Method of prevention of adhesions in the postoperative period in patients with tuboperitoneal infertility

 

(57) Abstract:

The invention relates to medicine, in particular to gynecology. The essence of the method is that after the surgery for 2 h are exposio 400 ml of blood of the patient, exposing to ultraviolet irradiation, carried out in two bottles of 200 ml of blood in each, spend centrifugal plasmapheresis each vial, then in one of the vials into the cell mass of the blood make 1 ml of ATP and 30 mg prednisolone, incubated mixture and then carry out a consistent return blends into the bloodstream of the patient intravenously, and the treatment is 4-5 sessions with an interval of 24 h between treatments. The method allows to increase the effectiveness of the treatment.

The invention relates to medicine and, in particular, to the gynecologist.

One of the urgent problems in modern gynecological practice is the treatment of pathology of the fallopian tubes associated with the violation of their patency. In recent years there has been a tendency to increase in the weight of endoscopic reconstructive plastic surgery in the treatment of disorders of the fallopian tubes.

Improving the efficiency of reconstructive plasticating surgical technique the development and widespread introduction into medical practice of new technical approaches, the operation could not be the final step in the treatment of gynecological diseases. This is particularly punishable reconstructive plastic surgery, in which the removal of the diseased part of the body does not eliminate the causes of disease, and the possibility of postoperative adhesions cause infertility tuboperitoneal Genesis, which negates the results of a risky and complicated surgery.

When conducting endosurgical operations about tuboperitoneal infertility is widely used electrocoagulation, which causes a vast area of aseptic inflammation, which is also a cause of adhesions. In this regard, it is interesting use for the prevention of adhesions of glucocorticoids with regard to their basic pharmacological properties: inhibition of development soedinitelnoj fabric; reducing the number of plasma and mast cells, which is the site of the formation of hyaluronic acid; action on mesenchymally fabric in the form of inhibition processes scarring; decrease capillary permeability; umanista intramuscular application of glucocorticoids in the postoperative period in patients after reconstructive operations ("tubal infertility" C. N. Davydov, M. , "Medicine", 1977 , page 131). Prednisolone was used in the form of intramuscular injection of 30 mg per day for 15 days. The disadvantages of the method include:

- with intramuscular injection of prednisolone creates a lack of concentration of drug in inflammation, about 70% of glucocorticoids parenteral inactivated by interacted (Y. B. Belousov, B. C Moses, 1993 ).

- the short duration of effect, the effect of the drug after intramuscular 8-12 h (M. D. Mashkovsky "drugs", volume II, page 97);

- prolonged use of the drug leads to the development of complications of peptic ulcers digestive, immune depression, cushingoid ("tubal infertility" C. N. Davydov, M. , "Medicine" 1977, page 85).

There is a method local, directly to the genitals, infusion of a mixture of the following composition: 100-150 ml of 0.25% R-RA novocaine, 1 g of kanamycin, 125 mg of hydrocortisone, 64 UNITS lidz during dynamic laparoscopy. (G. M. Savelieva, L. N. Boginskaya, Century, Breusenko, H. S. Tagieva, S. C. Shtyrov, A. A. Evseev "Prevention of adhesions after surgical treatment of gynecological patients in the reproductive period. Obstetrics and gynecology 2, 1995 , Stra;

- the complexity of procedures;

a limited number of procedures;

lack of efficiency.

The reason tuboperitoneal infertility are chronic inflammatory diseases of the uterus, about which the patient in the preoperative period repeatedly received a comprehensive anti-inflammatory therapy using antibiotics. The primary causative agent in the power of action of antibacterial therapy or microbial competition may disappear, and will perform other bacteria, in any case, the presence of chronic inflammation is almost always signal the presence of microbial factor.

Beyond the period of exacerbation of the inflammatory process bacteriological examination of mucus in the cervical canal may not serve as a basis for judgments about the nature of the microflora in the uterus (A. C. Ancyra, "Obstetrics and gynecology" 1972 , 10, pp. 42-45).

Surgery, as a powerful risk factor, leading to aggravation of chronic inflammation and activation possible microflora found in the content of zakosarenko and the wall of the fallopian tube, what causes postoperative irronically inflammatory diseases of the uterus, including intramuscular and intravenous antibiotics (Bodjagina Century. And. "Chronic nonspecific inflammatory diseases of female genital organs" M , Medicine, 1978, page 222-267).

The disadvantages of the method include:

- intramuscular and intravenous antibiotics creates a lack of concentration of drugs in inflammation because of the existence of inflammatory shaft and destroying them in a common flow decontamination systems microorganism;

- this method is not effective, as evidenced by low pregnancy rate up to 18% (Pshenichnikova So Ya Infertility, 1991).

The closest technical solution is a method of treatment of acute inflammatory diseases of the uterus with the use of ultraviolet irradiation of blood, incubation of cell mass obtained by discrete plasmapheresis, with a single dose of antibiotic, and the course of treatment is 4-6 treatments with an interval of 2 days. (RF patent 2142821, "a Method for the treatment of acute inflammatory diseases of internal genital organs in women) CL 6 And 61 M 1/38, And 61 To 31/185, A 61 N 5/06 publ. B 35, 20.12.99 year ).

The disadvantages of this method is what contributes to spikeblackfang.

The objective of the invention is to increase the effectiveness of treatment aimed at prevention of inflammation and spoilerthe after surgeries done about tuboperitoneal infertility.

This object is achieved in that after the surgery for 2 h are exposio 400 ml of blood of the patient, exposing to ultraviolet irradiation, carried out in two bottles of 200 ml of blood in each, spend centrifugal plasmapheresis each vial, then in one of the vials into the cell mass of the blood make 1 ml of ATP and a single dose of broad-spectrum antibiotic, in another bottle with cell mass of the blood make 1 ml of ATP and 30 mg of prednisolone, incubated mixture and then carry out a consistent return blends into the bloodstream of the patient intravenously, when this treatment is 4-5 sessions with an interval of 24 h between treatments.

The novelty of the method:

1. Holding exposee blood within 2 h after the operation is selected taking into account the fact that by this time the patient is recovering adequate consciousness disappear signs of anesthetic depression, there is no risk of bleeding, and the process of adhesions begins with the first is teaching, division of blood on two bottles for incubation cell mass, because glucocorticoids have a possible competitive binding of receptors of blood cells with antibiotics.

3. Introduction in a separate vial prednisolone at a dose of 30 mg due to the fact that this dose is sufficient to provide anti-inflammatory action and prevention of adhesions.

4. Given the conservation rezorbirovannogo on cells prednisolone advisable to hold consistent reinfusion first cell mass with an antibiotic, then cell mass with prednisolone.

5. 4-5 treatments with an interval of 24 hours is due to the fact that the process of adhesions ends to 6-7 days from the start of the operation, it was during this period it is necessary to provide maximum anti-inflammatory and antibacterial action of prednisone and antibiotics, and reliably on the basis of the practical application of this method of treatment.

The method of treatment is as follows:

The patient operated on for tuboperitoneal infertility within 2 h after surgery, when there is adequate recovery of consciousness, signs disappear anesthetic de is Andi consistently comes through a single system and flow-through quartz cuvette in two sterile bottle the vial 1 and vial 2, 5 thousand heparin in 50 ml of physiological solution. When passing through the sample cell, the blood is subjected to irradiation of a mercury lamp of the type [DRB]-8 from a distance of 30 mm, a wavelength of 254 nm, exposure to 20 W/m, the total time exposee is 15 minutes During this time in both capacity comes in 200 ml of blood. Then there is the centrifugation of blood at 2000 rpm (700g) for 15 min, followed by removal of plasma (plasmapheresis centrifuge). The next step is the introduction of in-cell mass of the blood of each vial with 1 ml of ATP and a single dose of broad-spectrum antibiotic that is allowed for intravenous injection in vial 1, and 30 mg of prednisolone in a bottle 2; incubation of the resulting mixtures at a temperature of 18-24oC for 20 min with occasional careful stirring the mixture. Then there is a sequential introduction of the first cell mass with an antibiotic, then cell mass with prednisone in the bloodstream of the patient intravenously. Treatment is 4-5 sessions. The interval between treatments is 24 hours

Thus, the carried out in this order and combination treatment immediately after surgery to prevent the formation of adhesions, since the applied dose of PR is possible due to the fact, the process of adhesions ends to 6-7 days from the start of the operation. Using the same mode of antibiotic, in turn, prevents septic inflammation.

Clinical example:

Patient K. was admitted to the gynecological Department GNCC ASS 23.06.99 g with a diagnosis of a cyst of the left ovary. Infertility II.

From the anamnesis: a cyst of the left ovary revealed by ultrasound from 17.06. 99,

Infertility within 2 years of regular sexual intercourse without the use of contraceptives in marriage.

Chronic adnexitis since 1998 , exacerbation twice a year, the outpatient treatment.

Upon receipt detected - General analysis of blood: erythrocyte sedimentation rate of 12 mm/h, L 5,4109, Ayr. 4,01012, b 124 g/l, p-2, p-59, l-15 m-10.

Gynecological examination of the body of the uterus is normal in size, rejected the right muscle consistency, mobile, painless. Left in the field of appendages is defined granulomas education, elastic consistency, size 64 cm, slightly painful, right appendages without palpation features, region palpation them painless. Selecting bright, scarce.

Smear on flora L 4-5 p/SP. gram-bacilli large number.

Livingstone left.

DS after surgery: false tubo-ovarian education left, left hydrosalpinx, adhesions in the pelvis II-III century

After 50 min after surgery, the patient held exposio 400 ml of blood. The blood of the patient consistently reported through a single system and flow-through quartz cuvette in two sterile vial - vial 1 and vial 2, 5 thousand heparin in 50 ml of physiological solution. When passing through the sample cell, the blood is subjected to irradiation of a mercury lamp of the type [DRB]-8 from a distance of 30 mm, a wavelength of 254 nm, exposure to 20 W/m, the total time exposee is 15 minutes During this time in both vessels received 200 ml of blood. We then conducted centrifugation of blood at 2000 rpm (700g) for 15 min, followed by removal of plasma (plasmapheresis centrifuge). The next stage was the introduction of in-cell mass of the blood of each vial with 1 ml of ATP and a single dose of broad-spectrum antibiotic that is allowed for intravenous injection in vial 1, and 30 mg of prednisolone in a bottle 2; incubation of the resulting mixtures at a temperature of 18-24oC for 20 min with occasional careful stirring the mixture. Then spent a serial reinfusion first cell mass is Eden 5 sessions with an interval between treatments 24 hours

On the second day after the operation conducted dynamic laparoscopy, rehabilitation of small pelvis, hydrotubation under visual control. Adhesions during the control laparoscopy were not observed.

The postoperative period was uneventful.

The patient was conducted physical-El. phoresis sodium thiosulfate 5% on the lower abdomen 10, the magnetic field 10.

After 3 months control hysterosalpingography - both fallopian tubes are permeable, signs of adhesions in the pelvis not.

4 months after surgery, the patient came uterine pregnancy.

Thus, in GNCC OSS, in the Department of gynaecology in this way treated 70 patients after reconstructive operations conducted over tuboperitoneal infertility, which gave the opportunity to restore reproductive function in 21 (30%) women.

Method of prevention of adhesions in the postoperative period in patients with tuboperitoneal form of infertility, including ultraviolet blood irradiation and reinfusion autologous cell mass of the blood, intense antibiotic, characterized in that within 2 h after surgery are exposio 6-7% (400 ml) volume of the each, spend their centrifugal plasmapheresis each vial, and then in one of the vials into the cell mass of the blood make 1 ml of ATP and a single dose of broad-spectrum antibiotic, and the other vial containing cell mass make 1 ml of ATP and 30 mg of prednisolone, incubated mixture and then carry out a consistent return blends into the bloodstream large intravenous drip, when this treatment is 4-5 sessions with an interval of 24 h between treatments.

 

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