and long-term results; (5) to determine the morphological features and immunohistochemistry profile of PSE.

Novelty and scientific originality: The main risk factors for PSE development were identified based on the clinical assessment. The present study has demonstrated the presence of nonspecific clinical signs. The following features have been established: the predominance on the anterior abdominal wall region, dominance of single endometriomas, incision of Pfannenstiel, left angle of the Pfannenstiel laparatomy. The diagnostic criteria (ultrasound, Doppler, CT, MRI) were determined, which proved to be highly informative in the diagnosis of PSE. There have been proventhe following basic principles of surgical treatment in PSE: preserving the integrity of the structure; en bloc surgical excision. There were developed the criteria for applying the method of reconstruction of the abdominal wall, following the endometriomaremoval. The morphological featuresand theimmunohistochemistry profile of the PSE were also studied. Both the long-term treatment outcomes and quality of life, based on EHP-5 score, were assessed within this research. The scientific issue to be solved consists of development and implementation of the PSE diagnostic and treatment approach, which help improve patient outcomes, prevent relapses, and enhance quality of life.

Theoretical significance: This research paper identified the potential risk factors, leading to the onset of PSE. The importance of the imagistic methods for the preoperative diagnosis has also been justified. The serological tests (tumor marker CA-125, preoperative values of the mean platelet volume and neutrophil to lymphocyte ratio) proved to be highly informative in diagnosing PSE. The basic principles of the surgical treatment were specified. This research emphasizes the morphological features and immunohistochemistry profile for definite diagnosis of PSE. The applicative value of the research: The research findings formulated and justified the principles of PSE diagnosis and surgical treatment.

Implementation of scientific results: The study results enabled implementation of the new methods of diagnosis and treatment of the PSE patients with in the surgical units, at Emergency Medicine Institute (Chisinau, Republic of Moldova), Department of Gynecology Surgery, Department of Research, at the Health Care Institute of Mother and Child (Chisinau, Republic of Moldova) and within the teaching process of “Nicolae Anestiadi” Department of Surgery No.1, at Nicolae TestemitanuState University of Medicine and Pharmacy. Five certificates have been obtained to be implemented into practice.