Medikamentozno liječenje mioma maternice

master's thesis

• Title (english): Medical treatment of women with myoma
• Author: Ines Pitner
• Mentor: Marina Šprem Goldštajn (mentor)
• Committee member: Miro Kasum (predsjednik povjerenstva)
• Committee member: Dinka Pavičić-Baldani (član povjerenstva)
• Committee member: Marina Šprem Goldštajn (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Gynecology and Obstetrics); Zagreb
• Defense date and country: 2016-07-15, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Gynecology and Obstetrics

Abstract

Miomi su vrlo česti dobroćudni tumori maternice koji se pri kraju generativne dobi nalaze u oko ¾ populacije. Najčešće tegobe koje su prisutne su nenormalno krvarenje iz maternice te tegobe koje dolaze zbog pritiska mioma na okolne strukture. U dijagnostici najčešće se koristi transvaginalna ultrasonografija a po potrebi i trantransabdominalni pristup. Magnetska rezonanca zbog svoje dostupnosti i cijene rjeđe se koristi. Liječenje mioma ovisi o više faktora, a najviše o tegobama kojima su oni uzrok. Operativno liječenje može biti kirurško radikalno, odstranjivanjem maternice ili konzervativnije, odstranjivanjem mioma.
Poštednije i češće je liječenje lijekovima. Nenormalna krvarenja iz maternice najčešća su posljedica mioma a u njihovom reguliranju koriste se oralna kontraceptivna sredstva, peroralni i paretneralni gestageni, intrauterini ulošci s kontinuiranim otpuštanjem gestagena, nesteroidni antireumatici i antifibrilonolitici. Agonisti gonadotropnih hormona smanjuju razinu spolnih hormona u krvi te tako dovode do smanjenja odnosno prestanka krvarenja i do redukcije veličine mioma, što se koristi u preoperativnoj pripremi. Primjena selektivnih modulatora progesteronskih receptora, posebno ulipristalacetata, omogućila je kontrolu krvarenja i dovela do dugotrajnog smanjivanja pa i nestanka mioma. U mnogih pacijentica tako je moguće dugotrajnije odgoditi ili i izbjeći operativni zahvat, što je posebno važno kod žena koje nisu rodile ili je operativno liječenje preopasno. Popratno smanjivanje mioma primjećeno je i kod pacijentica koje su uzimale antifibrotične lijekove, imunoterapiju te statine.
Veličinu mioma i maternice moguće je smanjiti i radiološkom tehnikom embolizacije uterinih arterija, njihovim laparoskopskim zatvaranjem ili prolaznom transvaginalnom okluzijom te MR vođenim fokusirajućim ultrazvučnim zračenjem.

Abstract (english)

Uterine leiomyoma are very common benign tumors that affect ¾ women at the end of reproductive age. They typically present with symptoms of abnormal menstrual bleeding or pelvic pain or pressure. Transvaginal or transabdominal ultrasound are the most frequently used methods in diagnosis. Magnetic resonance imaging is used less frequent due to its expense and availability. Leiomyoma management depends on several factors, and present symptoms are decisive. Surgical treatment can be radical, meaning hysterectomy or more conservative, in case of myomectomy.
More often medical therapy is used. Combined hormonal contraceptives, oral and parenteral gestagens, intrauterine system with prolonged releasing of gestagen, nonsteroidal antiinflammatory drugs and antifibrinolytic agents are commonly prescribed to regulate abnormal uterine bleeding. Gonadotropin-releasing hormone agonists are used preoperatively. They decrease sex hormones level in blood witch causes reduction or cessation of bleeding and shrinkage of leiomyoma. Usage of progesterone receptor modulators, especially ulipristal acetate, enables bleeding control, reduces volume of myomas and occasionally leads to their disappearance. In many patients it is possible to postpone or even avoid surgery. That is important for women who have not given birth or in whom the operation is dangerous. Reduction of myoma was noticed in patients who used antifibrotic agents, immunotherapy or statins.
Uterine artery embolization, laparoscopic permanent or transient transvaginal uterine artery occlusion and MR guided focused ultrasound treatment are another options for shrinkage of myomas and uterine size reduction.

• Keywords: miomi maternice; liječenje; medikamentozna terapija
• Keywords (english): uterine myoma; treatment; medical therapy
• Language: croatian
• URN:NBN: urn:nbn:hr:105:144410
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2017-07-04 07:03:56