RU2000747C1 - Method of treatment of cervix of uterus ruptures which women recently confined have - Google Patents

Abstract

The invention relates to obstetrics and gynecology. The aim of the invention is to increase the effectiveness of treatment. Daily, for 4-5 days, intramuscular laser therapy of cervical wounds in the postpartum period is carried out for 4-6 minutes depending on the size of the wound at an angle of 110-130 °; semiconductor infrared laser ALLD-05M. The method is carried out using an ALLD-05M laser physiotherapeutic apparatus. output power l 150 mW / cm. which is determined by the device. available in a physiotherapy laser apparatus, wavelength 0.81 µm, continuous operation. A fiber with a length of 80-100 cm and a thickness of 0.4-0.6 cm is fixed at the exit point of the laser beam. After treatment of the vagina and cervix with antiseptic solutions, the laser is applied using a fiber inserted into the cervical canal by 3-5 cm depending on the degree rupture of the cervix. At the end of the fiber there is a reflector mirror. The dapad laser beam is reflected and scattered on it, affecting the wound of the cervix at an angle of 110-130 °. The luminous part of the fiber is 3-5 cm. The power density of the laser radiation at the irradiated 9th object is 4-7 4-7 mW / cm. Sessions are held daily for 4-5 dm. Exposure 4-6 minutes with a daily decrease in exposure for 30s,

Description

The invention relates to medicine, namely to obstetrics and gynecology, and can be used to treat cervical wounds.

Cervical wounds are one of the most common forms of postpartum disease. The disease occurs in 5.0-28% of cases. The healing of cervical wounds has its own differences, due to the anatomical and physiological features of the wound area, namely the impossibility of creating a wound due to tonic and volitional contractions of the muscles of the cervix, constant bacterial contamination of the wound with suckers and vaginal contents, functional changes in the tissues of the birth canal. They often lead to serious complications, in particular postpartum inflammatory diseases, healing by secondary tension, the formation of rough scars, stenosis of the outer opening of the cervical canal, ectropions, dysplasia, and dysplasia.

The requirements for the treatment of such wounds are as follows: prevention of infection of the wound, acceleration of reparative processes, prevention of the formation of gross scars.

Of the many proposed methods for preventing divergence of uterine wound sutures, only a few are currently used - this is a group of medications that have an antiseptic, biostimulating effect on regenerative and reparative processes in the cervical wound.

The prototype is a method of treating cervical wounds by applying a single suture and treatment with an antiseptic solution.

The disadvantage of this method is the incomplete treatment effect and a large percentage of complications - seam divergence in 90% of puerperas with healing by secondary tension.

The aim of the invention is to increase the effectiveness of treatment by shortening the treatment time and reducing the percentage of wound healing by secondary tension with the formation of a gentle scar. The goal is achieved by the fact that every day for 4-5 days laser therapy of the cervical wounds in the postpartum period is performed for 4-6 minutes depending on the size of the wound at an angle of 110-130 ° with an ALLD-0.5 M semiconductor infrared laser ,

The method is carried out using a laser physiotherapy unit

The ALLD-05 M with an output power of 150 mW / cm2, which is determined by the device available in the physiotherapeutic laser apparatus with a wavelength of 0.81 microns, is continuous. At the exit point of the laser beam, a light length of 80-100 cm, a thickness of 0.4-0.6 cm is fixed. After the vagina and cervix are treated with antiseptic solutions, they are laser-applied using a light guide inserted 3-5 cm into the cervical canal of the uterus, depending from the degree of rupture of the cervix. At the end of the fiber there is a reflector mirror. A laser beam incident on it is reflected and scattered, acting on the wound of the cervix at an angle of 110-130 °. The luminous part of the fiber is 3-5 cm. The laser radiation power density at the irradiated object is 4-7 mW / cm. Sessions are carried out daily for 4-6 days, depending on the size of the cervical rupture. Laser therapy of postpartum cervical wounds was performed in 34 women, the full effect of treatment was noted in 33 cases, a partial effect in 1 case. The most optimal exposure is 5 min with a daily decrease of 0.5 min, taking into account the reduction in cervical size, power density of 6 mW / cm2. The length of the light at the end of the fiber is 3-5 cm. An exposure of 2 minutes was carried out, the result is negligible. The effect was achieved with an exposure of 4 minutes. Increasing exposure to 10 minutes did not give an improvement in treatment effect.

PRI me R 1. Sick A., 22 years old. in childbirth, a bilateral rupture of the cervix of the II degree occurred. The wound was sutured with a single catgut suture.

Objectively: the general condition is satisfactory. HELL 110/70 mm Hg, pulse 75 beats, / min, satisfactory qualities, moderate blood bloody.

Tests before treatment: total blood: er. 3,100,000; HB 11.7 g / l; CPU 0.9; leukemia 10,200; E 2; P 4; L 29; C 59; M 6; ESR 38 mm / h.

Examination of the cervix in the mirrors: there are left-sided and right-sided ruptures of the cervix of the II degree, on which catgut sutures are applied. The wound is swollen, hyperemic.

The diagnosis of urgent delivery, I. The postpartum period of 1 day. 2-sided rupture of the cervix II degree.

From the first day of the postpartum period, a laser therapy course was started using a fiber inserted into the cervical canal of the cervix to a depth of 4 cm at an angle of 110 °. After treatment of the rena infnm p, β-L About 02% NEW CHLOROGECOIDIN P GGN CHI POWER

laser beam nl irradiated object 4 mW / cm Exposure 5 min. Improvement was noted on the 2nd day from the start of treatment, which was expressed in a decrease in edema of the wound surface, pain and hyperemia decreased. The exposure time was reduced daily by 30 seconds, correspondingly to a reduction in the size of the cervix. By the end of the laser treatment within 5 days, the wound was completely healed by primary intention with the formation of a gentle scar; no complaints. In bacteriological culture from the wound of the cervix uteri, microflora was not found.

Total blood: er. - 3,300,000; HB 12.4 g / l; CPU 1.0; white blood cells 8100; E 1; P 2; C 67; M 6; L 24; ESR 14 mm / h.

She was discharged home in satisfactory condition on the 6th day of the postpartum period. At the follow-up examination after six months, there were no complaints; a tender scar formed on the cervix.

PRI me R 2. Patient K., 28 years old, in childbirth there was a left-sided rupture of the cervix of the I degree, the wound was sutured with a single catgut suture.

Objectively: the general condition is satisfactory, blood pressure is 1 10/70 mm Hg, pulse is 78 beats / min, satisfactory qualities, blood lochy, moderate. Analysis before treatment: total. blood: er. 2,900,000; HB 10.8 g / l; CPU 0.8; white blood cells 11100; E 1; P 5; L 28; C 57; M 9; ESR 35 mm / h.

Examination of the cervix in the mirrors: there is a left-sided rupture of the cervix of the first degree, on which a single catgut suture is applied. The wound is swollen, hyperemic.

Diagnosed with Urgent Delivery, II. The postpartum period is 1 day. Rupture of the cervix I degree.

From the first day of the postpartum period, a laser therapy course was started using a fiber inserted into the cervical canal of the cervix uteri to a depth of 3 cm at an angle of 130 °, after treatment of the cervical wound with 0.02% chlorhexidine, the laser beam power density at the irradiated object was b mW / cm2. Exposure 4 min. Improvement was noted on the 2nd day from the start of treatment, which was manifested in a decrease in edema of the wound surface, pain and hyperemia decreased. The exposure time was reduced daily by 10 seconds, correspondingly to a reduction in the size of the cervix. By the end of the FJ laser treatment, the turning of 4 days was full hoarse MPI; (see primary tension with formig-p. tender scar, not red nfipa. I .. m i R ml of the theiological sowing of their wounds of the cervix of the microflora was not detected.

Total blood: er. 2,300,000; HB 11.7 g / l. CPU 0.9; white blood cells 9000; E 0; P 2; C 60; M 5; 5 L 25; ESR 16 mm / h.

She was discharged home in satisfactory condition on the 5th day of the postpartum period. At the follow-up examination after 6 months, there are no complaints, a soft scar was formed on the neck, 0 pale

Example 3. Sick O., 21 years old, in childbirth there was a left-sided rupture of the cervix of the III degree. The wound was sutured with a single catgut suture.

5 Objectively: the general condition is satisfactory, blood pressure 115 70 mm Hg, pulse 72 beats / min, satisfactory qualities, blood lochy, moderate.

Tests before treatment: total blood: er.

0 3200000; HB 12.4 g / l; CPU 0.9; white blood cells 97000; E 1; P 5; L 30 C 58; M 6; ESR 32 mm / h. Examination of the cervix in the mirrors: there is a left-sided rupture of the cervix of the III degree, on which a single

5 catgut seam. The wound is swollen, hyperemic.

The diagnosis was established: Term delivery, I. Postpartum period 1 day. Rupture of the cervix III degree.

0 From the first day of the postpartum period, a laser therapy course was started using a fiber inserted into the cervical canal of the cervix to a depth of 5 cm at an angle of 120 °, after treatment of the cervical wound with 0.02% chlorhexidine. The power density of the laser beam at the irradiated object is 7 mW / cm. Exposure 6 min. Improvement was noted on the 2nd day from the start of treatment, which was expressed in a decrease in wound edema.

0 surface, decreased pain, hyperemia. The exposure exposure was reduced daily for 30 seconds, correspondingly to a reduction in the size of the cervix. By the end of the laser treatment within 5 days

5 complete healing of the wound by primary intention with the formation of a gentle scar; no complaints. In bacteriological culture from the wound of the cervix uteri, microflora was not found.

0 Total blood: er. 3,500,000; HB 12.7 g / l;

CPU 1.0; white blood cells 8000; E 0; P 3; C 64, L 26; M 7; ESR 11 mm / h

Discharged in satisfactory condition on the 6th day of the postpartum period. At

On the 5th inspection after 6 mh, it does not show sforge on the cervix; hall-with a delicate scar.

All patients received o6uirt i, r treatment, treatment with antiseptic - and solutions, vitamin therapy

Using this method, one can achieve an advantage over the known ones by using intramuscular laser irradiation with a fiber. This helps to increase the effectiveness of treatment by reducing the treatment time, reducing the percentage of complications, and diverging sutures with healing by secondary tension.

The ALLD-05 M physiotherapeutic laser apparatus with an output power of 150 mW / cm2, which is determined by the apparatus available in the physiotherapeutic apparatus, has a wavelength of 0.81 microns as a laser source. Irradiation is carried out using a fiber, at the end of which the laser beam is scattered using an existing reflector. Radiation occurs at an angle of 110-130 ° from the end of the fiber, 3-5 cm long. The laser power density is 4-6 mW / cm2 at the irradiated object. A fiber is inserted into the cervical canal at an angle of 110-130 °. An irradiation session is carried out for 4-6 minutes, depending on the degree of cervical rupture daily for days. When the laser power density of the non-irradiated object is reduced to less than 4 mW / cm and the exposure is reduced to 2 minutes, the treatment effect worsens. With an increase in exposure to 10 minutes and an increase in power density above 7 mW / cm, no improvement in treatment effect is noted.

As a result of the studies, the optimal parameters of the effect of laser radiation at

Claims (1)

The claims METHOD FOR TREATING CERVICAL CERVIA Maternity ward, including suturing and treatment with antiseptic agents, characterized in that, in order to shorten the treatment time and reduce the number of complications after treatment with antiseptic cervical irradiation of puerperas with a power density of 4-7 mW / cm2 and exposure of 4-6 minutes. Optimal exposure parameters are within the parameters that have a stimulating effect on the healing of inflammatory processes, see AK Polonsky, Lazerna and magneto-laser therapy 1985. Materials of the international symposium Lasers in surgery and medicine. M .: 1988. A study of known data showed that the effect of treating wounds of the cervix uteri by intramuscular laser irradiation is a new method of treating this pathology and has the character of an immunomodulating effect on the pathological focus and the body of puerperas with an increase in metabolism in tissues, under the conditions of a holistic organism, has an antibacterial effect. Thus, the proposed method for the treatment of cervical ruptures in puerperas is a more effective means of treatment in the treatment of cervical wounds. This leads to an increase in the effectiveness of treatment due to the persistent healing effect, shortening the time treatment, reducing the severity of the disease, reducing the percentage of complications, with wound healing by primary intention with the formation of a tender scar. (56) Dobrovolsk V.A. The immediate and long-term consequences of cervical ruptures in childbirth. Diss. Candidate of Science, Omsk. 1978, p. 181. they act intracervically through a light guide located at an angle of 110-130, reflected by the radiation of an infrared semiconductor laser with a power density of 4-7 mW / cm2, with a gradual decrease in the exposure time from 6 to 2 minutes for 4-5 days.