Method for treating patient for external genital endometriosis

FIELD: medicine.

SUBSTANCE: method involves carrying out endoscopic operation. SCENAR-therapy is additionally administered with pulsating bipolar electric current being used without constant component as pulses at succession frequency from 10 to 350 Hz including swinging frequency mode within 30-120 Hz bandwidth with 2 to 8 pulses formed as batches at succession rate of 540 Hz to 4.5 kHz. The signal is modulated by varying ratio of action time to pauze duration within 1:1-1:5. 1-3 SCENAR-therapy courses are administered with 1-3 months long pauses. The first course begins at the first menstrual cycle occurred after endoscopic operation. Each course is carried out according to a scheme. 15-20 sessions are administered during the first menstrual cycle and 7-10 sessions are administered during the second menstrual cycle. The 25-40 min long sessions are applied daily.

EFFECT: enhanced effectiveness of treatment.

 

The present invention relates to medicine, namely to obstetrics and gynecology, and can be used for the treatment of patients with external genital endometriosis.

Endometriosis is one of the most urgent problems of modern gynecology. The frequency of the disease among women of reproductive age varies from 7 to 12%, and in recent years there has been a steady increase of this pathology. It is established that 30-80% of patients with endometriosis suffer from infertility. Not less than 20-53% of patients who received hormone therapy for endometriosis, marked persistence of the disease and its recurrence[1, 2, 3, 4].

Currently accepted 2-stage system of therapeutic measures in patients with external genital endometriosis (NEG). The first stage is performed laparoscopic surgery depending on the prevalence of negs: coagulation lesions of the NEG, husking endometriotic of ovarian cysts with coagulation Lodge, dissection of adhesions. The second stage consists of hormonology therapy to regress invisible foci of endometriosis and prevention of relapse[9, 11, 12].

Among a wide range of hormonal preparations used in clinical practice for the treatment of the NEG distinguish the following groups[1, 2, 3, 4, 9, 11, 12]:

1) combined estrogen-gestagennye drugs;

2) Progestogens;

3) antiestrogens;

4) antiprogestin;

5) inhibitors of gonadotropin;

6) agonists of GnRH.

All hormones are prescribed long courses on 4-6-9 months, cause in the body of a diseased condition of pseudopregnant and pseudomenopause, lead to regression, but not elimination of foci of endometriosis, the return of a disease after 2-3 months. Optimal hormonal treatment of the NEG does not exist. The pregnancy rate varies from 20 to 45%, the recurrence rate from 15 to 80% [1, 4].

To reduce the frequency of relapses of the NEG is recommended on the 2nd stage of treatment in combination with gormonozawisimy preparations to use the following types of therapy[1, 2, 3, 9, 10, 11, 12]:

1) Effects on the immune system immunomodulators (splenin, decaris, sandoglobulin, thymalin, T-activin, cycloferon).

2) Correction of violations of adaptive mechanisms (tranquilizers, adaptogens, calcium antagonists, antispasmodics, antihypoxants).

3) non-pharmacological therapy (phytotherapy, physiotherapy alternating magnetic field, ultrasound in pulsed mode, electrophoresis with iodine, laser therapy, radon baths, HBO, UBI RTI).

4) Maintaining liver and pancreas (legal LIV-52, Essentiale, Kars, festal, pansinin).

5) Symptomatic treatment (inhibitors of prostaglandins: indometacin, as the IRIN).

This diversity of methods of influence when the NEG often leads not to the synergies between them, and, conversely, increased allergic predisposition to refuse any treatment.

Currently, the NEG is considered from the standpoint of the disorder protective and adaptive reactions with involvement in the pathological process of many body systems. Long-term voltage nonspecific protective and adaptive reactions of the organism leads to increased anaerobic metabolism and inhibition of apoptosis (uncontrolled multiplication of cells and proliferative processes) [1, 2, 3, 4, 9].

Endometroid lesions in the abdominal cavity are considered as a physiological phenomenon in all menstruating women. Under normal conditions protective system peritoneum eliminates abandoned the endometrium and the formation of non-pigmented transparent bubbles, then petechiae and red ognibene foci are considered as stages in the local immune response of the peritoneum. For endometriosis as a disease should be considered only in those cases when the development of lesions does not stop defensive mechanisms of peritoneal and occurs adhesions in the pelvis, endometriosis ovarian cysts and deep invasion into the recto-vaginal septum[1, 2, 3].

The task of the present invention, it should:

1) providing the possibility of the surface treatment of external genital endometriosis without the use of hormones;

2. the use of drugs to correct the immune system, the adaptive mechanisms that maintain the functions of the liver and pancreas;

3) reduce the frequency of relapses;

4) increased stimulation of pregnancy (higher fertility);

5) reduction of complications in the postoperative period;

6) elimination of the need for traumatic and unsafe physiotherapeutic procedures (UBI, HBO).

The task in the way of treatment of patients with external genital endometriosis, including endoscopic surgery volume opredelennym the severity of the disease, is achieved by the fact that further conduct of SCENAR-therapy (self controlled Energo neuro adaptive regulation) using a bipolar pulse of electric current without DC component in the form of pulses with a repetition rate of from 10 to 350 Hz, which includes the mode sweep within 30-120 Hz with the formation of pulses in packs of 2 to 8 and with the frequency of repetition of 540 Hz to 4.5 KHz and a modulation signal by varying the ratio of exposure to the pause in the range of 1:1-1:5 while spend 1-3 course of SCENAR-therapy interval between courses of 1-3 months.

Thus, to improve protective and adaptive reactions of the organism and its not spetsificheskoi reactivity in patients with NEG after performing endoscopic surgery in the present invention is used electro-therapy through family SCENAR (self controlled Energo neuro adaptive regulation) (Russia, Taganrog, OKB “RITM”).

As signal electric pulse effects used pulsed bipolar current without DC component that generates dynamic information of the neural signal. Affecting the signal-stimulator in the form of pulses with a repetition rate of from 10 to 350 Hz, including the rocking mode frequency (30-120Hz) and has the ability to create them in packs (the number of pulses in a packet from 2 to 8 with a repetition frequency of 540 Hz to 4.5 kHz), the ability to modulate the signal to change the ratio of exposure time to pause in the range of 1:1-1:5).

Biological effects of pulsed effects of currents includes the phenomena associated with the implementation of their impact on functional and morphological state of the tissue, intracellular metabolism, reduction of tension of regulatory processes. A more complete use of the potential biological effects of pulsed currents are possible when changing pulse effect in the direction of maximum approach to the physiological signals. The feature of SCENAR-therapy - individual optimal impact on the patient, since the parameters of electrical stimulation is changed in accordance with the indicators of skin impedance in a biologically active zones, korrespondiruetsya with pathological lesion in the body by the Prince of the PU biological feedback [5, 6, 7, 8].

Electro therapy should be the first menstrual cycle after performing endoscopic surgery on the long scheme (15-20 sessions in the 1st cycle and 7-10 sessions - 2nd cycle), as achieved positive effects in the clinical picture of the disease. Sessions should start after the end of menstruation (on average 5-6 days of the menstrual cycle), held every day before the next menstruation, duration 1 session - 25-40 minutes, the interval between courses - from 1 to 3 months. Duration 1 session and the number of treatment determined by the achievement of positive dynamics in biologically active zones.

The proposed method is as follows.

At the first stage provide endoscopic operation is determined by the severity of the disease (husking endometrioid ovarian cysts with coagulation their bed, their dissection of adhesions in the pelvis, coagulation foci of endometriosis in the pelvic peritoneum).

The second stage instead of the conventional therapy SCENAR-therapy.

On 1 session processing electrode area of 4 cm3exposed areas of the skin in the areas of General impact (3 pathways and 6 points on the face - space output of the trigeminal nerve), suprapubic region, which define the characteristics of small asymmetry pale spot, area g is Perenyi, which do impact to the disappearance of these signs.

2 session processed by the front electrode and the inner surface of the right thigh, the back and the outer surface of the left tibia; large labia; the rear of both feet, which determine the characteristics of small asymmetry pale spot, hyperemic area, which is affected until their disappearance. Sessions alternate between a sequentially until the disappearance of small asymmetry, indicating a normalization of skin impedance biologically active zones, korrespondiruetsya with pathological lesion in the body.

Before conducting the session the special treatment of the skin surface and the electrode is not required.

Conducted the examination and treatment of 241 patients with external genital endometriosis (NEG) at the age from 21 to 37 years with the primary (79%) and secondary (21%) infertility. Duration of infertility ranged from 2 to 10 years (7,8±0.9 years).

The NEG was installed during laparoscopy, produced in the early luteal phase of the menstrual cycle, confirmed by histological examination. According to the classification of the American fertility society I the severity of the NEG was observed in 60 (24,8%) patients, II severity 50 (20,7%) patients. III severity at 111 (46%) patients, and V the severity of the 20 patients (8.5%). All patients fallopian tubes were passable. Adhesions in the pelvis was installed in 41% of patients (I, II, III, IV degrees of severity - 22, 26, 49, 80% respectively).

All patients in the first stage treatment was performed laparoscopic surgery depending on the prevalence of negs: coagulation lesions of the NEG, husking endometrioid ovarian cysts with coagulation Lodge, dissection of adhesions. The second step in the treatment of patients with negs were divided into 2 groups. In the first group of 141 patients received hormonomodulizing drugs within 6 months (progestin - 55 patients; antigonadotropin - 51 patients; agonists of gonadotropin - 36 patients). In the second group of 100 patients with the NEG received electro-therapy with the help of SCENAR-therapy (Russia) from 1 to 3 courses in the long scheme: in the first menstrual cycle 20 sessions, in the second menstrual cycle - 7 sessions. The interval between courses was 1 month.

In both groups the distribution of patients according to the severity of the NEG was adequate. 50 healthy fertile women formed the control group.

In all patients studied, the nature of the menstrual cycle on clinical parameters and tests of functional diagnostics (identification of rectal temperature and cervicales number).

The status of the hypothalamic-pituitary-ovarian system was evaluated by the concentration in the shelter of the luteinizing hormone (LH), follicle-stimulating hormone (FSH) and steroid hormones (estradiol, progesterone, testosterone) radioimmunological method before and after treatment in 50 patients in each group. The immune status was determined by subpopulation composition of cells by the method of flow cytofluorimetry using monoclonal antibodies (LED3, CD4, CD8, CD, SD, SD) and the content of immunoglobulins in the peripheral blood by the method of radial immunodiffusion in acrylic gel according to Mancini in 50 patients in each group before and after treatment.

Diplomaticheskii blood flow studies with a quality rating curves flow velocity (CSC) and the calculation systolicdiastolic relations (SRE). pulsation index (PI) and resistance index (IR) was performed in all patients before and after treatment in the small pelvis (internal iliac artery, uterine artery, ovarian artery and the ovarian branch of the uterine artery).

Statistical analysis of the obtained results was performed using non-parametric methods of mathematical statistics Fisher's exact and CHI-square. The results of the study:

During the research it was found that the leading symptoms negs were dysmenorrhoea in 81,7%, dyspareunia 40%, the severity of which is not dependent on the prevalence of the NEG.

Test F. the purpose ground receiving stations diagnosis was revealed, that patients with negs in 95% of cases remains 2-phase menstrual cycle with defective ovulation and luteal phase deficiency in 20% of cases.

The results of hormonal research at the NEG indicate the prevalence of dysfunction of Central origin in the hypothalamic-pituitary-ovarian system with increased basal levels of LH and FSH with reduction of their ovulatory peak. The result is a relative hyperestrogenemia in I and II phase of the menstrual cycle, defective ovulatory peak estradiol, decreased levels of progesterone in the middle and in the second phase of the menstrual cycle.

The results of immunological studies under the NEG showed inhibition of T-cell immunity by activation of the b-cell level and as a consequence - increase in blood immunoglobulin M and g

Analysis of the results diplomaticheskogo studies in patients with NEG allowed to establish vysokonasyshchennye circulation in all the studied vessels of the pelvis. Patients with the NEG was no significant increase in SRE, IL and PI in the ovarian branch of the uterine artery in the pre-ovulatory period, which indicates a lack of vascularization of the dominant follicle.

The frequency of recurrence of the disease after hormonomodulizing therapy in the interval from 6 months to 1.5 years amounted to 38.2% (I, II, III, IV the severity and 22.8, 33,3, 37,7, 60% respectively). Only 25.5% of patients with negs after conducting hormonomodulizing therapy pregnancy in the interval from 6 months to 1 year.

In patients with negs, received electro-therapy in the postoperative period, in the interval of 1.5 years has not been received recurrence of the disease. Pregnancy occurred in 68% of patients (I, II, III, IV degrees of severity - 82, 79, 35, and 22% respectively).

During the research it was found that in the implementation of electro-therapy brings together local reflex mechanisms, and the General reaction of an organism to the action of an external factor.

The local effect is the activation of the processes of microcirculation and improve the trophic tissue not only in the area of local impact (moderate persistent hyperemia), but also in the internal organs that are associated with this area of the skin on the principle of dermal-visceral reflex with increasing pulse blood vessels, decreased vascular tone, improving venous outflow.

The overall impact of electro-therapy is reflected in the activation of non-specific immune mechanisms of protection by increasing the number of T-activated leukocytes, normalization of the balance of immunoglobulins. In the hypothalamic-pituitary-ovarian system is a decrease in the basal level is th LH, FSH and estradiol and increase their ovulatory peak.

Thus, in patients with NEG electro-therapy used in phase 2 remedial measures, provides an optimizing effect on the hypothalamic-pituitary-ovarian system, immune system, hemodynamic parameters in the pelvic organs, which helps to normalize homeostatic indicators and leads to a significant reduction of relapse and increase fertility.

As a clinical example, data about the results of treatment of two patients.

Example 1.

Patient M (no history 0201756) is directed to the gynecological Department Bureau them. Iasiello with complaints of constant aching pain in the lower abdomen, worse before and during menstruation, painful sexual intercourse, primary infertility for 3 years. Husband was surveyed at andrologist (fertility sperm is stored). In tests of functional diagnostics of the menstrual cycle is a two-phase screening for STIs - negative.

Was operating laparoscopy with ramosarimaske. The uterus is a small, pink. On both ovaries, the pelvic peritoneum and the Sacro-uterine ligaments are the foci of endometriosis. Between the ovaries and the rear of the ovarian fossa are planar spikes. Produced coagulation foci of endometriosis, R is Szechenyi adhesions. The fallopian tubes on both sides passable.

The diagnosis of External genital endometriosis II degree. Sick for 5 days without complications and was discharged from the hospital. From the 5th day of the next menstrual cycle started electropulse therapy on the long circuit. At the first session electrode was processed 3 pathways (identified 5 areas of small asymmetry), 6 points on the face (the trigeminal nerve) (identified 3 areas of small asymmetry) and suprapubic area (3 areas asymmetry), which are handled consistently from 1 to 3 lines before their disappearance. The total duration of the session 27 minutes.

On the second session electrode was processed in the front and the inner surface of the right thigh (1 zone asymmetry), the back and the outer surface of the left tibia (2 zones asymmetry), large labia (4 zones asymmetry), the rear of both feet (2 zones asymmetry), which are handled consistently from 1 to 4 minutes before their disappearance. The total duration of the session 36 minutes.

In subsequent sessions alternated, but the time to extinction zones asymmetry left 2 times less. Just made 16 procedures in the 1-St menstrual cycle and 7 procedures - 2nd menstrual cycle. Pregnancy occurred in the 2nd menstrual cycle. The pregnancy was without complications. A girl was born 3200 g, 48 cm, with a score on the Apgar 8 ball is s.

Example 2

Patient R. (no history 9828966). Aimed at the gynecology Department Bureau them. N. A. Semashko with complaints of primary infertility for 7 years, aching pain in the lower abdomen, radiating to the back, a relapse of endometriosis.

The first endoscopic surgery was performed 1.5 years ago, where was Filomena endometrioma cyst of the right ovary with coagulation her bed and foci of endometriosis on the other ovary.

Within 6 months has been on Zoladex 3.6 mg p/in the anterior abdominal wall. In patients receiving Zoladex noted tides heat up to 10 times per day; dryness of the vaginal mucosa, increased sweating, insomnia.

After withdrawal of the drug after 2.5 months resumed menstruation, which remained painful, pregnancy does not come. A semen of the husband was fertile.

The patient was re-laparoscopic surgery, where he was Filomena endometrioid cyst of the left ovary with coagulation her bed. Complications in the postoperative period was not.

The next menstrual cycle (6 days) the patient started to get electro therapy on the long circuit. On the 1st session electrode was processed 3 pathways (identified 8 areas of asymmetry), 6 points (4 zones asymmetry), in the suprapubic area (4 areas asymmetry)that pic is edutella processed from 3 to 5 minutes before their disappearance. The total duration of the session in 40 minutes.

On the second session electrode was processed in the front and the inner surface of the right thigh (1 zone asymmetry); rear and outer surface of the left tibia (1 zone asymmetry); large labia (2 zones asymmetry); the rear of both feet (2 zones asymmetry), which are handled consistently from 3 to 5 minutes until the disappearance of areas of small asymmetry. The total duration of the session 30 minutes. In subsequent sessions alternated. Just made 20 procedures in the 1-St menstrual cycle and 7 procedures - 2nd menstrual cycle. Pregnancy occurred in the 2nd menstrual cycle. The pregnancy was without complications. The boy was born 3100 g - 50 cm, with a score on the Apgar of 9 points.

Thus, the present invention can be considered a highly efficient design that solves a major health problem of great social significance. For the first time in the treatment of external genital endometriosis achieved these results as providing opportunities for treatment of external genital endometriosis without the use of hormonal drugs non-invasive method for reducing the frequency of relapses and increase fertility in infertile patients.

Literature

1. L.V. Adamyan Infertility in patients with severe forms of endometriosis and tactics restorative treatment is Oia.// Diagnosis and treatment of infertile couples. - M., 1988.

2. L.V. Adamyan, Kulakov V.I. Endometriosis. A guide for physicians. M., 1998, 317 S.

3. Baskakov VP Clinic and treatment of endometriosis. - 2nd edition, revised and enlarged. - M., 1990, 240 S.

4. Volkov, N.I. Infertility with external genital endometriosis (clinic, diagnostics, treatment, pathogenesis): author. Diss....Prof. the honey. Sciences. - M., 1996, 44 S.

5. Greenberg AS the Effectiveness of SCENAR-therapy. Physiological aspects// SCENAR-therapy and SCENAR-expertise. A collection of articles. Issue 4. Taganrog, 1989. - S. 8-9.

6. Zilov VG, K.V. Sudakov, Epstein I. Elements of information biology and medicine. Monograph MGUL, 2000.

7. Revenko A.N. Place of SCENAR-therapy technologies in modern medicine./SCENAR-therapy and SCENAR-expertise. A collection of articles. Issue 4. Taganrog, 1998. - S. 19-30.

8. Sarkisov DS., Fingers M.A., Khitrov I.K. General human pathology. - M., 1997.

9. B. I. Zheleznov, Summary A.N. Genital endometriosis. - M., 1985.

10. Bayer S.R., Seibel M.M., Saffan D.S., Berger, M.Y., Taymor M.L. Efficacy ofdanazol. Treatment for minimal endometriosis infertile. Woman a prospective randomized stady.//Reprod. med. - 1998.

11. Donnez I., Nissole M. Endoscopic surgery//Balliere's Clin. obstet. Gynaecol. - 1993. - 7. - p.839-848.

12. Mettler L., Semm K. Phree-step-therapy of genital endometriosis.//In: Medical Management of Endometriosis. p.233-47 (New York: Raven. 1986).

The method of treatment of patients with external genital endometriosis, including endoscopic surgery volume defined by the degree of t is tin disease, characterized in that it further conduct of SCENAR-therapy (self controlled Energo neuro adaptive regulation) using a bipolar pulse of electric current without DC component in the form of pulses with a repetition rate of from 10 to 350 Hz, which includes the mode sweep within 30 - 120 Hz with the formation of pulses in packs of 2 to 8 and with the frequency of repetition of 540 Hz to 4.5 kHz and a modulation signal by changing the ratio of exposure time to break within 1:1 to 1:5, while spend 1-3 course of SCENAR-therapy with intervals between courses (1-3 months), the first course starts with the first menstrual cycle after performing endoscopic surgery; each course is conducted according to the scheme 15-20 sessions in the first menstrual cycle and 7-10 sessions in the second menstrual cycle, the sessions are conducted daily duration of 25-40 min, the zone of influence of alternate and in every odd session the impact of exercise on the following areas of the skin: 3 pathways and 6 points on the face - space output of the trigeminal nerve and the suprapubic region, and at every even-numbered session the impact of exercise on the following areas of the skin: the front and the inner surface of the right thigh, the back and the outer surface of the left tibia, large labia and rear of both feet; in each of these areas of skin which define the zones with signs of small asymmetry in the form of white spots or redness and it is these areas with signs chosen as the impact zones moreover, the duration of each session and total number sessions on the course chosen individually by positive changes in skin impedance, which is determined by the disappearance of signs of small asymmetry and areas of impact.



 

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