RU2281108C1 - Method for treatment of fallopian-peritoneal infertility form in women with chronic endometritis - Google Patents

Abstract

FIELD: medicine, gynecology.

SUBSTANCE: invention relates to a method for treatment of fallopian-peritoneal form of infertility suffering with chronic endometritis. After carrying out reconstructive endoscopic operations in small pelvis cavity under control of histerscope tool a medicinal cocktail is administrated by intrauterine route by the following schedule: at the first and third days of treatment - prednisolon in the dose 30 mg, dioxydin in the dose 50 ml of 0.5% solution, metrogil in the dose 5.0 ml, lydaze in the dose 32 IU, antibiotic - "Makmimor" suppository before night by vaginal route and vagina syringe with matricary solution in the morning. At the second and fourth days of treatment prednisolon is administrated in the dose 30 mg by intrauterine route, "Instillagel" in the dose 6-11 mg into vagina posterior fornix in the dose one tampon with 20 ml of Vishnevsky's ointment. On the fifth, seventh and ninth days dioxydine is administrated in the dose 50 ml of 0.5% solution by intrauterine route and also 5.0 ml of metrogil, 0.5 ml of cycloferon, 32 IU of lydaze, antibiotic, and "Makmimor" suppositories are administrated by vaginal rout before night, and vagina syringe with matricary solution is carried out in the morning. On sixth, eighth and tenth days of treatment "Instillagel" is administrated in the dose 6 ml by intrauterine route, dimexide in the dose 5 ml and tampon with 20 ml of Vishnevsky's ointment is administrated into vagina posterior fornix before night. Since the 1-st day of treatment wobenzym is prescribed in the dose 5 tablets, 3 times per a day for 14 days and cyclic hormonal therapy for 3 months. Method provides the full-value elimination of pathogens from uterine cavity, normalization of vagina biocenosis and recovery of the menstrual function.

EFFECT: improved and enhanced method of treatment.

4 tbl, 1 ex

Description

The invention relates to medicine, namely to obstetrics and gynecology, and can be used to treat tubal peritoneal form of infertility (TPFB) in women with chronic endometritis (CE).

Female infertility, its causes, diagnosis and treatment are one of the urgent problems of gynecology. The largest proportion (60-70%) in the structure of female infertility belongs to the tubal-peritoneal factor [1]. One of the main causes of barren marriage is inflammatory diseases of the genitals [2]. Inflammatory diseases of the internal genital organs occupy the first place in the structure of gynecological pathology and make up 60-65% among outpatients and up to 30% among inpatients [3, 4]. In recent years, there has been a tendency to generalization and chronicity of inflammatory processes characterized by a long, recurrent course, the development of serious pathophysiological and pathomorphological changes in the affected tissues [5]. Long-term and irrational use of antibiotics led to the selection of multiresistant strains of microorganisms, in addition, opportunistic microbes acquired the properties of pathogenic pathogens (hemolytic, fibrinolytic, plasma-coagulating and hyaluronidase activity), which caused an increase in the frequency and severity of purulent-septic diseases [6]. The chronic inflammatory process in the endometrium is one of the important causes of infertility, unsuccessful attempts at in vitro fertilization, miscarriage. Long-term and asymptomatic persistence of infectious agents in the endometrium leads to marked changes in the structure of the tissue, interfering with normal implantation and placentation, forming a pathological response to pregnancy, and also causes a violation of proliferation and normal cyclic tissue transformation [7]. The latent course of the disease, erased symptoms contribute to the fact that chronic endometritis is more often detected when determining the causes of infertility, miscarriage and menstrual dysfunction [8].

Currently, endoscopic surgeries are widespread for surgical treatment of patients with tubal-peritoneal infertility, whose advantages over traditional laparotomy surgeries are undeniable and universally recognized [9, 10].

Given that patients with tubal-peritoneal infertility have a high frequency of chronic endometritis, the question arose of the most effective method of treatment.

There are various methods of treating tubal-peritoneal infertility, consisting in conducting electrical stimulation of the fallopian tubes with an autonomous electrical stimulator with rectangular impulses with the electrode leading to the posterior fornix of the vagina; exposure to a physical factor using the Ultraton-TNCh-10-1 apparatus with alternating every other day with hydrogen sulfide balneotherapy in the form of vaginal irrigation and common baths; reconstructive endoscopic operations, spa treatment [11, 12, 9, 10].

However, the traditionally used methods of treatment are not effective enough, since they do not always allow you to restore reproductive function, according to the literature, the restoration of reproductive function after reconstructive endoscopic operations is from 15-35% [1]. Most of the methods are difficult to implement and inaccessible for widespread application taking into account socio-economic aspects. All this dictates the need to search for new effective methods of treating tubal-peritoneal infertility, taking into account the high frequency of this pathology of chronic endometritis, which allows to achieve a stable therapeutic effect and restore the reproductive health of women.

Closest to the claimed is a method of treatment, which consists in conducting therapeutic laparoscopy (adhesiolysis, salpingo-ovariolysis, fimbriolysis, salpingostomy) [9].

The disadvantages of this method are:

- the absence of an effect on the endometrium, taking into account the high frequency of chronic endometritis in women with TPFB, while the uterus remains the focus of infection, which serves as a constant source of inflammation, which leads to the formation of synechia in the uterus, adhesions in the pelvis and fallopian tubes;

- lack of effectiveness in the restoration of reproductive function, according to the literature, the effectiveness of such operations is from 15-35% [1].

The problem solved by the invention: improving the effectiveness of treatment of tubal-peritoneal infertility in women with chronic endometritis, restoration of reproductive, menstrual function, relief of chronic pain, achieving complete rehabilitation.

The objective is achieved due to the fact that after surgery, under the control of a hysteroscope, intrauterine instillations of the drug composition are performed according to the following scheme: on the first and third days of treatment, prednisone 30 mg, dioxidine 0.5% solution in an amount of 50 ml, metrogil 5.0 ml are administered, lidase 32 PIECES, an antibiotic taking into account the sensitivity of microflora, McMimore candles are vaginally administered as local therapy at night, vaginal douching is performed with chamomile solution; on the second and fourth days of treatment, prednisone 30 mg, Instillagel 6-11 ml are intrauterine administered, a tampon containing Vishnevsky ointment in the amount of 20 ml at night is injected locally into the posterior vaginal vault; on the fifth, seventh and ninth days, intrauterine administration of dioxidine 0.5% solution in an amount of 50 ml, metrogil 5.0 ml, cycloferon 0.5 ml, lidase 32 units, antibiotic taking into account the sensitivity of microflora, McMimore candles are administered vaginally at night, in the morning douching of the vagina with a solution of chamomile; on the sixth, eighth and tenth days, Instillagel 6 ml, dimexide 5 ml are administered intrauterine, a tampon containing Vishnevsky ointment in the amount of 20 ml at night is administered into the posterior vaginal vault, immunomodulating therapy and systemic enzyme therapy are simultaneously carried out; course of treatment 10 procedures.

The method is as follows. After reconstructive endoscopic surgery in the manipulation room, the external genitalia and vagina are sanitized with an antiseptic solution (1: 5000 aqueous solution of furatsilin), outpatient hysteroscopy is performed without anesthetic aid, since the expansion of the cervical canal is not required. Liquid hysteroscopy is carried out using an isotonic solution, 5% glucose solution, Instillagel or high molecular weight dextrans, in particular reopoliglukin, as a medium using a simple system for intravenous injection at a positive pressure of 60-100 mm Hg. Art. 30 minutes before the manipulation, an antispasmodic is administered - a no-shpa solution, then, under the control of a hysteroscope, a medicinal cocktail is administered according to the following scheme:

- first day of treatment:

Prednisone 30 mg, dioxidine 0.5% solution in an amount of 50 ml, metrogil 5.0 ml, lidase 32 units, antibiotic taking into account the sensitivity of microflora are administered intrauterine. As a local therapy, Makmimor suppositories are vaginally administered at night, and vaginal douching with chamomile solution is performed in the morning.

- second day of treatment:

Intrauterine injected prednisone 30 mg, Instillagel 6-11 ml. Locally, a tampon containing Vishnevsky ointment in an amount of 20 ml at night is injected into the posterior vaginal fornix.

- the third day:

Prednisone 30 mg, dioxidine 0.5% solution in an amount of 50 ml, metrogil 5.0 ml, lidase 32 units, antibiotic taking into account the sensitivity of microflora are administered intrauterine. As a local therapy, Makmimor suppositories are vaginally administered at night, and vaginal douching with chamomile solution is performed in the morning.

- fourth day:

Instillagel 6 ml, dimexide 5 ml are administered intrauterine. Locally, a tampon is introduced into the posterior vaginal fornix containing Vishnevsky ointment in an amount of 20 ml at night.

- fifth day:

dioxidine 0.5% solution in an amount of 50 ml, metrogil 5.0 ml, cycloferon 0.5 ml, lidase 32 IU, antibiotic taking into account the sensitivity of microflora is administered intrauterine. As a local therapy, Makmimor suppositories are vaginally administered at night, and vaginal douching with chamomile solution is performed in the morning.

- sixth day:

Instillagel 6 ml, dimexide 5 ml are administered intrauterine. Locally, a tampon is introduced into the posterior vaginal fornix containing Vishnevsky ointment in an amount of 20 ml at night.

- seventh day:

dioxidine 0.5% solution in an amount of 50 ml, metrogil 5.0 ml, cycloferon 0.5 ml, lidase 32 IU, antibiotic taking into account the sensitivity of microflora is administered intrauterine. As a local therapy, Makmimor suppositories are vaginally administered at night, and vaginal douching with chamomile solution is performed in the morning.

- eighth day:

Instillagel 6 ml, dimexide 5 ml are administered intrauterine. Locally, a tampon containing Vishnevsky ointment in an amount of 20 ml at night is injected into the posterior vaginal fornix.

- ninth day:

dioxidine 0.5% solution in an amount of 50 ml, metrogil 5.0 ml, cycloferon 0.5 ml, lidase 32 IU, antibiotic taking into account the sensitivity of microflora is administered intrauterine. As a local therapy, Makmimor suppositories are vaginally administered at night, and vaginal douching with chamomile solution is performed in the morning.

- tenth day:

Instillagel 6 ml, dimexide 5 ml are administered intrauterine. Locally, a tampon containing Vishnevsky ointment in an amount of 20 ml at night is injected into the posterior vaginal fornix.

The composition of the drug shake for intrauterine administration includes the Instillagel preparation, which contains 2.0 g of lidocaine, 0.05 g of chlorhexidine, 0.06 g of methyl 4-hydroxybenzoate, and contains hydroxyethyl cellulose and propylene glycol as a gel base. The therapeutic effect of Instillagel is based on the fact that the drug has a lubricating, disinfecting and local anesthetic effect. It has a bactericidal effect on a wide range of gram-positive and gram-negative flora, as well as on fungi of the genus Candida, genital mycoplasmas, and Trichomonas vaginalis [13]. The bactericidal effect occurs 5-10 minutes after administration of the drug. Instillagel does not have the side effects characteristic of antibiotics (dysbiosis, allergic reactions). Since autoimmune processes are induced in chronic endometritis, secondary immunodeficiency and immunosuppression develop, leading to the persistence of microorganisms [2], it is advisable to include low doses of glucocorticosteroids in the composition of the drug shake. For the correction of immune disorders, an immunomodulator cycloferon is administered. The McMimore drug is included in the treatment regimen for local sanitization treatment, since all women have identified sexually transmitted pathogens such as chlamydia, mycoplasma, and ureaplasma.

At present, it has been convincingly proved that among the most frequent etiological factors of nonspecific bacterial vaginitis and bacterial vaginosis, anaerobic microflora plays a significant role - 50-60% [14, 15]. Their role in acute and chronic endometritis is even more significant - 54-79% [16]. Given the importance of anaerobic microflora in the etiology of inflammatory diseases of the external and internal genital organs in women, metragil is included in the treatment complex.

Given the absorbable and biostimulating effect of the hyaluranidase enzyme, a dose of 32 units is included in the cocktail for intrauterine administration. It has the ability to accelerate the action of anesthetics, increase tissue permeability and fluid absorption. No less significant, especially in patients with tubal-peritonial infertility, is the effect of resorption of scar tissue.

The composition of the cocktail includes dimexide, which has a pronounced anti-inflammatory, antiseptic properties, penetrates biological membranes, including skin and mucous barriers, while acting as a kind of "carrier - escalator" for other drugs. The treatment of chronic endometritis is carried out comprehensively using cyclic hormonal therapy for 3 months, local intrauterine treatment is carried out, enzyme therapy is carried out for 14 days - wobenzym 5 tablets 3 times a day.

The main purpose of the use of the drug composition is to increase the effectiveness of treatment of tubal-peritoneal infertility in women with chronic endometritis due to the complex local intrauterine exposure to the drug composition.

104 patients aged 24 to 36 years were examined and treated (mean age was 30.51 ± 5.18 years). In all patients, on the basis of complaints, an anamnesis of the disease, clinical picture, vaginal status, laboratory and instrumental and additional research methods, a tubal-peritoneal form of infertility, chronic endometritis was established. The first group included 48 women with TPFB and chronic endometritis. The average age of the patients in the first group was 30.82 ± 5.44. The second group included 56 women with infertility. The average age of patients in the second group was 30.3 ± 4.9 years. Patients of the second group underwent only therapeutic laparoscopy (adhesiolysis, salpingo-ovariolysis, fimbriolysis, salpingostomy).

All patients before treatment presented the following complaints: infertility, persistent pain in the lower abdomen, menstrual dysfunction, dyspareunia, discharge from the genital tract. In the first group of patients, primary infertility occurred in 54.39%, secondary infertility in 45.61%. Analysis of obstetric history showed that almost half of the patients had pregnancies (45.6%), they ended in delivery more than 3 times less often (19.1-31.6%). Almost every third patient (26.3-27%) had a history of abortion. Moreover, it should be noted that, as a rule, the first pregnancy ended with an abortion. The vast majority of patients with TPF infertility (89.5%) noted the presence of inflammation of the uterine appendages in the anamnesis, mainly of a chronic nature. The menstrual function was studied, since a combination of several factors of infertility, for example, tubal and endocrine, is often noted at once. The following forms of menstrual irregularity were identified: algomenorrhea (14.2%), hyperpolymenorrhea (10%), oligomenorrhea (10.4%).

According to the tests of functional diagnostics and direct methods for studying hormonal status, a violation of the functional state of the ovaries was found in 21 (43.78%) patients, luteal phase insufficiency was found in 21 (43.78%) patients, and failure of both phases in 9 (18.75 %) of patients, a monophasic cycle was observed in 4 (8.33%) and 3 (5.35%) patients.

The first group included 48 women with TPF of infertility, who, in addition to medical diagnostic laparoscopy (LS), underwent local intrauterine treatment of chronic endometritis using the method developed by us. A vaginal examination determined moderate pain on palpation in the lower abdomen, a slight increase in the size of the uterus, its compaction, limitation of uterine mobility during palpation, shortening of the vaginal arches, and pathological leucorrhoea. Ultrasound examination was performed for all women; in the majority of patients, echographic signs of chronic endometritis, endometrial hyperplastic processes, and sactosalpinx were noted; in isolated cases - adenomyosis and uterine fibroids. Performed outpatient hysteroscopy, performed curettage or vacuum aspiration of the contents of the uterine cavity. Scrapes and aspirates were sent for histological examination. Focal form of CE was observed in 62.90% of patients, and diffuse in 37.20%. A histological examination revealed more than half of patients with TPFB the presence of endometrial hyperplastic processes. Also characteristic was perivascular, periglanular, as a rule, diffuse lymphoid infiltration of the stroma with single or focal located plasma and segmented leukocytes and macrophages. Collagenization of the stroma ranged from severe to weak, up to its absence.

A laparoscopic study was carried out, in which it was established:

Table 1
Laparoscopic examination of patency of the fallopian tubes in patients with TPFB (in%) Patency of the fallopian tubes The first group (n = 48) The second group (n = 56) Significance of Differences Pipes are impassable on one side 47.92 47.37 p> 0.05 Pipes are impassable on both sides. 22.92 15.79 p> 0.05 Pipes partially passable 29.17 36.84 p> 0.05 Note: the significance of differences in the comparison groups at p <0.05.

During laparoscopic examination, patients with TPPD revealed chronic salpingitis (salpingoophoritis) in 33% of cases, hydrosalpinx - 28%, sactosalpinx - 39%.

Adhesive process in the field of the pelvic organs (uterus, ovaries, fallopian tubes) during laparoscopic surgery was confirmed in 91.6% of cases among patients with TPFB of infertility of the first group and 85.9% of cases among patients with TPFB of the second group. The severity of the adhesion process was determined according to the classification of J.F. Hulka et al. (1978), corresponded to I degree in 25% of patients with TPFB, II degree in 50%, III degree in 16.67% and IV degree in 0% of the first group.

All patients in both groups of the study underwent a comprehensive microbiological examination, including: microscopy of vaginal smears, bacteriological examination with the quantitative and species composition of microorganisms from the separated cervical canal and vagina, polymerase chain reaction (PCR) for the diagnosis of chlamydia, ureaplasmosis, mycoplasmosis.

table 2
The incidence of sexually transmitted infections of the genital infections (in%) Sexually transmitted diseases Group 1 (n = 48) Group 2 (n = 56) Significance of Differences Chlamydia 45.83 44.64 - Ureaplasmosis 54.17 33.92 p <0.05 Mycoplasmosis 45.83 14.28 p <0.01 Trichomoniasis 27.08 24.56 - Gonorrhea 14.58 8.92 p <0.05 Candidiasis 22.91 17.85 - Gardnerella 16.67 30.35 p <0.05 Note: p <0.05 - significance of differences in indicators in comparison groups.

As shown by the results of a microbiological study of the contents of the cervical canal and vagina, 82 (78.84%) patients with tubal-peritoneal infertility revealed pathogenic or conditionally pathogenic microorganisms or microbial associations. The most frequently detected mixed conditionally pathogenic microflora was identified: epidermal staphylococcus (69.23%), Staphylococcus aureus (12.5%), E. Coli (53.57%), Proteus vulgaris (15.38%), Enterococcus faecalis (65% ) and Streptococcus hemoliticus (11.53%). In addition, fungi of the genus Candida were detected in 20.19% of the examined women, and key cells in 18%.

Thus, based on the study, it was found that women with tubal-peritoneal infertility revealed a high frequency of endometrial pathology (100%), the most common variant of which is chronic endometritis (74.03%).

After the final diagnosis of TPFB, patients of both groups underwent reconstructive endoscopic surgery. The volume of performed endoscopic operations in patients with in both groups was as follows: salpingo-ovarioadhesiolysis (84.61%), salpingostomatoplasty (46.15%), fimbriolysis (25.96%), salpingostomy (5.78%).

Patients of the first group with TPFB were prescribed local sanitizing antibacterial therapy, which included a 10-day course of intrauterine instillations. Daily under the control of a hysteroscope, intrauterine instillations of the drug composition were performed. Due to the fact that as a result of the examination in patients with TPFB, in most cases, sexually transmitted infections such as chlamydia, ureaplasma and mycoplasma were detected, we performed local sanitation of the vagina with the prescription of the drug mcmiror (in the form of candles or gel for tampons) - in the evening before going to bed, in a day No. 5.

In addition, they carry out systemic enzyme therapy, cyclic hormone therapy for 3 months.

The clinical effect of the treatment was evaluated according to the subjective sensations of the patients, ultrasound data, bimanual gynecological examination, and outpatient hysteroscopy data. Each item was rated at 5 points (0 points - no effect). The total effect of the treatment at 26-30 points was evaluated as complete (complete cure), 20-25 points - as significant, below 15-19 points - as partial and below 14 points - as the lack of effect from treatment (see table 3 )

Table 3
The characteristic of clinical signs of chronic endometritis in patients with TPFB in the dynamics of treatment (summary data) Clinical symptoms After the 1st procedure After the 5th procedure After the 10th procedure Pain in the lower abdomen 2 3 5 Vaginal discomfort 3 four 5 Pathological leucorrhoea 2 four 5 Perimenstrual discharge 0 2 four Sonographic changes 0 2 four Bimanual study data 0 3 5

Thus, after 5 local treatment procedures, all patients had an average total effect of 18 points, indicating a partial effect and the need for further treatment. The average total effect after 10 procedures was evaluated by us at 28 points, which testified to the high effectiveness of the treatment we proposed.

Against the background of treatment with this method, a gradual increase in the thickness and echogenicity of the endometrium and the disappearance of anechogenic contents in the uterine cavity were noted. All these changes were tracked by us as a result of dynamic ultrasound monitoring of patients.

Within 6 months after the local sanitization treatment, we carried out dynamic monitoring of patients. All women had disappeared earlier complaints, the menstrual cycle was normalized, the vaginal microecology was restored, and echographic signs of endometrial pathology were not detected.

After treatment, pathogenic or conditionally pathogenic flora in the uterine cavity during a three-month dynamic clinical, instrumental and bacteriological control was detected only in 12.5%. The results of PCR diagnostics of sexually transmitted infections (STIs) of the contents of the uterine cavity during a three-month dynamic control after treatment showed that the detection rate of chlamydia decreased from 60.5% to 6.2%, ureaplasma from 32.6% to 0%, mycoplasmas from 34.6% to 2.0%. A similar pattern was observed in the dynamics of a decrease in the causative agents of the STI group during PCR diagnostics of vaginal contents: the frequency of detection of chlamydia decreased from 45.1% to 4.1%, ureaplasmas from 47.1% to 2.08%, mycoplasmas from 28.8% to 4.1%.

The overall pregnancy rate was 34.5%, in 12 (in 21.4% of cases) patients of the second group, after laparoscopic surgery, uterine pregnancy occurred, and in patients of the first group, after laparoscopic surgery and an additional course of local intrauterine treatment of chronic endometritis, pregnancy occurred more than 3 times more often - in 37 (in 77.1% of cases) patients. In all cases, pregnancy occurred during the first year after treatment (in most cases, in the first 6 months).

Table 4
Pregnancy outcomes as a result of treatment in patients with TPFB (in%) Pregnancy outcomes 1st group (n = 48) 2nd group (n = 56) Significance of Differences Ectopic pregnancy 2.70 (1) 16.66 (2) P <0.01 Frozen pregnancy 5.40 (2) 25.0 (3) P <0.01 Premature birth 8.1 (3) 16.66 (2) P <0.05 Urgent delivery 83.78 58.33 P <0.05 Note: p <0.05 - significance of differences in indicators in comparison groups.

As can be seen from table 4, in the first group of patients with TPFB infertility is statistically significantly less likely than in the second group of patients, the pregnancy ended in an ectopic pregnancy (2.7% and 16.66%, respectively, p <0.01), which ended in pregnancy ( respectively, 5.4% and 25.0%; p <0.01), preterm birth (8.1% and 16.66%, respectively; p <0.05). In the first group of patients, significantly more often than in the second group, the pregnancy ended with an urgent delivery and the birth of a live child - 83.78% and 58.33%, respectively.

Clinical example: Patient K., 28 years old, turned to the androgynecological clinic on 08/15/2001 with complaints of infertility for 4 years, minor pain in the lower abdomen, menstrual irregularities in the form of hyperpolymenorrhea, intermenstrual bleeding, pain discomfort during intercourse, discharge from genital tract. From the anamnesis it is known that the first pregnancy in 1995 ended in medical abortion in the period of 10 weeks, for 5 years it suffers from chronic salpingo-oophoritis, notes annual exacerbations. There were no gynecological operations. A gynecological examination revealed: hyperemia of the mucous membrane of the vagina and cervix, with a bimanual examination, sensitivity was noted during palpation of the uterus, a slight increase in the size of the uterus, its compaction, limitation of uterine mobility during palpation, shortening of the vaginal arches, and pathological leucorrhoea. Microbiological examination of the vaginal secretion revealed an increase in Enterococcus faecalis, and PCR diagnostics revealed: Cl. Thrachomatis, Tr. Vaginalis. An ultrasound scan revealed foci of increased echogenicity, gas bubbles in the uterine cavity, a slight expansion of the uterine cavity, a small amount of fluid in the adjacent space in the mid-M-echo zone. During a hysteroscopic examination, a focal form of chronic endometritis was found, vacuum aspiration of the uterine cavity was carried out, the material was taken for histological and cytological examination, in which leukocyte infiltration, foci of sclerosis and endometrial fibrosis were detected. During medical diagnostic laparoscopy, the pipes are partially passable, according to the classification of J.F. Hulka, the severity of the adhesive process corresponded to 2 degrees, the operation was performed: salpingo-ovariadhesiolysis. After the conduct of the study, the diagnosis of TPFB, chronic endometritis was established. After the diagnosis was established and laparoscopic surgery was carried out, chronic endometritis was treated using an integrated approach, local intrauterine exposure and visual assessment of the effectiveness of treatment in dynamics using the hysteroscopic method, using the drug composition according to our scheme, with simultaneous hormonal therapy and systemic enzyme therapy. When treating pain in the lower abdomen, it was stopped on the 5th day of treatment, the discharge corresponded to the physiological norm on the 4th day, with a gynecological examination on the 10th day, no pathology was found. During dynamic echographic control, a gradual increase in the thickness and echogenicity of the endometrium and the disappearance of anechogenic contents in the uterine cavity were noted. With hysteroscopic control during treatment, positive dynamics were noted. During microbiological research after treatment and within 3 months after treatment, pathogenic and conditionally pathogenic microflora were not found, with PCR diagnostics of STI pathogens were not detected. A control study of the patient was conducted within 6 months after treatment. Subsequent menstruation occurred without delay, spotting was moderate, intermenstrual bleeding was absent. Pregnancy occurred 4 months after treatment, which ended in an urgent delivery. A healthy girl was born, weighing 3450 g.

Thus, the analysis of pregnancy outcomes in patients with tubo-peritonial infertility and concomitant chronic endometritis associated with this pathology indicates that the intrauterine treatment of chronic endometritis as a component of complex treatment after laparoscopic surgery increases the effectiveness of treatment for TPFB (pregnancy rate 77.1 %), not only increases the chances of pregnancy, but also significantly reduces the risk of complications such as ectopic pregnancy by 6 times, frozen pregnancy 5 times and premature birth 2 times. Provides a complete elimination of pathogens from the uterine cavity, normalizes vaginal microbiocinosis, restores irregular menstrual function, and relieves chronic pain.

Literature

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Claims (1)

A method of treating tubal-peritoneal infertility in women with chronic endometritis, including reconstructive endoscopic surgery in the pelvic cavity, characterized in that under the control of a hysteroscope, intrauterine instillations of a drug cocktail are performed according to the following scheme: prednisolone 30 mg is administered intrauterine on the first and third days of treatment , dioxidine 0.5% solution in an amount of 50 ml, metrogil 5.0 ml, lidase 32 units, antibiotic taking into account the sensitivity of microflora, as a local therapy at night vaginally they bring in McMimore candles, in the morning they douche the vagina with a solution of chamomile; on the second and fourth days of treatment, prednisone 30 mg, Instillagel 6-11 ml are intrauterine administered, a tampon containing Vishnevsky ointment in the amount of 20 ml at night is injected locally into the posterior vaginal vault; on the fifth, seventh and ninth days intrauterine administration of dioxidine 0.5% solution in an amount of 50 ml, metrogil 5.0 ml, cycloferon 0.5 ml, lidase 32 units, antibiotic taking into account the sensitivity of microflora, McMimore candles are administered vaginally at night, in the morning syringing of the vagina with chamomile solution, instillagel 6 ml, dimexide 5 ml are intrauterine administered on the sixth, eighth and tenth days, a tampon containing Vishnevsky ointment in the amount of 20 ml at night is injected into the posterior vaginal vault, simultaneously with 1 tablet of treatment, 5 tablets are prescribed 3 times a day, including 14 days and cyclic hormone therapy for 3 months.