RU2246906C2 - Method for treating inflammatory diseases of uterine adnexa - Google Patents

Abstract

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

Description

The present invention relates to medicine, in particular to the field of treatment of human diseases, and can be used to treat patients with inflammatory diseases of the uterus.

There is a method of treating patients with inflammatory diseases of the uterine appendages (purulent salpingitis, as well as pyosalpinx, pyovar, purulent tubo-ovarian formation with a disease duration of no more than 2-3 weeks) by laparoscopy in combination with the introduction of an intramuscular or intravenous combination of two or three antimicrobial agents ( Krasnopolsky V.I. et al. Purulent inflammatory diseases of the uterine appendages. - M .: MEDpress, 1998. - 233 p.). However, this method, in our opinion, has several disadvantages.

It is well known that with the development of an inflammatory disease, the role of the lymphatic system is especially significant, since it carries out drainage and detoxification of tissue fluid and lymph (Borodin Yu.I., 1998). It is proved that with the traditional intramuscular and intravenous administration of an antimicrobial drug, the minimum amount of a medicinal substance enters the lymphatic system, which limits the clinical effect (Levin Yu.M. Fundamentals of therapeutic lymphology. - M .: Medicine, 1986. - 288 p.).

A known method of lymphotropic therapy, including the introduction of lidase in a solution of lidocaine (increases the permeability of the main substance of the connective tissue and directs the fluid flow to the roots of the lymphatic system) and an antimicrobial drug. The method allows you to create sufficient and stable concentrations of antimicrobial agents in the lymphatic system and regional lymph nodes. This achieves the maximum effect on the pathogen, both in the focus and in the lymphatic system, which helps to improve the results of treatment of purulent-inflammatory diseases (Buyanov V.M., Danilov K.Yu., Radzikhovsky A.P. Drug saturation of the lymphatic system. - Kiev, 1991 .-- 134 p.).

Closest to the claimed object (prototype) is a method of treating nonspecific metroendometritis and acute inflammatory diseases of the uterine appendages, which consists in the fact that during laparoscopy, a microirrigator is installed between the leaves of the wide uterine ligament and fixed with one or two vicryl sutures. An antibiotic is injected lymphotropically through the microirrigator once a day for 3-5 days (Goldyreva E.V. Clinical and morphological substantiation of the method of lymphotropic therapy of acute nonspecific metroendometritis: Author's abstract .... Candidate of medical sciences - Novosibirsk, 2000. - 23 p.).

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

- in the known method it is proposed to dissect a wide ligament of the uterus, insert a catheter into the parametric tissue for 5 days, which, with the purulent nature of the process, can contribute to the spread of pathogenic microorganisms to the parametrium, followed by suppuration and generalization of the infection;

- to fix the microirrigator, endoshes are superimposed, which requires a certain experience of the surgeon, the presence of special tools;

- the presence of a microirrigator in the abdominal cavity for 5 days contributes to the formation of an adhesive process around it, which is also undesirable;

- the introduction of drugs in the interval between the uterine round ligament and the fallopian tube (into the parametric tissue) ensures that it enters the lymphatic collection region from the uterus, which is important for metroendometritis and less significant for inflammatory diseases of the uterine appendages.

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

The problem is achieved in that in the method of treating inflammatory diseases of the uterine appendages, including laparoscopy and administration of the antimicrobial drug lymphotropically, at the final stage of the operation, 16 U of lidase in 1 ml of a 2% solution of lidocaine are introduced into the mesentery of the fallopian tube, and then, without removing the needle, half a single dose of an antimicrobial agent in 1 ml of a 2% lidocaine solution. The same amounts of drugs are injected into the mesentery of the fallopian tube from the opposite side.

In the postoperative period, along with the administration of one antimicrobial drug intravenously, one antimicrobial agent that was used during laparoscopy is injected lymphotropically under the mucous membrane of the lateral vaginal fornix on both sides for 5-7 days once a day.

The above optimal rate of administration of the solutions was chosen from the considerations that, with faster administration of drugs in the interstitial tissue, an infiltrate is formed, the effect of stimulation of interstitial humoral transport and lymphatic drainage is lost. Slower administration does not significantly affect the pharmacokinetics of drugs, but increases the duration of the operation.

The method is as follows.

Laparoscopy is performed for patients with inflammatory diseases of the uterus (purulent salpingitis, as well as pyosalpinx, pyovar and purulent tubo-ovarian formation with a prescription of the disease of no more than 2-3 weeks). At the final stage of the operation, for 5-7 minutes, 16 units of lidase in 1 ml of a 2% solution of lidocaine are injected into the mesentery of the fallopian tube, after which, without removing the needle, half a single dose of a broad-spectrum antimicrobial drug in 1 ml of 2% lidocaine solution. The same amounts of drugs are injected into the mesentery of the fallopian tube from the opposite side.

In the postoperative period, along with the administration of one antimicrobial drug intravenously, one antimicrobial agent that was used during laparoscopy is injected lymphotropically under the mucous membrane of the lateral vaginal fornix on both sides for 5-7 days once a day. For lymphotropic administration, antimicrobials are used that are approved for intravenous use.

Example. Patient A., 23 years old (medical history No. 19241), was admitted to the gynecology department of the regional clinical hospital in Omsk on 08.10.02 with a diagnosis of exacerbation of chronic bilateral adnexitis with the formation of tubo-ovarian formations on both sides. Upon admission, the patient complained of pain in the lower abdomen, fever up to 38 ° C. A bimanual examination and ultrasound scans of the uterine appendages revealed a 5 × 6 cm tubo-ovarian mass on both sides of the whole blood count. Leukocytosis (16.7 × 10 ⁹ / L), an increase in ESR up to 22 mm / hour were noted. The patient underwent surgical laparoscopy (salpingo-ovariolysis, salpingotomy on both sides), lymphotropic therapy (80 mg of gentamicin was introduced lymphotropically into the mesentery of the fallopian tube on both sides). In the postoperative period, the administration of gentamicin in a dose of 80 mg was continued lymphotropically under the mucous membrane of the lateral vaginal arches on both sides once a day for 7 days. In addition, a metrogil of 500 mghZ was prescribed once a day intravenously for 10 days.

A positive effect of the treatment was noted: body temperature returned to normal on the first day from the start of therapy, peripheral blood counts within 72 hours, the pain syndrome stopped within 48 hours. Ultrasound scanning on October 21, 02 revealed the normal structure of the uterine appendages. The patient's treatment duration was 17 bed days (instead of 21 bed days in the comparison group). The application of the proposed method of treatment allowed to perform organ-preserving surgery.

This method treated 10 patients with inflammatory diseases of the uterus.

As studies have shown, the proposed method can improve the effectiveness of treatment of patients with inflammatory diseases of the uterine appendages, reduce the length of hospital stay, reduce the course dose of an antimicrobial drug, and expand indications for organ-preserving operations.

Claims (2)

1. A method of treating inflammatory diseases of the uterine appendages, including laparoscopy and the administration of an antimicrobial drug lymphotropically, characterized in that at the final stage of the operation, 16 units of lidase in 1 ml of a 2% solution are injected into the mesentery of the fallopian tube for 5-7 minutes lidocaine, and then, without removing the needle, half a single dose of the antimicrobial agent in 1 ml of a 2% solution of lidocaine, after which in the postoperative period the antimicrobial agent that was used during laparoscopy is injected lymphotropically under the mucosa the sheath of the lateral vaginal fornix on both sides for 5-7 days 1 time per day and one antimicrobial preparation intravenously for 5-7 days. 2. The method according to claim 1, characterized in that as antimicrobial agents use gentamicin, metrogil and other drugs approved for intravenous use.