Method for transcervical intrauterine sterilization

FIELD: medicine, gynecology.

SUBSTANCE: before photocoagulation it is necessary to remove mucous layer in intramural department uterine tube up to the level of fibrinous fibers of submucous membrane, close the passability of isthmus and intramural department of uterine tube due to photocoagulation with scattered laser radiation. A light guide should be replaced from isthmus' lumen through intramural department towards uterine cavity at stops for irradiation purpose by developing dead-end septa along forming closed sections. At photocoagulation one should apply a biological protein hematofibrinous intratissue solder of removed mucous layer. The innovation provides tight tissue welding, decreases traumatism of sterilization due to applying a biological solder, moreover, by keeping viability of epithelial parts in intramural department of uterine tube.

EFFECT: higher efficiency.

 

The transcervical method in-line sterilization relates to the field of medicine, in particular to gynecology, and medicine section when exposed to laser radiation therapy. The method can also be used in veterinary medicine.

The sterilization method is a widespread way of planning the population of people and animals. Sterilization is a manipulation in which it is impossible to ovum. There are various methods of sterilization. The fallopian tube may be surgically removed (partly or completely) or can be subjected to occlusion or the imposition of mechanical clips, terminals, clips tubes. Been various attempts transcervical in-line sterilization performed hysteroscopically and or blind. Laparoscopic and hysteroscopic electrocoagulation intramural division of the fallopian tube. Coagulation of the fallopian tube and hysteroscopic tissue adhesives have been found to be ineffective due to the frequent development of complications and a high level of failures.

In practical modern gynecology widespread method of occlusion, consisting in the use of different designs of brackets, tubes, clamps, plug in the transition zone of the isthmus of the uterus, because the diameter of the narrowest part of the isthmus is 0.3-05 mm. 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), see Atlas Ghirsh, Acheter, Finkler "Operative gynecology", publishing house "GEOTAR Medicine", M, 1991, p.71.

The disadvantages of this method of sterilization are: Allergy material, the method requires high precision and a large surgical experience gynecologist. It is very important that the bracket stood at right angles to the fallopian tube and blocked all of its lumen, or the bracket may move and clearance will not be fully blocked. Brackets, clamps and rings can be rejected because they are narodnie elements that can cause inflammation, allergic reactions, cause prolonged pain, atrophy of the tissue of the fallopian tube in the place of their installation, i.e. this method traumatic, inefficient and unable to reliably perform the function of sterilization.

There is a method of transcervical in-line sterilization, which consists in closing the intramural portion of the fallopian tube through photocoagulation intramural division multiple laser of the doctrine, moving the fiber laser irradiator of the intramural division of the fallopian tube towards the uterus, and through the influence of the stage of proliferation of the uterine cycle, see p. the Russian Federation No. 2201270 from 07.09.2000,

The disadvantages of this method are: solid closure intramural Department fallopian tubes throughout, difficulty to reversal of sterilization, i.e. recovery of fertility due to the destruction that is unique to the Department of transitional pipe-uterine epithelium as a result, in the laser photocoagulation, is not efficient enough.

The closest solution is the Way transcervical in-line sterilization", specified in C. No. 2003133145/14/035557/ from 12.11.2003,, Paul. Resch. 18.01.2005, and consisting of alternating (fractional) closing the opening of the isthmus and intramural division of the fallopian tube to the uterus, through the impact of photocoagulation scattered laser radiation in abalation mode when moving the fiber laser irradiator 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 forming a closed section with a preliminary application to the area of irradiation solder.

The disadvantages of this solution are: enabled the efficiency of the infection through the use of foreign solder, because of the soft looseness of the epithelium of the walls of the intramural division of the fallopian tube have to make more frequent blank panels, reducing viable epithelium in the sections between the partitions, the lack of high reliability of each partition when BioWare and, as a result, insufficient efficiency transcervical in-line sterilization.

The technical result of the proposed solution method is to increase the efficiency of transcervical sterilization due to more dense tissue welding the opposite walls of the cavity intramural Department fallopian tubes, reducing the morbidity sterilization through the use of biological solder and increase the strength and reliability of BioWare on a small area of the fallopian tube, preservation of viable areas of the epithelium intramural division of the fallopian tube to the uterus, thereby, increasing the possibility of restoring the fertility of the patient during the recovery through intramural division of the fallopian tube.

This result is achieved in that in the method of transcervical in-line sterilization, which consists in closing the opening of the isthmus and intramural division of the fallopian tube through the impact of photocoagulation scattered laser radiation when moving the fiber laser is about irradiator from the lumen of the isthmus through the intramural division of the fallopian tube towards the uterus, stopping for exposure, creating the path of movement of the fiber blank panels with the formation of closed sections, before the effects of photocoagulation carry out superficial destruction of the mucus layer in the intramural division of the fallopian tube to the level of fibrin fibers submucosal membrane of the fallopian tube, and if photocoagulation use the resulting biological protein hematopoiesis interstitial solder submucosal layer.

The essence of the invention is expressed in a set of key characteristics, sufficient to achieve the solution maintains a technical result.

The essential feature of the invention, coinciding with the prototype is: - closing of the cross-isthmus and intramural division of the fallopian tube through the impact of photocoagulation scattered laser radiation when moving the fiber laser irradiator of the lumen of the isthmus through the intramural division of the fallopian tube towards the uterus, stopping for exposure, creating the path of movement of the fiber blank panels with the formation of closed sections.

Salient features of the proposed method are: B - before impact photocoagulation carry out superficial destruction of the mucus layer in the intramural division of the fallopian tube to fibrin fibers in the mucosa of the fallopian tube, because it gives the opportunity to obtain biological neurosky organic solder for more effective BioWare; when photocoagulation use the resulting biological protein hematopoiesis interstitial solder submucosal layer, since it allows a more reliable Bioparco and limited to one blank wall, keeping the intramural Department and the epithelium in it.

The transcervical method in-line sterilization is closing the opening of the isthmus and intramural division of the fallopian tube to the uterus through irradiation in abalation or ablative mode photocoagulation scattered laser radiation when moving the fiber laser irradiator of the lumen of the isthmus through the intramural division of the fallopian tube towards the uterus, creating a travel guide of irradiator closed viable epithelial sections that are limited to the deaf partitions.

From the uterine cavity into the lumen of the mouth of the fallopian tube (diameter varies from 2 to 6 mm in women and from 2 to 3 mm in animals, for example cats, i.e. animal of medium size) in the direction of the isthmus, the smallest diameter at its narrowest part is 0.3-0.5 mm, enter the fibergastroscope (endoscope), the outer diameter of which is equal to 2.2 mm, equipped with a mouth the rum (knife in the form of a disk) and optical fiber, coupled with a laser, comprising the irradiator. The diameter of the fiber is 1 mm, the Smallest diameter of the isthmus is a kind of biological retaining ring, on which the endoscope will not work. With the rotor removed from the walls of the intramural division of the fallopian tube epithelium, turn it off after some time (1"), since enough in one place the disk rotates 360°. Then turn the laser on short exposure (1-3") in abalation mode (biological welding), irradiate the inner wall of the intramural division of the fallopian tube, carrying the dead wall in the intramural Department. The irradiation process start with the neck, gradually pulling the endoscope through the intramural Department in the direction of the uterine cavity. After a short irradiation of the laser off for 3-5" and pull it on 2-4 mm. Stop the endoscope, again remove the rotor epithelium and conduct biological welding intramural Department, creating the following blank wall. So create a separate section in the intramural Department. When working Japanese fibergastroscope use gynecological device, the construction of which is described in paragraph (RF # 201748 from 17.06.91, as the laser used in the process of biological welding (abalation or ablative mode), feasible, what about the use of diode lasers with wavelengths 810-1040 nm, helium-neon laser with a wavelength of 632.8 nm. The process of biological welding of organic tissues, blood vessels are widely known and regularly used in clinical practice. In order to achieve the effect of the absolute closure of the lumen of the fallopian tube in the neck area and intramural Department, irradiation is carried out in the stage of proliferation of the uterine cycle, during which the regenerated area rotary laser exposure and eliminates the possibility of rejection photocoagulator because it uses biological solder, i.e. elements hematotherapy fibers of the walls of the intramural Department. Fibers attach to each other, forming a blank wall. The wall of the fallopian tube in the neck area is thicker than the rest of its length, the thickness of the uterine wall in the passage intramural Department reaches more than 10 mm. in Addition, the effect of scattered laser radiation mode photocoagulation short (1-3") and provides a relatively superficial coagulation effects (depth of penetration does not exceed the depth of submucosal layer). The radiation is scattered and directed perpendicularly to the wall of the fallopian tube, and therefore excludes focal tissue overheating and, as a consequence, offset the effect of perforation. The lack in this area pain sensitive prescriptions the Directors in the mucosal and submucosal layer allows sterilization without anesthesia. Sterilization procedures in the proposed method is effective, it is accompanied by a laser (light) sterility, not in contact with the walls of the intramural Department, completely eliminates the risk of infectious complications. The creation of the sterilization during insertion of the fiber irradiator operating in the mode of biological welding, a short segment of the local (target) -allows you to perform only one blank wall and to improve the efficiency not only of the sterilization, but reversibility, i.e. the possibility of recovery intramural Department.

The use of transcervical Method in-line sterilization" according to the prototype allows to increase the efficiency of sterilization due to more dense tissue welding of the opposite walls of the intramural division of the fallopian tube, reducing the morbidity sterilization through the use of disposable biological solder, increase strength and reliability BioWare on a small area of the fallopian tube due to the fact that prior to exposure photocoagulation scattered laser radiation carry out superficial destruction of the mucus layer in the intramural division of the fallopian tube to the level of fibrin fibers submucosal membrane of the fallopian tube, as it gives an opportunity to receive the Oia biological solder, which ultimately leads to better BioWare and enhances proliferation; and also due to the fact that when photocoagulation use the resulting biological hematopoiesis in-line solder submucosal layer, because the possibility of rejection of the solder because of the genetic homogeneity of the welded tissue (solder body), eliminates allergies, body solder, since the latter is made of a material of an organism of the patient, eliminates the risk of contamination of the patient's infectious diseases. In addition, in the proposed method are better preserved in the sections between the high walls viable epithelium. Better saved intramural division of the fallopian tube, as it allows to carry out one blank wall, which suggests the possibility of restoring the intramural Department and allow the woman her desire to restore fertility. This method is noninvasive, there is no Allergy, excludes the possibility of infection through the use of disposable biological solder, no perforation of the walls of the intramural Department as at BioWare and recanalization. The proposed method is also effective when used in veterinary medicine in the sterilization of dogs and cats. For animals it is less bol is being emitted by contaminated and there are no such consequences, as with surgery. Therefore, the proposed method is quite effective and can be widely used in gynecology women, and in veterinary practice.

The transcervical method in-line sterilization, which consists in closing the opening of the isthmus and intramural division of the fallopian tube through the impact of photocoagulation scattered laser radiation when moving the fiber laser irradiator of the lumen of the isthmus through the intramural division of the fallopian tube towards the uterus, stopping for exposure, creating the path of movement of the fiber blank panels with the formation of closed sections, characterized in that before the effects of photocoagulation carry out superficial destruction of the mucus layer in the intramural division of the fallopian tube to the level of fibrin fibers submucosal membrane of the fallopian tube, and if photocoagulation use of biological protein hematopoiesis interstitial solder remote mucous layer.



 

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