RU1836928C - Method of treating right testicular vein syndrome - Google Patents

Abstract

The invention relates to medicine, namely to urology and gynecology, and can be used in the treatment of right ovarian vein syndrome. SUMMARY OF THE INVENTION: Transfemoral X-ray endovascular embolization of the left gonadal vein is performed. The method allows to reduce the invasiveness of the intervention, to correct the venous circulation of the internal genital organs.

Description

The invention relates to medicine, namely to urology and gynecology, and can be used to correct urodynamic disorders of the upper urinary tract caused by varicose veins of the right ovarian vein in case of impaired venous, renal and ovarian circulation.

The purpose of the invention is to reduce the invasiveness of the intervention in the treatment of right ovarian vein syndrome.

The goal is achieved by transfemoral x-ray endovascular occlusion of the left ovarian vein. After puncture of the femoral vein according to Seldinger and phlebotonometry in the femoral, inferior vena cava and left renal veins, super-selective catheterization of the left ovarian vein is performed, followed by ovaricophlebography. In the presence of pathological retrograde blood flow in the left ovarian vein, occlusive devices (spirals of the Gianturco type) or phlebosclerosis preparations (varicocide, varicosan, thrombovar) are introduced into the lumen of the latter.

Correction of venous renal vascular circulation, in addition to improving the functional state of the ovaries, is accompanied by the restoration of impaired urodynamics and the reversibility of retention changes in the upper urinary tract.

The method is illustrated by an example.

Sick K., 26 years old, medical history No. 1227. Diagnosis at admission: Infertility 1., hypofunction of ovaries. Complaints of pain in the lower abdomen, periodic pain in the right lumbar region with radiation to the right inguinal region, low-grade fever, painful menstruation, frequent slightly painful urination. Not pregnant 5 years. The husband is examined, healthy. Menarche at age 14, 2-3 days, after 28-30 days, plentiful. Sex life since 20 years. Objectively: the type of addition is correct, the hair is of a female type, secondary sexual characteristics are developed. Gynecological status: the external genitalia are developed normally, the vagina is nulliparous, the cervix is conical, the pharynx is closed, the uterus is of normal size, mobile, painless. In the area of appendages, the stiffness, more on the right. Metrosalpingography: there are no malformations of the internal genital organs, right

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the tube is not passable in the ampullar region; on the left, the fallopian tube is freely passable. According to tests of functional diagnostics, the alternation of luteal phase insufficiency with anovulation. Urine at 17 CS - 9.6 mg / day. The kidneys are not palpable; Pasternatsky’s symptom is slightly positive on the right. Blood test: hemoglobin 112 g / l., White blood cells 7 109 / l., ESR - 20 mm / h. Urinalysis: acid reaction, relative density 1015, epithelial flat cells 3-6 in the field of vision, calcium oxalates in a significant amount; according to De Almeida-Ne-chiporenko: 8000 leukocytes, 1000 red blood cells. Zimnitsky test 1005-1018; urea 6.6 mmol / lit., creatinine 0.08 mmol / lit. Urine sowing was increased prote (5000 colonies per 1 ml.).

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Selective renal venography: pathological retrograde blood flow is determined from the dilated left ovarian vein, the contrast of the grapevoid plexus of the left and right ovaries, extraorganic uterine veins, reflux of contrasting blood to the left iliac vein. On the X-ray taken in the excretory phase (15 minutes after the administration of the contrast medium), the kidney function was preserved on both sides, bilateral ureteropyelectasis was noted. In order to correct renogonadal hemodynamics, an occlusion of the left ovarian vein with the Gianturco spiral was performed. On the control phlebogram of the left ichnikova vein does not contrast, with.

Quantitative analysis of excretory urogram:

Area of the pyelocaliceal system Capacity of the calyaliceal system The length of the kidney.

Width of the kidney Thickness of the parenchymal layer in the region

-the upper pole

-bottom pole

-On the outer edge of the FCI

RCP PPO LPK

Clinical and radiological diagnosis 1: Violation of the venous renal and ovarian circulation. Varicose ovarian veins. Chronic bilateral pyelonephritis. Infiltrative inflammatory stage.

Examined 7 months after X-ray endovascular intervention. In the postembolization period, notes

Area of the pyelocaliceal system Capacity of the pyelocaliceal system Length of the kidney Width of the kidney Thickness of the parenchymal layer in the region

-the upper pole

-bottom pole

-On the outer edge of the FCI

RCP PPO LPK

rights

9.24cm2

8.58ml

12.6cm

6.2 cm

2.6cm

2.7cm

1.8cm 77 units

0.423

4.35

2.54

Left

14.61 cm2

13.03 ml

13.0cm

6.7cm

2.9 cm 2.8 cm 2.0 cm 40 units 0.415

4.30

2,50

spontaneous miscarriage (16 weeks). Urinalysis: acid reaction, relative density 1020, according to De-Almeida-Nechiporenko: leukocytes 4000, erythrocytes 1000. Zemnitsky test 1007-1026. Sowing urine and smears from the vagina - no bacteria growth.

Quantitative analysis of the excretory urogram (7 months later after occlusion of the left ovarian vein:

rights

0.17cm2

.66 ml

12.3 cm

6.5 cm

2.6 cm 2.9 cm 2.6 cm 42 units

0.36 4.15

2.0

Left

14.45 cm2

12.84 ml

12n9cm

6.5 cm

2.9cm 2.8cm 2.0cm 32 units 0.415

4.30

2.45

5 18369286

The method was applied in clinical practice - to abandon the traditional surgeon practice of 43 women suffering from syndromic intervention; MRM of the right ovarian vein, due to - reduce the treatment time to a single violation of the venous renal-ovarian procedure;

blood circulation. All women were examined in a 5-year follow-up strictly due to the pathological period from 4 to 27 months after X-ray genetic treatment,

Claims (1)

pre-vascular intervention on the left ovarian vein. 42 women have disappeared pain. A method of treating a syndrome of the right urodynamic disorder of the superior urinary vein, characterized in that ways, normalized urine tests. In 1 10s, in order to reduce the trauma of the inter-patient, the expansion of the right ureter, the correction of venous blood circulation, although it did not progress. organ transfemoral rent The proposed method of treatment allows: genoendovascular embolization of the left - reduce the invasiveness of treatment; 15 gonadal veins.