Postgisterektomichesky syndrome

Description:

Postgisterektomichesky syndrome – set of the psychoneurological and metabolic disturbances arising after removal of a uterus (hysterectomy) at preservation of one or both ovaries. Clinically postgisterektomichesky syndrome is shown by neurovegetative and psychoemotional disturbances: tachycardia, perspiration, inflows, hypertensia, depression, weakness, lability, uneasiness etc.
The problem of a postgisterektomichesky syndrome is urgent in connection with broad use in gynecology of a total and subtotal hysterectomy at various diseases of a uterus. In lack of adequate treatment after a total extirpation or supravaginal amputation of a uterus the resistant form of a postgisterektomichesky syndrome with approach of a physiological menopause for 4–5 years before estimated term can develop.
Development of a postgisterektomichesky syndrome is connected with sharp decrease in cyclic function of the kept ovaries, development of a gipoestrogeniya and its negative impact on TsNS. Frequency of development of a postgisterektomichesky syndrome among the operated patients depends on age, the volume of a hysterectomy, the nature of blood supply of ovaries and the accompanying pathology. Development of a postgisterektomichesky syndrome in women of socially active age negatively influences the state of health, working capacity and quality of life.

Classification:

On development terms the postgisterektomichesky syndrome can be early, developing in the first days of the post-operational period, and late, arising within a year after a hysterectomy.
On duration allocate resistant and tranzitorny forms of a postgisterektomichesky syndrome. At a tranzitorny form which meets at reproductive age during the period from 1 month to 1 year after a hysterectomy function of ovaries is recovered. Symptoms of a resistant form can be shown a year later and more after operation, demonstrating fading of function of ovaries and risk of an early menopause.
The Postgisterektomichesky syndrome can have easy, average or heavy degree of manifestation of clinical manifestations.

Reasons of a postgisterektomichesky syndrome:

The pathogenetic factor leading to formation of a postgisterektomichesky syndrome is the gipoestrogeniya. Disturbance of an innervation of ovaries, withdrawal from their blood-groove of branches of uterine arteries after a hysterectomy causes weakening of blood supply of appendages of a uterus, development in them acute ischemia, venous and lymphatic stagnation, structural and functional changes. Ovulatory and hormone-producing function of ovaries with dominance of anovulatory cycles and lowering of the level of oestradiol decreases; after removal of a myometrium and an endometria there is a disturbance of the return receptor bonds.
The Postgisterektomichesky syndrome meets after an extirpation, in comparison with supravaginal amputation of a uterus more often, and also during removal of one ovary, than at preservation both.
The heavy postgisterektomichesky syndrome is more probable when performing operation in a lyuteinovy phase of a cycle, at patients with a thyrotoxicosis and a diabetes mellitus.

Symptoms of a postgisterektomichesky syndrome:

The basis of clinic of a postgisterektomichesky syndrome is made by neurovegetative and psychoemotional frustration.
Psychoemotional disturbances can proceed in the form of an asthenic syndrome and a depression at which patients test weakness, slackness, bystry fatigue, deterioration in attention and memory, tendency to tears and feeling of uneasiness, feeling of own inferiority and fear of loneliness.
Neurovegetative changes at a postgisterektomichesky syndrome include a cardiopalmus (tachycardia) at rest, hypersensitivity to low and high temperature, a vestibulopathy, numbness of skin and feeling of goosebumps, inflows and the increased perspiration, puffiness, arterial hypertension, sleeplessness. Frequency of development of cardiovascular pathology, obesity, osteoporosis increases.
In case of a resistant postgisterektomichesky syndrome urogenital frustration - a stressful incontience of urine, a colpitis, dryness of a vagina, pain can appear at sexual intercourse, etc.

Diagnosis:

Diagnosis of a postgisterektomichesky syndrome includes assessment of psychoemotional and neurovegetative frustration, structural and functional changes of ovaries and their blood-groove, disturbances of gipotalamo-pituitary system in the rehabilitation period after a hysterectomy.
For definition of severity of clinical manifestations of a postgisterektomichesky syndrome use a menopausal index of Kupperman.
For assessment of functional activity of ovaries, gipotalamo-pituitary regulation and the forecast of a postgisterektomichesky syndrome conduct a research of levels of oestradiol, FSG and LG in dynamics.
Ultrasonography of appendages of a uterus with doppler sonography of vessels reveals structural changes of ovaries and an intraovarialny blood-groove after a hysterectomy. Cystous transformation of the kept ovaries (persistent cysts), in intraovarialny blood supply - delay of speed of a blood-groove, strengthening of venous stagnation is noted. The resistant postgisterektomichesky syndrome is followed by reduction of volume of ovaries, depletion of their follicular device, increase in echogenicity of a stroma, decrease in perfusion and the vascular reorganization of an intraovarialny blood-groove coming to post-menopausal indicators. At a tranzitorny postgisterektomichesky syndrome gradual recovery of volume and structure of ovaries is observed over time.
Inspection and maintaining patients with a postgisterektomichesky syndrome demands coherence of actions of the gynecologist-endocrinologist, the mammologist, the cardiologist and the neurologist.

Treatment of a postgisterektomichesky syndrome:

The nature of therapy of a postgisterektomichesky syndrome depends on its weight and duration of a current.
In the rehabilitation period of an easy and medium-weight postgisterektomichesky syndrome at the expressed psychoemotional symptomatology appoint sedative drugs, tranquilizers and antidepressants, homeopathic remedies, reflexotherapy. The physical therapy is applied to normalization of microcirculation in bodies of a small pelvis and a collar zone: an electrophoresis, galvanization of cervical and front area, transcranial electrostimulation by a sedative technique.
At a heavy or resistant postgisterektomichesky syndrome add the replacement hormonal therapy (RHT) which quickly removes psychoemotional and vegeto-vascular frustration to treatment, normalizes gipotalamo-pituitary regulation of ovaries, prevents development of metabolic disturbances.
At an early postgisterektomichesky syndrome parenteral administration combined estrogen – androgenic drugs is shown, use of estrogensoderzhashchy plasters is possible. In the late postoperative period carry out treatment by various combined drugs or monotherapy by estrogen.
At long ZGT control of coagulant system of blood by a koagulogramma research, and also prevention of a thrombogenesis with purpose of dezagregant and venoprotektor is necessary. Assessment of a condition of mammary glands prior to the beginning of and in the course of carrying out ZGT is carried out by means of palpatorny survey, ultrasonography of mammary glands and mammography.
ZGT duration at a tranzitorny postgisterektomichesky syndrome makes from 3 to 6 months; after its cancellation at patients of reproductive age functional activity of ovaries is recovered. At a resistant postgisterektomichesky syndrome it is desirable to continue carrying out ZGT before alleged approach of a natural menopause (1 – 5 years).

Prevention:

The prevention of development of a postgisterektomichesky syndrome is promoted, first of all, by rational definition of indications to performance of a total hysterectomy. Whenever possible it is desirable to limit the volume of intervention to supravaginal amputation of a uterus. It is reasonable to carry out operation during a follicular phase of a cycle.
After removal of a uterus the early beginning of rehabilitation therapy is necessary for the prevention of development of severe forms of a postgisterektomichesky syndrome.