Method for treating inflammatory diseases of uterine adnexa

FIELD: medicine, operative gynecology.

SUBSTANCE: at final stage of laparoscopic operation for 5-7 min one should introduce 16 U lidase in 1 ml 2%-lidocaine solution into uterine mesentery from both sides, and then, by not removing a needle - a half of single dose of antimicrobial preparation in 1 ml 2%-lidocaine solution, then in postoperational period - an antimicrobial preparation applied during laparoscopy lymphotropically under mucosa of lateral vaginal arch from both sides for 5-7 d once daily and one antimicrobial preparation - intravenously for 5-7 d, moreover, as antimicrobial preparations one should apply gentamicin, metrogyl and other preparations permitted for intravenous application. The present innovation stimulates lymphatic drainage in area of inflammation and activates interstitial humoral transport of antimicrobial preparations that, in its turn, favors complete sanitation of inflammation foci and prophylaxis of disease relapses.

EFFECT: higher efficiency of therapy.

1 cl, 1 ex

 

The present invention relates to medicine, namely to the field of therapy of human diseases, and may be used to treat patients with inflammatory diseases of the uterus.

There is a method of treatment of patients with inflammatory diseases of the uterus (purulent salpingitis, and pyosalpinx, power, purulent education tubo-ovarian ago when the disease is not more than 2-3 weeks) by the use of laparoscopy in combination with the introduction intramuscularly or intravenously combination of two or three antimicrobials (Krasnopolsky VI and other pyoinflammatory diseases of the uterine appendages. - M.: Medpress, 1998. - 233 S.). However, this method, in our opinion, has several disadvantages.

It is well known that during the development of inflammatory diseases especially important is the role of the lymphatic system, because it provides drainage and detoxification of tissue fluid and lymph (Borodin SCI, 1998). It is proved that under the traditional intramuscular and intravenous antimicrobial drug in the lymphatic system gets the minimum number of medicinal substances, which limits the clinical effect (Levin, Y.M. basis of the medical lymphology. - M.: Medicine, 1986. - 288 S.).

A known method of lymphotropic therapy, including the introduction lidz in the solution of lidocaine (increases resizemode the main substance of connective tissue and directs the fluid flow to the roots of the lymphatic system) and antimicrobial drug. The method allows to create a sufficient and stable concentration of antimicrobial agent in the lymphatic system and lymphatic nodes. This ensures maximum exposure to the pathogen, as in the hearth and in the lymphatic system, which helps to improve the results of treatment of purulent-inflammatory diseases (Buyanov V.M., Danilov KU, Radzikhovsky A.P. Drug saturation of the lymphatic system. - Kiev, 1991. - 134 C.).

Closest to the claimed object (the prototype) is a method of treatment of nonspecific MetroEthernet and acute inflammatory diseases of uterine appendages, namely, that when laparoscopy between the pieces of the broad uterine ligament install microirrigation and fix one or two wikilove seams. Through microirrigation lymphotropic injected the antibiotic once a day for 3-5 days (Goldyreva E.V. Clinical-morphological basis of the method of lymphotropic therapy of acute nonspecific MetroEthernet: author. dis ... KMN - Novosibirsk, 2000. - 23 S.).

However, this method, in our opinion, has several disadvantages:

in the known method is proposed to dissect the broad ligament of the uterus, to enter into parametrium catheter for 5 days, what with purulent nature of the process may contribute to the spread of pathogenic micro district, the organisms on parametri, followed by suppuration and generalization of infection;

- for fixing microirrigation superimposed andosov that requires a certain experience of the surgeon, the availability of special tools;

- finding microirrigation in the abdominal cavity within 5 days promotes the formation around him adhesions, which is also undesirable;

- administration of drugs in the gap between the round ligament of the uterus and fallopian tube (parametrium) provides it enters the region of lifebar from the uterus, which is important for metroendometrit and less important in inflammatory diseases of the uterus.

The objective of the invention is to improve the results of treatment of inflammatory diseases of the uterus.

This object is achieved in that in the method of treatment of inflammatory diseases of the uterus, including laparoscopy and the introduction of antimicrobial drug lymphotropic, at the final stage of the operation within 5-7 minutes of entering the mesentery of the fallopian tube 16 UNITS lidz in 1 ml of 2%lidocaine solution, and then, without removing the needle, half of a single dose of antimicrobial agent in 1 ml of 2%lidocaine solution. The same drugs injected into the mesentery of the fallopian tube from the opposite side.

In the postoperative period, along with the appointment of od is wow antimicrobial drug intravenously, one antimicrobial agent, which was used during laparoscopy, enter lymphotropic under the mucous membrane of the lateral fornix of the vagina on both sides for 5-7 days 1 time per day.

Above the optimal rate of introduction of the solutions selected from those considerations that a more rapid introduction of drugs in the interstitial tissue is formed infiltrate, you lose the effect of the stimulation of interstitial humoral transport and lymphatic drainage. Slower introduction does not significantly affect the pharmacokinetics of drugs, however, increases the duration of the operation.

The method is as follows.

Patients with inflammatory diseases of the uterus (purulent salpingitis, and pyosalpinx, power and purulent education tubo-ovarian ago when the disease is not more than 2-3 weeks) perform a laparoscopy. At the final stage of the operation for 5-7 min in the mesentery of the fallopian tubes enter the 16 UNITS lidz in 1 ml of 2%lidocaine solution, and then, without removing the needle, half of a single dose of antimicrobial drug with a wide spectrum of activity in 1 ml of 2%lidocaine solution. The same number of drugs injected into the mesentery of the fallopian tube from the opposite side.

In the postoperative period, along with the appointment of one antimicro the aqueous drug intravenously, one antimicrobial agent, which was used during laparoscopy, enter lymphotropic under the mucous membrane of the lateral fornix of the vagina on both sides for 5-7 days 1 time per day. For lymphotropic use of antimicrobial drugs permitted for intravenous administration.

Example. Patient A., 23 years old (case history No. 19241) entered in the gynecology Department of the regional clinical hospital, Omsk 08.10.02, with a diagnosis of Exacerbation of chronic bilateral adnexitis with the formation of tubo-ovarian formations on both sides. On admission the patient complained of abdominal pain, fever up to 38°C. bimanual examination and according to the ultrasonic scanning region of the uterus on both sides identified tubo-ovarian formations 5×6 see General blood was marked leukocytosis (16,7×109/l), increased erythrocyte sedimentation rate, up to 22 mm/hour. The patient is made operative laparoscopy (salpingoophoritis, salpingotomy on both sides), lymphotropic therapy (lymphotropic in the mesentery of the fallopian tubes on both sides put 80 mg of gentamicin). In the postoperative period continued introduction of gentamicin at a dose of 80 mg lymphotropic under the mucous membrane of the lateral arches of the vagina on both sides of 1 times a day for 7 days. Also what about the, appointed metrogel 500 mghz times a day intravenously for 10 days.

The positive effect of the treatment: the body temperature returned to normal in the first day of therapy, peripheral blood within 72 hours, the pain has stopped within 48 hours. By ultrasound scanning 21.10.02, the parameters of the normal structure of the uterus. Duration of treatment the patient was 17 bed-days (instead of 21 bed-days in the comparison group). The application of the proposed method of treatment has allowed to perform organ-saving operation.

In this way treated 10 patients with inflammatory diseases of the uterus.

Studies have shown that the proposed method improves the efficiency of treatment of patients with inflammatory diseases of the uterus, shorten the hospital stay, reduce the dose rate of antimicrobial drug, to expand the indications for organ-sparing operations.

1. A method of treating inflammatory diseases of the uterus, including laparoscopy and the introduction of antimicrobial drug lymphotropic, characterized in that at the final stage of the operation within 5-7 minutes of entering the mesentery of the fallopian tube with two sides 16 UNITS lidz in 1 ml of 2%lidocaine solution, and then, without removing the needle, half the time the first dose of antimicrobial agent in 1 ml of 2%lidocaine solution, then in the postoperative period antimicrobial agent, which was used during laparoscopy, enter lymphotropic under the mucous membrane of the lateral fornix of the vagina on both sides for 5-7 days 1 time per day and one antimicrobial drug intravenously within 5-7 days.

2. The method according to claim 1, characterized in that as antimicrobial agents used gentamicin, metrogylum and other approved medications for intravenous administration.



 

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