Značaj histeroskopije u dijagnostici i tretmanu urođenih anomalija materične šupljine
Sažetak
Uvod/Cilj. Histeroskopija predstavlja jednu od važnih endoskopskih metoda u dijagnostici i lečenju infertiliteta, posebno u ispitivanju morfologije i funkcionalnosti materice. Uterusni faktor je zastupljen kod oko 10% infertilnih žena, pri čemu promene u materici mogu biti urođene i stečene. Cilj rada je bio da se proceni značaj histeroskopije u dijagnostici i tretmanu urođenih anomalija materične šupljine kod osoba ženskog pola kod kojih je postojala osnovana sumnja za to na osnovu prethodnog kliničkog, ultrazvučnog i histerosalpingografskog (HSG) pregleda. Značaj histeroskopije je posmatran u odnosu na broj ostvarenih trudnoća u zavisnosti od dijagnostikovane anomalije u periodu od 12 meseci nakon obavljene histeroskopije u dijagnostičke ili operativne svrhe. Metod. Studijom preseka je bilo obuhvaćeno 176 ispitanica sa kongenitalnim anomalijama materice kod kojih je urađena histeroskopija, dijagnostička ili operativna, u periodu od 1.1.2013–1.1.2016. godine. Kod svih ispitanice je praćen procenat nastalih trudnoća u toku prvih 12 meseci posle operacije. Na taj način formirane su dve grupe ispitanica: one koje su ostvarile trudnoću i one koje nisu, i njihove karakteristike su upoređivane: godine života, trajanje infertiliteta, prethodne trudnoće, ultrazvučni i HSG nalazi, vrste kongenitalnih anomalija, vrste histeroskopskog tretmana, kao i postojanje udružene patologije. Rezultati. Srednja životna dob ispitivanih žena iznosila je 35 godina. Grupu sa primarnim infertilitetom činilo je ukupno 107 žena, dok je u drugoj grupi (sa sekundarnim infertilitetom) bilo 69 žena. Prosečna dužina trajanja infertiliteta kod ispitivanih osoba iznosila je 3 godine. U periodu od 12 meseci posle operacije, kod 39 žena je došlo do trudnoće, koja je kod njih 33 završena porođajem u terminu. χ2 testom je dobijena statistički značajna razlika (p < 0.05) između posmatranih grupa (sa i bez ostvarene trudnoće posle histeroskopije) u odnosu na vrstu infertiliteta, kao i broj prethodnih pobačaja. Zaključak. Od svih kongenitalnih anomalija materice, najzastupljeniji su bili uterus subseptus i septus, a ređe zastupljeni su bili uterus arquatus, uterus unicornis i uterus bicornis. U našem istraživanju, jedna petina ispitanica je ostvarila trudnoću nakon histeroskopije u posmatranom periodu od 12 meseci i kod većine njih trudnoća je bila završena porođajem u terminu. Procenat pobačaja kod ispitivanih žena bio je smanjen sa 38%, pre histeroskopije, na 15%, nakon histeroskopije. Kod žena koje su ostvarile trudnoću, većinom su dijagnostikovani septum i supseptum uterusa i kod njih je sa uspehom je izvršena histeroskopska resekcija promena.
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