1.Pregnancy cases after embolization of uterine fibroids
Uranchimeg R ; Ganbaatar R ; Bayarmaa L ; Lkhagvasuren J
Mongolian Medical Sciences 2014;168(2):43-48
INTRODUCTION:Uterine leiomyoma occurs with broad range of 20-50% among reproductive aged women. It takessecond place of all women’s genital diseases that cause abnormal menstrual bleeding. Leiomyomadependent surgical frequency such as hysterectomy is around up to 80, 6%. Lately uterine fibroidembolization treatment is highly effective, less painful, and more rapid recovery, most importantlykeeping organ while maintaining the reproductivity, is successfully entered in practice. We successfullyperformed 40 cases first time in Mongolia and 8 of them conceived naturally after treatment.GOAL:To determine if arterial embolization in women with uterine fibroids (leiomyomata) is an effectivemethod to keep their reproductive organ intact.OBJECTIVES:• To study pregnancy cases in women who had uterine fibroid embolization• To monitor and determine the features of course of pregnancy and childbirth.• To evaluate uterine fibroids.MATERIALS AND METHODS:The study was conducted in 2009-2012. A total of forty women between 23-50 years of age,diagnosed with symptomatic uterine fibroid that received embolization treatment of dominatingarterial blood vessel feeding the uterine fibroids were involved in the study. Eight of the forty womenwho conceived naturally were selected for the study. The study focused on monitoring the course oftheir pregnancy and delivery and its outcome.RESULTS:Among 40 women who underwent bilateral uterine artery embolization, 31 (75.5%) were seeking tobecome pregnant, and 8 of the 31 (25, 8%) became pregnant, four having been nulliparous. Onepatient had two pregnancies. All 8 pregnancies were spontaneous. The mean time from embolizationto conception was 12±3, 5 months (range, 6-27 months). Three medical terminations occurred. Theother 5 pregnancies went to term; one pregnancy had to be terminated pre-term due to placentapraevia. 60% experienced threatened abortion and 1 case with advanced age mother complicatedwith mild preeclampsia. 62,5% of the women’s pregnancy ended with childbirth, of which one woman(20%) had vaginal delivery and the remaining four pregnancies (80%) ended with C-section. On anaverage, post-treated uterine fibroids decreased in volume by 94% in comparison to pre-treateduterine fibroids in the patients who became pregnant. All of the neonates were healthy with Apgarscores greater than8. The mean weight of the neonates was 3,189± 200 g (range, 2,100–3,800 g). One neonate waspreterm due to placenta praevia (2,100 g).CONCLUSION:1. Of the forty women that received arterial embolization treatment with uterine fibroid, thirty one(75, 5%) women desired to keep their uterine for further reproduction, of which eight women (25,8% of the patients) between the ages of 23-42 years (mean age=35) conceived naturally. Arterialembolization to treat women with uterine fibroids is an effective method for women who wish to keeptheir reproductive organ intact to conceive and reproduce.2. 60 percent of the women who conceived experienced threatened abortion and 20 percent of thewomen’s pregnancy had to be terminated pre-term due to placenta praevia. 62,5 percent of thewomen’s pregnancy ended with childbirth, of which one woman (20%) had vaginal delivery and theremaining four pregnancies (80%) ended with C-section.3. On an average, post-treated uterine fibroids decreased in volume by 94% in comparison to pretreateduterine fibroids.
2.Contemporary treatment guidelines for managing вenign uterine tumors
Uranchimeg R ; Ganbaatar R ; Bayarmaa L ; Lkhagvasuren J
Mongolian Medical Sciences 2015;172(2):115-122
Uterine leiomyomas are common (20-50%) in women of reproductive age. It is a benign tumor and it ranks second place among genital organ disorders in women.To date, abdominal laparotomy and laparoscopic surgical treatment (myomectomy and hysterectomy) are widely used to manage symptomatic leiomyomas.Although, hysterectomy is considered to be a radical method to manage uterine leiomyomas, women who have had hysterectomy are left totally infertile and they also are at risk to develop post-surgical and post-anesthetic complications. The advantage of myomectomy is to preserve women’s fertility and menstrual function but, the probability of recurrence of leiomyoma is 15-30% [1, 2]. Furthermore, depending on the location, size and number of fibroids, duration of surgery lingers, volume of blood loss is high and the risk to develop post surgical adhesions are high too.In recent, more than a decade period, effective and minimally invasive new, non-surgical methods to manage uterine leiomyomas have been introduced in many countries around the world. These methods have short recovery period and are advantageous to women to preserve their reproductive organ and fertility. They include: uterine artery embolization, uterine artery occlusion via transvaginal route and MRI– guided focused ultrasound surgery of uterine fibroids. Antiprogesterone-low-dose mifepristone for uterine leiomyomas are being introduced as well.In our country, managing leiomyomas surgically is still occupying high rate among surgical treatments. Further, to prevent and reduce complications of surgical treatment and to preserve organ, it is essential and imperative to introduce some of the above- mentioned contemporary non-surgical methods.
3.A comparative study on the fertility of uterine artery embolization and myomectomy for leiomyoma
Uranchimeg R ; Ganbaatar R ; Bayarmaa L ; Enkhtsetseg J ; Lkhagvasuren J
Mongolian Medical Sciences 2017;181(3):20-24
Objective:
To compare the nature of pregnancy and deliveryin women with leiomyoma who were treated with uterine
artery embolization to the outcomes in women who were treated with abdominal myomectomy.
Material and Methods:
A prospective, clinical study was conducted in 2010-2013 at “Urguu” Maternity Hospital, Ulaanbaatar. 94
women meeting the criteria were selected for the study. Post-treatment, the patients were reviewed for a
period of two years. Uterine artery embolization was performed using polyvinyl alcohol particles (300-500
µm in diameter).
Results:
The percentage of conception in UAE group was 25.5% and 31.9% in myomectomy group (p=0.494);
complication of pregnancy was 50.0% and 57.1% respectively (p=0.729); complication of delivery was
33.3% and 0.0% respectively (p=0.047). 88.9% and 90.0% (p=0.596) had Caesarean delivery. 16 (84.2%)
women had uncomplicated and 3 (15.8%) women had complicated delivery due to placenta praevia,
placenta acreta and uterine hypotonia. These cases all belonged to UAE group.
Conclusion
Pregnancy rates in women with leiomyoma who were treated by uterine artery embolization,
compared with pregnancies after abdominal myomectomy, were similar.(p=0.494) In this study, there
was the rate of Cesarean delivery above 80 percent in both group. There were no differences in newborn
weights and Apgar scores.
4.Surgical treatment and survival rate from colorectal cancer in Mongolia
Ganbaatar R ; Chinzorig M ; Tuvshin B ; Erdene-Ochir Ya ; Jargalsaikhan D ; Erkhembayar E ; Bat-Оrgil Ch ; Khaliunaa B ; Batzorig B ; Ulziisaikhan B
Mongolian Medical Sciences 2021;197(3):59-63
Introduction:
In 2018, the overall colorectal cancer (CRC) incidence rate was 3.6%, according to the
National Cancer Center of Mongolia (NCCM), and the incidence of colorectal cancer has increased
slightly in recent years. According to cancer stages, late stage cancer has a 5-year survival rate of
51%, while early stage cancer has a 5-year survival rate of 79%. The overall survival rate of colorectal
cancer in Mongolia has not been studied in precisely. In Asia, the 5-year survival rate for colorectal
cancer was 60%. Therefore, this study investigated the colorectal cancer survival rate and prognostic
factors at NCCM.
Methods:
A total of 108 patients diagnosed with CRC at NCCM’s General Surgery Department from
2013 to 2015 were used in this retrospective cohort study. The Kaplan-Meier method was used to
develop the survival graphs, which were then compared using the Log-rank test.
Results:
The median survival time was 42 months, with a 95% CI (38.55-45.66). A 5-year period,
the overall survival rate for CRC was 61.2%. Survival rates at the I, II, III, and IV stages were 100%,
75%, 65.4%, and 13.5%, respectively. There was a significant difference in CRC survival rates across
all stages (p=0.0001). There was a statistically significant difference in determining the relationship
between adjuvant chemotherapy and survival rate (p=0.0003).
Conclusion
The outcome of the surgery is determined by the CRC stage. The postoperative survival
rate (61.2%) is directly related to tumor stage, peripheral glandular metastasis, distant metastasis,
and chemotherapy effects.