Method for treating genital fistulas

FIELD: medicine, gynecology, surgery.

SUBSTANCE: one should introduce 3.5%-chitosan ascorbate gel into fistulous channel that contains metronidasol at the dosage of 2 mg/ml, at the volume up to 20 ml once/2 d till complete fistula's closing. The present innovation enables to activate reparative processes and fistulous epithelization that favors for closing fistulous channel in earlier terms.

EFFECT: higher efficiency of therapy conducted.

2 ex


The invention relates to medicine, namely to obstetrics and gynecology, and can be applied in proctology, urology, surgery and dermatology.

Among the most serious diseases of women, which not only leads to multi-organ disorders, long-term permanent disability, but also causing severe physical and mental suffering, menstrual and reproductive functions are genital fistula [1].

Known widely used surgical treatment of genital fistula, which consists in stitching the fistula is not earlier than 4 months from the moment of its occurrence, and after the edges of the fistula is not already granularit, and healed [2]. The main stages of the closure of fistula - excision of the scar tissue surrounding the edges of the openings of the fistula, and the splitting of the edges of the fistula, the suturing of the defect. The specific localization of the fistula has its own methods of operational benefits, but they all require time, very often leading the woman to disability, which reduces the quality and usefulness of her life [1]. The severity of clinical manifestations and high recurrence rate raises issues of surgical treatment and prevention of genital fistula in a number of priority problems [2].

Conservative therapy consists in carrying out local and General events. Local treatment is douching is legalise 1% chlorhexidine or 1-3% solution of potassium permanganate, drainage him, the exposure threshold of the fistula by means of mirrors and summing it with the swab or introducing balsamic liniment on Avissawella. Tampon left in the day, through the day the procedure is repeated. After cleansing the wound liniment replaced with jelly or ointment solkoserila and use them to complete epithelialization of the wound [1].

However, currently applied topically balsamic liniment on Avissawella along with the obvious positive impact on the disease usually causes a number of side effects: allergic reactions like itching, swelling and hyperemia of the mucous membrane of the vagina that many women are unable to use it due to severe hyperemia [3]. The need for long time daily use of a treatment room for conducting the remediation and change dressings to complete epithelialization of the wound causes the woman to abandon their traditional way of life and activity.

The objective of the invention is to improve the effectiveness of the closure of genital fistula, reducing treatment time and lower rate of recurrence of the fistula.

The task of reach due to the fact that after treatment of the walls of the vagina with an antiseptic solution in fistulous entrance impose a 3.5% gel of chitosan ascorbate, containing metronidazole at a dose of 2 mg in 1 ml in volume to 20 ml of 1 every 2 days to complete the closing of the fistula. Treatment leads to the closure of the fistulous course early results fistulografii and wound healing.

The technical result of the high therapeutic effect is significant vascularization of the wound surface of the fistula and early epithelization of the defect [4-6], and selective antibacterial effect [7].

The method is as follows: in the treatment room the woman laid on the gynecological chair, conduct reorganization of the vulva and vaginal walls with an antiseptic solution, enter the vagina mirror Cuzco, reveal the eve of the fistula by means of mirrors, is injected into the fistula olive cannula with 3.5% gel of chitosan ascorbate, containing metronidazole at a dose of 2 mg in 1 ml in volume to 20 ml of 1 times in 2 days.

The proposed method treated five patients aged 26 to 40 years. All women on the basis of typical clinical signs and results of fistulography identified genital fistulas (2 women brunetoochka-ignorantly fistula, 2 women actually genital fistula, 1 women cervico-vaginal fistula). The disease duration ranged from 2 weeks to 2 years. Patients with brunetoochka-ignorantly fistula complained of gnetaceae of fistulous openings in the anterior abdominal wall and the anal opening, when in fact genitals the x fistula - pain in the perineum and purulent discharge from the vagina, in cervico-vaginal fistula - rich homogeneous discharge from the genital tract with an unpleasant odor, menstrual cycle and miscarriage. The results showed that using the proposed method in the treatment of genital fistula treatment time was 10 to 20 days.

Clinical example 1: patient P., 38 years old, was admitted 21.11.03 in the gynecological Department of the emergency hospital, Krasnoyarsk with a diagnosis of exacerbation of chronic bilateral adnexitis with the formation of tubo-ovarian tumors on the left and pyosalpinx right on the background of intrauterine devices. The operation - Nizhneserginsky laparotomy, adnexectomy left, tubectomy right, dissection of abdominal adhesions, sanitation and drainage of the abdominal cavity. Operations in the abdomen found 50 ml of purulent content, massive adhesions, chronic infiltrative omentitis, when the division of adhesions deseration rectosigmoidal part of the colon for 8 cm, sewn in individual nylon sutures. On the 5th day of drainage is to the left stood out abundant intestinal contents. For 12 hours in the area of the drain holes installed aspirazione-flow system Cansino. At 24 days, the system removed - formed fistula (drainage hole departs mind the counter intestinal contents). The local inspection found fistulous opening in the skin the size of 5x3 cm, expressed maceration and infiltration of the tissue around the fistula, the depth of the fistula on the probe 14 cm, the daily loss of up to 500 ml of intestinal contents. After treatment of the vaginal walls with a solution of furacin in fistulous course introduced Oliva cannula with 3.5% gel of chitosan ascorbate, containing metronidazole at a dose of 2 mg in 1 ml in a volume of 20 ml. of the introduction of the gel was carried out by 1 every 2 days for 12 days. 36 day results fistulografii fistulous course in the gut is not detected. On the skin in the area of the drainage holes on the left - soft scar healing. The patient received as a General antibacterial treatment, detoxification, immunokorrigiruyuschuyu therapy. In a local survey on the background of the application of the 3.5% gel of chitosan ascorbate with metronidazole disappeared maceration of tissues, fistulous course no. Thus, six application of chitosan gel for 12 days resulted in complete elimination of the fistulous course. Patient no complaints, was discharged from the hospital in satisfactory condition. After 9 months on check - fistulous course no, there are no complaints, the woman leads a normal life.

Clinical example 2: puerperal S., 34, gave birth to 23.03.03 in the p/No. 5, Krasnoyarsk live full-term baby boy. When viewed as an obstetrician-gynecologist detection of the n cervico-vaginal fistula, according to women, fistula functions 2 years after a previous birth (cervixes). The treatment gel chitosan ascorbate containing metronidazole. After sanation of a vagina 1% solution dioksidina in the course of the fistula entered Oliva cannula with 3.5% gel in a volume of 10 ml of 1 every 2 days until complete closure of the fistula. After discharge from the maternity hospital treatment continued in the antenatal clinic No. 3. On the 20th day from the start of treatment fistulous course according to fistulografii not detected, when viewed in the mirrors - the cervix and the vaginal mucosa pale pink, mucous allocation, odorless, bimanual vaginal examination the uterus is normal in size and consistency, the uterus is not palpable. At the control examination after 6 months - fistulous course not, menstrual cycle regular, pain and pathological secretions there. A woman on maternity leave to care for a child, the quality of life has improved significantly.

Thus, the proposed method for the treatment of genital fistula using the introduction in the course of the fistulous olive tip with gel chitosan ascorbate and metronidazole allows you to:

1. - To increase the effectiveness of the closure of genital fistula on the basis of their vascularization of the wound surface and the removal of pathogenic microflora, reduce or eliminate, thus, vaginal discharge, the value is positive to reduce or remove the pain for 2-3 s procedure.

2. To reduce the treatment time to 20 days

3. - Eliminate the recurrence of the fistulous opening stroke.

4. To return women to their normal lives, to give them the opportunity to have repeated positive flowing pregnancy and delivery.

Literature used:

1. Krasnopolsky V., Buyanova, S., Genital fistula, M.: "Medpress", 2001, s.

2. Pervanidou A.S., Operative gynecology. M.: Medicine, 1976, s.

3. Strel'nikov V.N., Dultsev J.V., Salamov KN. Surgical treatment premonicion-vaginal fistula (literature review)//Surgery. - 1980, No. 9, - s-108.

4. I. Bolshakov. et al. "A way to strengthen the sclera". The application for the invention, And 61 To 31/722, priority from 01.07.04 # 2004120228 (021704).

5. I. Bolshakov. et al. "A method of obtaining an artificial matrix of the skin". RF patent №2252787 from 27.05.2005. Bull. No. 15 dated 27.05.2005.

6. I. Bolshakov. et al. "Wound covering based on collenchymatous complex". A positive decision on the application for the invention. Priority No. 2003130390 from 4.10.2003.

7. I. Bolshakov. et al. Antibacterial filler for sanitary towels or tampons "HMD-BOL, the method of its production and use. The application for the invention. A 61 L 13/28. Priority No. 2005114248 (016342) dated 11.05.2005.

The method of treatment of genital fistula, including the treatment of the vaginal walls and the introduction of fistulous turn Antisept the ka, characterized in that the fistulous course impose a 3.5%gel of chitosan ascorbate, containing metronidazole at a dose of 2 mg in 1 ml in volume to 20 ml of 1 every 2 days until complete closure of the fistula.


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