Method for making transcervical intratubular sterilization

FIELD: medicine.

SUBSTANCE: method involves closing passability of intramural portion of uterine tube. Intermittent photocoagulation is carried out of isthmus and intramural portion of uterine tube in subablation mode with a sort of solder alloy being applied to irradiation area, scattered laser radiation in moving laser light guide from isthmus lumen through intramural portion of the uterine tube in the uterus cavity direction making pause for irradiation, creating solid partitions on the traveling path and forming closed sections in cavities of cervix and intramural portion of the uterine tube.

EFFECT: enhanced effectiveness of treatment; retained areas of transit tube and uterus epithelium.

1 dwg

 

The transcervical method in-line sterilization refers to the section of medicine, in particular to the gynecologist and to see the medical effects of radiation therapy. The method can also be used in veterinary medicine.

The sterilization method is a widespread way of planning populations of people and animals. Sterilization is male and female and is a manipulation in which it is not possible fertilization of the egg, as the main condition of the two types of sterilization, and the passage of the egg to the uterus.

There are various methods of sterilization. The fallopian tube may be surgically removed partly or fully/or can be subjected to occlusion by coagulation or by the imposition of mechanical clips, terminals, clamps, tubes. Made various attempts transcervical in-line sterilization performed hysteroscopically or blind. Laparoscopic and hysteroscopic electrocoagulation intramural Department fallopian tubes, coagulation tubes and hysteroscopic tissue adhesives have been found to be ineffective due to the frequent development of complications and a high level of failures.

When surgical sterilization practical importance are the operations performed on the fallopian tubes. The basis of all these modifications is a violation of the passage is on the fallopian tubes. The most simple method of sterilization - ligation of the fallopian tube. Fallopian tube straighten and stretch, therefore, to choose an avascular area of mesosalpinx approximately 1 cm from the uterine angle. Then, using circular needles pierce mesosalpinx close to the tube and produce a ligation of first one side and then on the other hand, refer to the Manual for doctors. Vigoleno, Ndzalama, Vigersky. "Operative gynecology", M, "Medicine", 1990, s. This sterilization method is not effective enough, as traumatic, can no longer perform the reproductive function, atrophy in the intramural portion of the uterus tribometry epithelium.

For the implementation of sterilization is very common now consider the method of temporary sterilization of women by imposing terminals on interstitial departments of the fallopian tubes during laparoscopy, which further optionally women laparoscopic reduce, restoring reproductive function, see the Manual for physicians. Vigoleno, Ndzalama, Vigersky. "Operative gynecology", M, "Medicine", 1990

The disadvantages of this method of sterilization are: Allergy material, soreness because of the contact terminals with the peritoneum /sometimes quite intense and prolonged/traumatic is h, the method requires high accuracy in the performance and experience of the surgeon /gynaecologist/. The method is a surgical method /laparascopically/, therefore, as a surgery, surgical support, and maintain the patient in the postoperative period, especially in cases of postoperative infectious and other complications. Manipulation leaves a small scar on the anterior wall of the stomach in place operational access.

In practical gynecology common method of occlusion, see Atlas. Ghirsh, Acheter, F. Mickle. "Operative gynecology", publishing house: "GSTAR Medicine", M., 1999, p.71-72. Performing sterilization mechanical method of occlusion using various designs of brackets, tubes, clamps, plug in the transition zone of the isthmus of the uterus. The most effective are the brackets Hulka and Felsi. The first is made of plastic and is closed by a metal spring. Bracket Filse - titanium bracket is covered with silicone. The plot of the fallopian tube under each of these brackets atrophies over time. The fallopian tube is closed also elasticum ring /ring Jung/.

The disadvantages of this method of sterilization are: Allergy material, the method requires high accuracy in the performance and experience of the surgeon /gynaecologist/. It is important that the bracket lay is at right angles to the pipe and blocked the entire lumen, otherwise, the bracket may be moved, and the lumen is not fully blocked. Brackets, clamps and rings can be rejected, cause inflammation, allergic reactions, cause prolonged pain, Trofeu tissues pipe in the place of their production, i.e. how traumatic and ineffective, unable to reliably perform the function of sterilization.

The closest technical solution of the proposed method is transcervical in-line sterilization specified in paragraph (RF # 2201270 from 07.09.2000, consisting in closing the intramural part /division/ fallopian tubes scattered laser radiation, moving the irradiator of the intramural portion of the fallopian tube towards the uterus, through the influence of the stage of proliferation of the uterine cycle.

The disadvantages of this method are closing only intramural Department fallopian tubes throughout, inability to reversal of sterilization /restore fertility/ due to the destruction that is unique to the Department of transitional clubmatches epithelium in the photocoagulation.

The technical result of the invention is to increase the efficiency transcervical in-line sterilization, the reduction in the morbidity of radiation, raising the possibility of reversibility /restore rap is oductive functions/ after sterilization by storing /full/ phase transition clubmatches epithelium.

This result is achieved in that in the method of transcervical in-line sterilization, which consists in closing the patency of the intramural portion of the fallopian tube, conduct intermittent photocoagulation in abalation mode isthmus and intramural division of the fallopian tube, with pre-applied to the area of irradiation "solder"scattered laser radiation, moving the fiber laser of the lumen of the isthmus through the intramural portion of the fallopian tube towards the uterus, stopping for exposure, creating the path of movement of the fiber blank panels and forming a closed section in the cavities of the isthmus and intramural portion of the fallopian tube.

The essential feature of the invention, coinciding with the prototype, is the closing of the patency of the intramural portion of the fallopian tube.

A distinctive feature of the proposed method is: - conducting intermittent photocoagulation isthmus in abalation mode and intramural division of the fallopian tube, with pre-applied to the area of irradiation "solder"scattered laser radiation, moving the fiber laser of the lumen of the isthmus through the intramural portion of the fallopian tube towards the uterus, stopping for exposure, creating the path of movement of the fiber deaf, perehara the key and forming a closed section in the cavities of the isthmus and intramural portion of the fallopian tube, because roaming fiber laser laser mode time-lapse laser flash /oh-off/creating multiple times during their movement biogaracin jumpers, bounding together with the walls of these departments independent closed viable epithelial sections that store the parts unique to the isthmus and intramural departments of the fallopian tube transition clubmatches epithelium, which allows you to revive the female reproductive function and to exclude trauma of the neck and intramural division of the fallopian tube, and ultimately to preserve the woman's health.

The transcervical method in-line sterilization is illustrated in the drawing.

The transcervical method in-line sterilization is alternately /fractional/ and multiple closing the opening of the isthmus and intramural portion of the fallopian tube to the uterus through intermittent exposure in abalation mode isthmus scattered laser radiation and intramural portion of the fallopian tube in the slow movement of the fiber from the lumen of the isthmus through the intramural portion of the fallopian tube towards the uterus, creating the path of movement of the fiber laser enclosed viable epithelial sections that are limited to the blank walls, inthe operation of the laser in the laser flash with the effect of photocoagulation /biological welding/.

From the uterus through intramural division 1 in the wall 2 of the uterus into the lumen of the neck 3 of the fallopian tube 4, the smallest diameter at its narrowest part of women is ˜0,3-0,5 mm, enter the light guide 5, the diameter of which is ˜1 mm, connected to a laser 6, representing over fiber 5 irradiator. The smallest diameter of the neck 3 is a kind of biological retaining ring, on which is larger in diameter, the fiber will not work. The distal end of the optical fiber 5 is made rounded to the emergent radiation was scattered. Include laser 6 for a short exposure time /for example, 1-3"/ abalation mode /mode of biological welding/ and irradiated first inner wall of the isthmus, and then the walls of the intramural division of the fallopian tube by turning off the laser irradiator after short-term exposure at some time /for example, 3-5"/. Simultaneously with the irradiation output of the optical fiber 5 from the lumen of the neck 3 into the lumen of the intramural division 1 of the fallopian tube 4 in the direction of the uterine cavity, creating in the course of movement of the optical fiber 5 blank panels 7, forming a closed section in the cavity of the neck 3 of the fallopian tube 4 and intramural part 1 in the wall 2 of the uterus.

To achieve the effect of biological welding is advisable to use relatively low-power laser IP is full of /for example, holmium laser at a wavelength of λ=2,09 μm, helium-neon laser with a wavelength of 0.63 µm, diode - λ=0.81-83 μm, CO2laser λ=1.06 µm/. In place of irradiation is the process photocoagulation with the effect of the surface of biological tissue welding. Optimization of the effect of the surface of biological tissue welding is easily performed using pre-delivery in the field of irradiation is widely used for these purposes in laser medicine "solders" /for example, vysokointegrirovannyh 50% albumin akrasiel-ink/. Tools that can be used for the supply of the laser radiation in the fiber, is a gynecological device, the construction of which is described in the patent of the Russian Federation No. 201748 from 17.06.91,, tested and used at the Institute of obstetrics and gynecology Imota of St.Petersburg medical laser illuminator on p. the Russian Federation RU # 2056872, transscleral optical probe according to St. useful. model RU # 16248. Laser welding of tissues in medical practice are available in several decades. In order to achieve the effect of the absolute closure of the lumen of the fallopian tube in the neck area and intramural part of the irradiation is carried out in the stage of proliferation of the uterine cycle, during which the regenerated remaining intact in the closed sections of the pipe sections and the uterine epithelium, and also sites is mixed clubmatches epithelium. Given the fact that the wall of the fallopian tube in the neck area is thicker than on the rest of the course, and the thickness of the uterine wall at the location of the intramural Department reaches a thickness more than 10 mm, and, given the short duration of the impact of scattered laser radiation with enough pauses, provides a relatively superficial coagulation impact /penetration depth to the submucosal layer/, and the radiation is scattered and directed perpendicular to the wall of the fallopian tube, is completely eliminated focal tissue overheating and, as a consequence, completely exclude the possible effect of perforation. The absence in this region pain-sensitive receptors in the mucosal and submucosal layer allows sterilization without anesthesia, and therefore a large therapeutic and economic effect. The procedure of sterilization by this method is bloodless and is held in the condition of the laser sterility, which reduces the risk postmanipulation infectious complications to zero, i.e. the method is noninvasive. The creation of the sterilization along the path of insertion of the optical fiber irradiator with a laser operating in the mode of biological welding, several solid partition, can also improve the effectiveness of sterilization.

Use the options Method transcervical in-line sterilization" according to the prototype allows to increase the effectiveness of sterilization by maintaining viability after irradiation saved plots and other layers of the uterine pipe when exposed to laser radiation in biological mode of welding /abalation mode/ tissues, because the radiation is delivered quickly /laser flash/ and once in a limited area of the fallopian tube that end / value in itself to restore patency of these sections of the fallopian tube /recanalization/ availability, partially preserved functioning troublemaking epithelium and peristaltiki pipe, and, consequently, to reduce the risk of pipeline pregnancy, and at the same time when the woman's desire to recreate her ability to make childbearing function. In this way excluded perforation of the wall of the intramural division of the uterine wall and the wall of the isthmus of the fallopian tube. Biological welding tissues of humans and animals is being successfully implemented in the last 3 decades, tissue well welded cone, the seam is flat and smooth, so you almost to zero to reduce the trauma due to exposure of the internal walls of the intramural Department and neck perpendicular to the diameter of the hole along the wall thickness. The proposed method can be used in veterinary medicine. Therefore, the method of transcervical fractional in-line sterilization can be widely applicable in medical and veterinary practice.

The transcervical method in-line with what realizatsii, consisting in closing the patency of the intramural portion of the fallopian tube, characterized in that conduct intermittent photocoagulation in abalation mode isthmus and intramural division of the fallopian tube with pre-applied to the area of irradiation "solder"scattered laser radiation, moving the fiber laser of the lumen of the isthmus through the intramural portion of the fallopian tube towards the uterus, stopping for exposure, creating the path of movement of the fiber blank panels and forming a closed section in the cavities of the isthmus and intramural portion of the fallopian tube.



 

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