Tumorile inflamatorii tuboovariene: versiuni şi controverse

Abstract

Background: Pelvic inflammatory disease (PID) occupies one of the leading positions in the structure of gynecological morbidity. The incidence of PID, according to different authors ranges from 46.8% to 75%. A very important place in the structure of PID is occupied by adnexal inflammations, complicated by purulent tubo-ovarian tumors. One of the main risk factors in the development of adnexal purulent processes is the prolonged use (over 5 years) of intrauterine devices. During the recent decades the incidence of purulent tubo-ovarian tumors has increased by 2-3 times. In the present work the conflicting literature data regarding the etiopathogenesis, clinical presentation, diagnosis and treatment of purulent tubo-ovarian tumors are presented as well as the contemporary data about the management of the patients in question. The leading place in the tubo-ovarian tumors diagnosis is occupied by trans vaginal ultrasonography. At present the leading medical schools from Russia and Europe propose that the treatment of adnexal purulent processes should begin with laparoscopy. Conclusions: It has been concluded that the early surgery allows a successful performance of conservative interventions, organs preservation and the future restoration of menstrual function, sexual and reproductive health in patients with suppurative tubo-ovarian tumors. The performance of laparoscopy is optimal for the patients with uncomplicated forms of purulent processes or complicated processes lasting less than 3 weeks, but for chronic complicated forms, without purulent endometritis, laparotomy with preservation of the uterus, ovaries or a portion of the ovary is optimal with the following preparation to applying the assisted reproductive techniques.