Assessment of quality of life after hysterectomy with opportunistіс salpingeсtomy with uterine myoma by vaginal and abdominal access

Abstract

The aim of the research – to identify violations of quality of life after hysterectomy with opportunistic salpingectomy, considering different approaches to surgery. Materials and methods. Quality of life assessments of hysterectomy with opportunistic salpingectomy for uterine fibroids were performed in 160 women of reproductive age, who were divided into two groups: I – 90 patients with vaginal access, and II – 70 patients with abdominal access. The control group included 50 women with asymptomatic fibroids of reproductive age. The diagnostic algorithm included a physical examination, ultrasound examination of the pelvic organs, assessment of urogenital dysfunction questionnaire using the MOS SF-36 questionnaire; to identify signs of vegetative changes in Wayne, to assess general fatigue, physical and mental fatigue MFI-20 was performed using a standardized POP-Q system. Results. The leading violations of quality-of-life parameters are general somatic symptoms 107 (66.9±6.0 %), psychoemotional disorders 89 (55.6±6.7 %), genitourinary and sexual disorders 39 (24.4±3.0 %). Among the most common somatic ones – complaints of headaches, edema and fluctuations in blood pressure. The dominance of asthenic, anxiety and depressive disorders among psycho-emotional disorders has been established. The diagnosis of “organic asthenic disorder” was established in 47 (52.2±9.7 %) and 39 (55.7±7.3 %), respectively, in the groups of examined patients. Vaginal hysterectomy causes more increase in the proportion of urogenital disorders 25 27.7±8.3 %) compared to control – 7 (14.0±4.8 %) (p<0.05). An ultrasound examination showed a 2.25-fold increase in ovarian volume one month after the hysterectomy, and a reduction in ovarian tissue volume in both study groups 2 years after surgery. Conclusions. Hysterectomy with opportunistic salpingectomy affects the parameters of quality of life. The leading violations of quality-of-life parameters are general somatic symptoms, psycho-emotional disorders without statistically significant difference in groups, but the indicators are better in group I. The minimal effect on ovarian function and size was determined – 2 years after surgery, there was a decrease in ovarian tissue volume in both study groups, but statistically significant – in the second group (3.12±0.7 cm3 , p<0.05) against the data control (5.82±1.7 cm3). Although the results showed a more frequent manifestation of pelvic floor descent in vaginal access, quality of life parameters were higher in these patients. Given its safety, efficiency and cost-effectiveness, it is advisable to choose it as a method of choice