RU2557957C1 - Method of treating patients with chronic endometritis and tubal and peritoneal infertility factor - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method involves antibacterial, antimycotic, antiviral therapy taking into account sensitivity and recovered pathogenic flora and/or immune-enhancing therapy. From the 3^rd day of the above therapy, local treatment involving the intrauterine insertion of a device for administering a complex of preparations and the prescribed hormone therapy is conducted. The device for administering the complex of preparations is presented by the Foley catheter, which is used to administer Miramistin 5 ml daily, Cefazoline or Ceftriaxone 4-6 minutes later, then Derinate 5 ml 4-6 minutes on even days, Longidaza 3 thousand units on odd days; the procedure is immediately followed by inserting a Miramistin tampon vaginally for 1-2 hours; one capsule of Polygynax is inserted vaginally for the night, whereas the hormone therapy is prescribed after the treatment.

EFFECT: effective treatment of chronic endometritis and prevention of the tubal and peritoneal infertility.

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Description

The invention relates to the field of medicine, namely to the section "gynecology", and for the treatment of chronic endometritis and the prevention of tubal-peritoneal infertility. Given that patients with chronic endometritis have a high incidence of tubal-peritoneal infertility, the question arose of the most effective way to treat it. Currently, treatment of chronic processes of the pelvic organs during exacerbation or outward for 3 cycles is recommended. But the use of this therapy does not always give the expected result and is too expensive for patients.

A known method for the treatment of chronic endometritis, including the introduction of a medicinal product and subsequent exposure to the lower abdomen with low-intensity infrared pulsed laser radiation with a wavelength of 0.89 μm, a pulse power of 5 W, for 10 minutes daily, with a course of treatment of 10 procedures. As a therapeutic drug, a multivalent complex pyobacteriophage is used, which is administered intrauterine in an amount of 4-7 ml, every other day, during a course of treatment of 5 procedures, exposure to low-intensity infrared pulsed laser radiation is carried out at a frequency of 80 Hz, additionally affecting the projection of cubital vessels and jugular clipping daily for 2-3 minutes, with a treatment course of 10 procedures (Patent for invention No: 2493863 Author: Motovilova Tatyana Mikhailovna (RU), Kachalina Tatyana Simonovna (RU)).

The disadvantage of this treatment method is that the drug does not enter the pelvic cavity, which is ineffective for the prevention and treatment of tubal peritoneal infertility.

There is a method of treating chronic endometritis using aspiration-washing drainage of the uterine cavity, where dimexide, lidase, calendula tincture, novocaine solution, diphenhydramine are used as dialysis solution (Smetnik V.P., Tumilovich L.G. Non-operative gynecology. Manual for doctors. - M.: Medical News Agency, 1998. - 592 p., Ill.).

The disadvantage of this treatment method is that the main component of this solution, which has a sanitizing effect on the uterine mucosa, is dimexide or dioxidine, which can cause a number of side effects. Dimexide causes nausea, vomiting, bronchospasm, is contraindicated in violation of the antitoxic function of the liver, excretory function of the kidneys, angina pectoris, and may increase the toxicity of certain drugs. Dioxidine gives a headache, chills, fever, dyspeptic symptoms, muscle twitching (Mashkovsky M.D. Medicines: in 2 volumes. T. 2. - M .: Medicine, 1990. - 576 p.).

Closest to the claimed invention is 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 installations of a medicinal cocktail are performed according to the following scheme: on the first and third days 30 mg of prednisolone, dioxidine 0.5% solution in an amount of 50 ml, metrogil 5.0 ml, lidase 32 units, antibiotic taking into account micro sensitivity Flora, as a local therapy for the night, vaginally inject Macmimore suppositories, in the morning they douch 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 injected 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, at the same time from the first day of treatment 5 tablets are prescribed Wobenzym 3 times a day, including 14 days and cyclic hormone therapy for 3 months. Application: 2005107156/14, 03/14/2005 GOU VPO "Krasnoyarsk State Medical Academy of the Ministry of Health of the Russian Federation" (RU).

The disadvantage of this method of treatment is the large spread of drugs by day and an expensive method of treatment.

The main disadvantage of intrauterine methods for treating chronic endometritis is the immediate evacuation of a drug from the uterine cavity into the vagina and the high cost of treatment methods.

The purpose of the invention: the creation of an effective method for the treatment of chronic endometritis with the prevention of tubal peritoneal infertility factor.

This goal is achieved by conducting antibacterial, antifungal, antiviral therapy, taking into account the sensitivity and allocated pathogenic flora and / or immunostimulating therapy, and from the 3rd day of systemic therapy, local treatment is carried out by using a Foley catheter balloon, with which the patient daily 5 ml of miramistin is administered, then after 4-6 minutes cefazolin or ceftriaxone, and then after 4-6 minutes every other day 5 ml of derinat or 3 thousand units longidases, immediately after the procedure, a tampon with miramistin is placed in the vagina for 20-40 minutes, then one capsule of polygenax is injected into the vagina at night, and hormone therapy is prescribed after treatment.

A Foley catheter balloon is inserted into the uterine cavity instead of a conventional catheter, where the drug immediately flows into the vagina, and instead of a hysteroscope, which is not available in all gynecological rooms and is expensive for the patient. After a full examination, which includes a smear on the flora, inoculation on the microflora and sensitivity to antibiotics from the vagina, cervical canal and uterine cavity, identification of the genome of possible pathogens of CE using polymerase chain reaction (PCR) - (chlamydia, mycoplasma, ureaplasma, trichomonads, gonorrhea , gardnerella, HPV, HSV, CMV), systemic and local therapy was prescribed. Antibacterial drugs were prescribed taking into account the sensitivity and the selected pathogenic flora: unidox-solutab, 1 tab. 2 times a day - 10 days + flemoclav solutab 875/125 mg 2 times a day - 7 days, or Vilprofen 500 mg 3 times a day 10 days + flemoclav solutab 875/125 mg 2 times a day - 7 days. Antifungal therapy taking into account sensitivity: fluconazole 50 mg 1 time per day - 7 days, then 150 mg 1 time per week for 3 months or pimafucin 1 t 4 r. per day - 5-10 days. Antiviral, immunostimulating therapy with Panavir, Viferon 2, Genferon 500 thousand units. in the form of suppositories according to the scheme per. rect. Bifiform 2 cap. 3 times a day - 2 weeks or normobact 1 sachet 2 times a day - 10 days. Local reorganization was carried out from the 3rd day of treatment. A Foley catheter is inserted into the uterine cavity, the bladder is injected with a syringe in an amount of 3-4 ml, which prevents the outflow of the drug into the vagina, and the substance enters the fallopian tubes and pelvic organs, providing a local therapeutic effect. 5 ml of miramistin is administered, after 4-6 minutes cefazolin or ceftriaxone is administered, after 4-6 minutes, 5 ml of derinate is administered on even days, and 3 thousand units are administered on odd days. longidases. The first day, the procedure is carried out under the supervision of ultrasound, while checking the patency of the fallopian tubes. Immediately after the procedure, a tampon with miramistin is placed in the vagina, and polygynax at night.

The proposed method for the treatment of patients with chronic endometritis (morphologically confirmed or not) and tubo-peritoneal infertility factor (inflammatory diseases of the pelvic organs) was used in 50 patients. All women were divided into 2 groups: control (20 people) and main (30 people). In the 1st control group, only systemic drug therapy was used. Patients of the 2nd group received, in addition to the main treatment, local therapy as described above. Treatment was carried out for patients in the acute stage and in infertility. The diagnosis was established according to the results of laboratory data, ultrasound examination of the pelvic organs and dopplerography, morphological studies. The course of local therapy was carried out for 10 days. The effect of treatment was observed for 6 months.

Patients of the 1st group underwent treatment for 3 cycles with a change of drugs and nevertheless noted insufficient treatment effectiveness: pains in the lower abdomen and in the lumbar region decreased, but 12 patients were still concerned, discharge from the genital tract in 4 patients, infertility in 18 patients. Patients of the 2nd group underwent treatment once, while pain in the lower abdomen persisted in 2 patients, pathological discharge from the genital tract in 1 patient. Out of 30 women, within 6 months, pregnancy occurred on their own or by artificial insemination with husband's sperm in 22 women.

Thus, it follows from the foregoing that the effect of combination therapy with the local intrauterine method of treatment, with the obligatory entry of the drug into the fallopian tubes and pelvic cavity, surpasses traditional drug therapy and reduces the patient’s economic costs, because treatment of the chronic pelvic process is prescribed for 3 courses.

Brief examples are provided as an illustration:

Example 1

Medoeva L., 27 years old.

Complaints about the absence of pregnancy during 2 years of regular sexual activity, yellowish discharge from the external genital tract, which appeared about a week ago, pain in the lower abdomen of a pulling nature.

Menses from 12 years, 4-5 days, after 30-35 days, regular, moderate, painful for the first 2 days.

Sexual life since 18 years. Pregnancy 1, childbirth alone in 2009

At the time of the examination, the general condition is satisfactory, the skin and visible mucous membranes are clean, chronic diseases from the side of internal organs and systems are not noted. Stool, diuresis is normal.

The mammary glands are soft, painless.

Gynecological status. NGOs are developed correctly, hyperemic; body hair by type.

In the mirrors, the w / uterus is covered with the main epithelium; the walls of the vagina and the neck are hyperemic, white discharge, abundant.

PV: Uterus in ant.fl, mobile, sensitive to palpation, appendages enlarged on both sides, painful to palpation.

Diagnosis: Infertility 2. Sluggish metroendometritis. Subacute 2-sided oophoritis. Vulvovaginitis. Cervicitis.

Inspected according to the scheme:

On ultrasound from 02/08/13 (15th day of the cycle): M-echo 12, expansion of the uterine cavity due to fluid contents, right. the egg. - 38 * 29 * 30; a lion. the egg. - 39 * 28 * 29. In the smear: gardn., Mucus, trembling. to, cocci. In the crop of growth pathog. no flora. In the NDP found: - ureaplasma, gardnerella vag.

In scraping from the uterine cavity by the method of a biopsy pipelines for histological analysis - inflammatory infiltrates, consisting mainly of lymphoid elements.

Diagnosis: Subacute 2-sided oophoritis, metroendometritis?

Urogenital ureaplasmosis. Bacterial vaginosis.

Prescribed treatment:

- Unidox-Solutab 1 t. * 2 p. per day - 10 days after a meal.

- Flemoklav-solutab 1 t (875/125) 2 p. per day - 10 days.

- Fluconazole 50 mg 1 p. per day - 7 days. - Bifiform for 2 K. * 3 p. per day - 10 days.

- Genferon 500 thousand at night per.rect - 10 days.

On the third day of systemic therapy, local treatment was started for 10 days: they were introduced into the uterine cavity according to the described scheme: miramistin - 5 ml, after 5 minutes - ceftriaxone 1 g. diluted in 7-10 ml of physical. solution, after 5 min 5 ml of longidase in alternation with 5 ml of derinate. in one day. The first day of treatment was carried out under the supervision of an ultrasound study, while checking the patency of the fallopian tubes.

Control of analyzes h-4 weeks after treatment.

03/18/13

There are no complaints. The condition is satisfactory. The skin and visible mucous membranes are clean.

In the mirrors: w / womb clean, mucous discharge, moderate. PV. The uterus is dense, b / painful, appendages without features. 03/21/13

On ultrasound from 03/21/13 (21 medical doctors): M-echo 11, the endometrium is homogeneous with clear contours, appendages without features. NDP- ureapl., Garden. - absent. Smear - trembling. units, flora - stick.

M-c on o / cytology and scraping from the uterine cavity by pipelid biopsy for histological analysis - without features, hormones are normal.

Appointed: pimafucin 1 soup. at night in the vagina for 6 days, duphaston 1 t. 2 p. per day from 16 to 25 day m.

After 2 months, the patient began an independent pregnancy.

Example 2

September 21, 2012 Murieva N.

Complaints about the absence of pregnancy during 3 years of regular sexual activity, copious discharge from the external genital tract, itching, pulling pains in the lower abdomen.

Menses from 14 years, 5 days, after 28-30 days, regular, moderate, painful first days. P / menstru. 08/23/2012.

Sexual life since 25 years. Pregnancy 1, childbirth alone in 2009.

At the time of the examination, the general condition is satisfactory, the skin and visible mucous membranes are clean, chronic diseases from the side of internal organs and systems are not noted. Stool, diuresis is normal.

The mammary glands are soft, painless. NGOs are developed correctly, hyperemic; body hair by type.

In the mirrors, the w / uterus is covered with the main epithelium; the walls of the vagina and the neck are hyperemic, the discharge is white, curdled, plentiful. PV: Uterus in ant.fl, mobile, b / disease., Appendages enlarged on both sides, painful on palpation.

Diagnosis: Infertility 2. Subacute 2-sided oophoritis.

Colpitis (yeast?). Vulvovaginitis.

Recommended by:

Candida colpitis treatment:

 - fluconazole 50 mg each. * 1 r / day - 7 days,

- pimafucin 1 St. at night in the vagina - 9 days.

Appearance a week after treatment.

11/27/2012. (7 day mts.) Complaints only about the absence of pregnancy. After the treatment, the itching passed, the discharge does not mark.

In the mirrors of leucorrhoea, w / uterus bleeds when taking tests:

1. A smear on the flora.

2. Sowing on m / flora and chuvst. to antib.

3. PCR for trash., Mycopl. home. and genit., ureapl., HSV, CMV, HPV.

4. Ultrasound of the pelvic organs.

5. Blood for hormones 1 and 2 phases for 4-5 and 20-22 days mts. 11/07/12 g.

On ultrasound from 11/28/12 (8th day of the m cycle): M-echo 6, right. the egg. - 39 * 29 * 31 f. - 12 mm .; a lion. the egg. - 37 * 26 * 27.

In the smear: mucus, trembling. to, cocci.

In the crop, the growth of E. coli., Sensitive to amoxicillin.

In PCR detected: - ureaplasma

- Mycoplasma genitals.

Diagnosis: Infertility 2.

Subacute bilateral oophoritis.

Urogenital myco-ureaplasmosis. Cervicitis.

Prescribed treatment:

- Wilprofen 1000 1 t. * 2 p. per day - 10 days after a meal.

- Flemoklav-solutab 1 g. 2 times a day for 10 days with meals.

- Fluconazole 50 mg 1 p. per day - 7 days.

- Terzhinan or polygynax 1 t. At night in the vagina.

- Genferon 500 thousand for 1 supp. at night per.rect.

- Bifiform for 2 K. * 3 p. per day - 10 days.

On the third day of systemic therapy, local treatment was started for 10 days. Into the uterine cavity according to the described scheme was administered: miramistin - 5 ml, after 5 minutes. - ceftriaxone 1 g, diluted in 7-10 ml of physical. solution, after 5 min 5 ml of longidase in alternation with 5 ml of derinate every other day. The first day of treatment was carried out under the supervision of an ultrasound study, while checking the patency of the fallopian tubes. 1 month after treatment, the patient took control tests. All tests are normal. There are no complaints. Hormone therapy (Yarina) was prescribed for 3 months. Against the background of cancellation, pregnancy occurred by insemination with the husband's sperm at his own insistence.

Example 3

Hallaeva K.

Complaints about the absence of pregnancy during 2 years of regular sexual activity, yellowish discharge from the external genital tract, pulling pains in the lower abdomen.

Menses from 12 years, 4-5 days, after 30-35 days, regular, moderate, painful for the first 2 days.

Sexual life since 18 years. Pregnancy 1, childbirth alone in 2010 by cesarean section, complicated by postpartum endometritis.

At the time of the examination, the general condition is satisfactory, the skin and visible mucous membranes are clean, chronic diseases from the side of internal organs and systems are not noted. Stool, diuresis is normal.

The mammary glands are soft, painless.

NGOs are developed correctly, hyperemic; body hair by type.

In the mirrors, the w / uterus is covered with the main epithelium; the walls of the vagina and neck are hyperemic, the discharge is purulent, plentiful.

PV: Uterus in ant.fl, mobile, sensitive to palpation, appendages enlarged on both sides, painful to palpation.

Diagnosis: Infertility 2. Sluggish metroendometritis. Subacute 2-sided oophoritis. Vulvovaginitis. Cervicitis.

Recommended by:

1. A smear on the flora.

2. Sowing on m / flora and chuvst.k antib.

3. PCR for trash., Mycopl. home. and genit., ureapl., HSV, CMV, HPV.

4. Ultrasound of the pelvic organs.

02/08/13

On ultrasound from 02/08/13 (15th day of the cycle): M-echo 12, expansion of the uterine cavity due to fluid contents, right. the egg. - 38 * 29 * 30; a lion. the egg. - 39 * 28 * 29.

In the smear: gardn., Mucus, trembling. to, cocci.

In the crop of growth pathog. no flora. In PCR detected: - ureaplasma

- gardnerella vag.

Diagnosis: Subacute 2-sided oophoritis. Chronic metroendometritis?

Urogenital ureaplasmosis. Bacterial vaginosis. Prescribed treatment:

- Unidox-Solutab 1 t. * 2 p. per day - 10 days after a meal.

- Flagyl 250 mg * 3 p. per day - 5 days with meals.

- Terzhinan or polygynax 1 t. At night in the vagina.

- Fluconazole 50 mg 1 p. per day - 7 days.

- Bifiform for 2 K. * 3 p. per day - 10 days.

On the third day of systemic therapy, local treatment was started for 10 days. Into the uterine cavity according to the described scheme was introduced: miramistin - 5 ml, after 5 minutes - ceftriaxone 1 g, diluted in 7-10 ml of physical. solution, after 5 min 5 ml of longidase in alternation with 5 ml of derinate every other day. The first day of treatment was carried out under the supervision of an ultrasound study, while checking the patency of the fallopian tubes. 1 month after treatment, the patient took control tests. All tests are normal. There are no complaints. Pregnancy occurred on its own 4 months after treatment.

Claims (1)

A method for the treatment of patients with chronic endometritis and tubo-peritoneal infertility factor, including antibacterial, antifungal, antiviral therapy, taking into account sensitivity and selected pathogenic flora and / or immunostimulating therapy, and local treatment is carried out from the 3rd day of treatment, including the introduction of uterine cavity of a device for administering a complex of drugs and the appointment of hormone therapy, while a catheter ball is used as a device for administering a complex of drugs Foley it, through which the patient is administered daily 5 ml miramistina, after 4-6 minutes or cefazolin, ceftriaxone, and then after 4-6 minutes on even days is administered 5 ml derinata and on odd days 3 thousand units longidases, immediately after the procedure, a swab with miramistin is placed in the vagina for 1-2 hours, at night one capsule of polygynax is introduced into the vagina, and hormone therapy is prescribed after treatment.