RU2082465C1 - Method to treat female tubal infertility of inflammatory genesis - Google Patents

Abstract

FIELD: medicine, gynecology. SUBSTANCE: topography of tubal obstruction is preliminarily determined by hysterosalpingography and bimanual vaginal inspection. Then distal end of light guide is deeply inserted into vaginal fornix tissues to approach necessary tubal part. Irradiation is conducted by helium-neon laser for 2-4 min at cyclic fluctuation of incoming power density ranged 20-60 milliwatt/cmcm² at first and vice versa at corresponding energy density of 2.4-7.2 J/cmcm² at 1-2 hertz frequency for 5-7 seances. Then treatment should be conducted in a day at incoming power density ranged 1-10 milliwatt/cm_cm2 and vice versa at energy density of 0.1-1.2 J/cm_cm2 at the same frequency for 6-8 seances by alternating with tubal hydrobougienage at 120-130 mm mercury column pressure using novocaine, kanamycine, lidase for 6-8 procedures. EFFECT: higher efficiency in treating female tubal infertility. 3 tbl

Description

 The invention relates to medicine, namely to gynecology, and is intended for the treatment of chronic salpingo-oophoritis complicated by obstruction of the fallopian tubes.

 One of the ways to increase the birth rate is to treat female infertility of inflammatory origin. As you know, in recent years there has been a tendency to the spread of this disease. The problem is all the more urgent because a perfect treatment method has not yet been developed that would satisfy the modern requirements of therapy and rehabilitation.

A known method of treating a chronic inflammatory process of the fallopian tubes (Bykhovsky A. E. Bykhovsky Y. E. Some clinical and laboratory data on the effectiveness of treatment of patients with chronic inflammatory processes of the uterine appendages with laser beams. Some issues of normal biology and bioenergetics of the body in normal and pathological conditions, laser radiation biostimulation Alma-Ata, 1972, p. 56 60), with the help of which 68 women were treated with an LG-75 helium-neon laser with an incident radiation power density of 25 mW / cm ² ; in addition, acupuncture points and reflexogenic zones of the internal genitalia were irradiated. The irradiation time was 10 15 minutes. The course of treatment included 20 25 daily procedures. One course of laser therapy was given to all women. 16 patients who did not have a cured effect, after 2 3 months was given a repeated irradiation course, consisting of 10 15 sessions. 7 women became pregnant as a result of treatment.

 The disadvantages of this method of treatment are a large daily exposure to radiation (10 15 min), the duration of the course of laser therapy (20 - 25 procedures), a low pregnancy rate.

The most preferred method for treating female infertility with inflammatory genesis is a method of treating with a helium-neon laser, based on the transvaginal approach of the laser beam to the projection of the uterine appendages on the vaginal fornixes (V. Baranov 1987) and adopted as a prototype (V. Baranov. Complex therapy tubal infertility of inflammatory genesis with the inclusion of a helium-neon laser. Proceedings of the I Congress of obstetrician-gynecologists. M. 1987, p. 320). The essence of the treatment method is to conduct courses of laser therapy with the subsequent appointment of therapeutic hydrotubes. The course of laser therapy consists of 9 12 daily transvaginal irradiations with the LG-75-1 helium-neon laser projections of the uterine appendages on the arches of the vagina and external pharynx of the cervix with an incident radiation power density of 100 mW / cm ² for 1 6 min with an energy density of one irradiation field of 6 J / cm ² . After 1 - 2 months after the course of laser therapy, therapeutic hydrotubes are performed with a treatment mixture consisting of trypsin, lidase, a broad-spectrum antibiotic dissolved in 10 15 ml of 0.25% novocaine solution and includes 8 10 procedures. Laser therapy courses are repeated after 4-6 months. As a result of treatment of 155 patients, in 94 (60.3%) patients the patency of the pipes was restored, and in 43 (45.3%) patients the pregnancy started.

 The disadvantages of the treatment method are the low frequency of pregnancy, the duration of rehabilitation measures.

 The purpose of the invention is to increase the effectiveness of the treatment of female tubal infertility of inflammatory genesis due to local targeted exposure to helium-neon laser radiation in certain modes on impassable sections of the fallopian tubes and connection of the tube hydro-pumping to the laser therapy process.

 The goal is achieved by first determining the topography of the impassable area, then the fiber is deeply recessed into the vaginal arches to the impassable section of the fallopian tube.

The object of exposure is irradiated for 2–4 min, first with cyclic fluctuations in the density of incident power from 20 to 60 mW / cm ² and vice versa with a frequency of 1 2 Hz with varying energy density within 2.4 7.2 J / cm ² ) daily 5 7 times until the pain syndrome disappears, then laser therapy is continued 6 8 times every other day with fluctuations in the density of the incident power from 1 to 10 mW / cm ² and vice versa with the same frequency. Sessions of laser therapy now alternate with the injection of a medicinal mixture under pressure into the fallopian tubes by hydrotubation (in this method it is more appropriate to call hydrobuffing). Hydrobuying is carried out under a pressure of 120 130 mm RT. Art. novocaine 0.5% 10 15 ml, kanamycin sulfate 0.5 g, lidase 64 units. Such procedures are carried out 6 to 8 times.

 The method is as follows.

On the 7th 8th day of the menstrual cycle, the patient is laid on a gynecological chair, a bimanual vaginal examination is performed to determine the topography of the fallopian tubes. Comparison of the obtained information with the data of previously performed hysterosalpingography, determine the location of the obturated section of the pipe on the patient. The distal end of the fiber is placed in a sterile glass vessel (laboratory tube) with a flat flat bottom. The light guide is recessed through the vaginal arch into the parametric tissue to an impassable pipe section. For laser therapy, the LG-75-1 device is used with a serial quartz fiber having a diameter of the optical part of 5 mm. The radiation power at the output of the fiber is 12 mW. The incident power density (N) is determined by the formula 2 HP / S, where P is the radiation power at the output of the fiber in W; S is the irradiation area, see Energy Density (Dose) is defined as = H • t, where H is the power density in W / cm ² ; t exposure time, s.

 The density of the incident power is changed by moving the fiber along the axis of the tube fixed on the object of influence.

 The hydrobuging of the fallopian tubes is as follows.

 The patient is laid on a gynecological chair. The external genitalia and the inner surfaces of the thighs are disinfected, then a spoon-shaped mirror is inserted into the vagina, wiped with a dry and then swab moistened with alcohol. After inserting the front mirror and capturing the cervix with bullet forceps, a uterine syringe is inserted into the cervical canal and at a pressure of 130 mmHg. Art. with interstitial and isthmic obstruction and 120 mm RT. Art. during ampoule obstruction, a drug mixture is introduced into the fallopian tubes consisting of 10 15 ml of 0.5-novocaine, 0.5 g of kanamycin sulfate, 64 units of lidase.

 As a result of the studies, the optimal laser irradiation modes were selected.

It is known that laser therapy uses a radiation power density of 0.1 to 200 mW / cm ² with a total exposure of radiation in one session from 30 s to 15 min (V.N. Serov et al. 1988; L.P. Peshev and et al. 1990; R. A. Rodkin and V. N. Baranov et al. 1992), as well as:
Laser therapy in gynecological endocrinology. V.N. Serov, A.A. Kozhin et al. Results of the use of GNL radiation in conservative gynecology. Rostov-on-Don; 1988.

 Peshev L. P. Kildyushnikov A. N. et al. On the substantiation of optimal regimes of helium-neon therapy in obstetric and gynecological practice. Obstetrics and gynecology. 1990, N 11.

 Rodkina R. A. Baranov V. N. Laser radiation in the complex treatment of female infertility of inflammatory etiology. Samara, 1992, 68 p.

In the proposed method of treatment, it turned out to be effective to irradiate a helium-neon laser with cyclic fluctuations in the density of the incident power in the range of 1 60 mW / cm ² . Moreover, the greatest anti-inflammatory, decongestant, analgesic effect was exerted by radiation exposure with a cyclic fluctuation in the density of incident power from 20 to 60 mW / cm ² and vice versa. A more pronounced absorbable effect was possessed by radiation with fluctuations in the density of the incident power from 1 to 10 mW / cm ²
The highest efficiency is irradiated with a frequency of fluctuations in the density of incident power in 1-2 Hz (1 Hz is one fluctuation in the density of incident power, for example, from 20 to 60 mW / cm ² and back to 20 mW / cm ² in one second). Irradiation carried out with vibration frequencies of less than 1 Hz and more than 2 Hz did not lead to such a quick relief of pain, softening of adhesions and restoration of patency of the fallopian tubes as with a frequency of 1 2 Hz. A high biostimulating effect is due to the fact that the frequency of fluctuations in the intensity of the laser beam at 1 2 Hz is resonant with the frequency of vibrations of the energy potential of the cells of the fallopian tubes. This leads to power pumping and excitation of the energy structures of the fallopian tubes, which contributes to the transition of the organ from a stationary state of pathology to a dynamic one, directed towards recovery.

For irradiation of impassable sections of the fallopian tubes, an exposure of 2–4 min was chosen. So, in case of obstruction of a single tube (for example, after an ectopic pregnancy), they are exposed to laser light for 2 minutes to obtain a radiation dose at an incident power density of 20-60 mW / cm ² 2.4-7.2 J / cm ² , and at an incident density power 1-10 mW / cm ² 0.1-1.2 J / cm ² . With occlusion of both fallopian tubes, the total exposure is 4 min (2 + 2 min), respectively, with a doubling of the radiation dose. Such exposure parameters are optimal for providing anti-inflammatory and absorbable effect on obstructed fallopian tubes.

 The connection of tube hydro-pumping to laser therapy enhances the destruction of in-tube adhesions by injected medicinal fluid.

 The method was tested on 43 patients with tubal infertility of inflammatory origin. Of these, in the main group receiving treatment by the proposed method was 15 people. in the control (prototype) 28 people. By the type of obstruction of the tubes, the patients were divided as follows (Table 1). The results of treatment are given in table. 2.

 As can be seen from the table. 2, restoration of tube patency occurred 1.5 times more often in patients of the main group.

 The duration of treatment to restore patency is shown in table. 3.

 As can be seen from the table. 3, the duration of treatment in patients of the main group is 2.5 times less than in patients in the control group.

 Pregnancy in patients with restored tubal patency occurred in the main group in 7 (77.9), and in the control group in 5 (45.4). Patients with unrestored tubal patency after 3 to 4 months were re-treated.

 Thus, the effectiveness of the treatment carried out by the proposed method is 1.5 times higher compared to the prototype method. At the same time, the course of treatment is reduced by 2.5 times.

 Consider the proposed method of treatment with examples.

 Example N 1. Extract from the medical history N 289.

 Patient D. 23 years old, was admitted to the office of laser therapy of the women's consultation N 3, Tyumen, 24.09. 1990 with complaints of infertility, pulling pains in the lower abdomen. Suffers infertility for 2.5 years after suffering a medical abortion in 1987, complicated by acute inflammation of the uterus and appendages. Exacerbation of chronic adnexitis occurs 1 2 times a year. The last exacerbation was 8 months ago. Menses from 12 years, 4 days, after 30 days. Settled throughout the year. The date of the last menstruation is September 17. 1990. Sexual life since 19 years. Married for 3 years. An objective examination shows that the woman is of the correct physique, satisfactory nutrition. The skin and mucous membranes are clean. From the cardiovascular, respiratory, urinary systems, pathology was not detected. The mammary glands are soft. Gynecological examination revealed that the external genitalia are formed correctly, the mucous membranes of the vulva and vagina are pink in color. Discharges milky, moderate. The cervix is cylindrical, clean. The body of the uterus is medium in size in anteflexio verzio painless on palpation. The appendages on the left are enlarged slightly painful, on the right, extended, sensitive. Vaults and parametries are free. General blood test data from 09/20/1990: hemoglobin - 130 g / l; red blood cells 4.2 million; color score 1.0; white blood cells 9.0 t. E-1, P-4, S-60, L-30, M-5; ESR-20 mm • h. General urine analysis data from 09.20.1990: straw-yellow color, specific gravity 1030, no protein, white blood cells 0-1 in p.z. squamous epithelium 2-4 in the pz The result of a vaginal smear from 09.20.1990 N. leukocyte urethra 1-4-6 in p.z. flat epithelium 2-3-4 in p.z. gram / - / sticks; cervix of leukocytes 2-7 in the pz flat epithelium up to 5 in p.z. gram / - / sticks, cocci. The result of histosalpingography from 12.9.1990: pipes are impassable in the ampullar sections, peritubular adhesions. Diagnosed with secondary infertility. Chronic adnexitis without exacerbation. Ampoule obstruction of pipes.

Treatment started in the first phase of the menstrual cycle. 09.24.1990, the first session of laser therapy. The ampullar sections of the fallopian tubes were alternately irradiated with a helium-neon laser for 2 min. The incident power density cyclically with a frequency of 1-2 Hz varied from 20 to 60 mW / cm ² and back to 20 mW / cm ² . The energy density varied accordingly in the range 2.4 - 7.2 J / cm ² . The woman tolerated the radiation session well. A short-term analgesic effect was achieved. 25.9. 26.9. 27.9. 28.9. 29.9. 1.10. laser therapy was performed in the above modes until the pain in the lower abdomen was permanently stopped. 2.10.1990, with a gynecological examination: the mucous membranes of the vagina and cervix are pink; discharge "milky", moderate; uterus of normal size, painless; appendages on the left painless, on the right sensitive to palpation; infiltrates, no severity. Diagnosis: secondary infertility. Chronic bilateral adnexitis without exacerbation. Ampoule obstruction of pipes. The patient was referred to the gynecological department of maternity hospital N 3 to continue treatment, including tubal tubal hydroboughening. 10/03/1990, the tubal tubing was hydrobottled with a solution of novocaine 0.5 to 10 ml, with kanamycin sulfate 0.5, lidase 64 units. The pressure of the treatment mixture was adjusted to 120 mm Hg. Art. The patient did not present complaints; she endured the procedure well. On October 4, 1990, the 8th laser therapy session was conducted with cyclically varying the density of incident power from 1 to 10 mW / cm ² and vice versa for 4 minutes (2 minutes per tube) with an energy density of 0.1 1.2 J / cm ² with a frequency of 1-2 Hz. There are no complaints. 5.10. a second tube hydroboughening procedure was performed. There are no complaints. 6.10. 9th session of laser therapy 8.10. third hydroboosion procedure. 9.10. 10th session of laser therapy. 10.10. fourth hydroboosing procedure. 11.10. 11th session of laser therapy. 12.10. Fifth hydroboosing procedure. 10/15. 12th session of laser therapy. The patient of the procedure tolerated well, pains in the lower abdomen did not resume. On October 16, 1990, in order to clarify the patency of the fallopian tubes, chromohydrotubation was performed by introducing into the uterine cavity and tubes 10 ml of a 0.04-mg indigo carmine solution. The urine sampled after 6 and 12 hours was colored blue, which indicated the restoration of tube passage. General blood test data from 10/11/1990% of red blood cells 4.4 million hemoglobin 135 g / l; c. p. 1.0; leukocytes 6.8 t. E-2; P-4; S-63; L-24; M-7; ESR - 10 mm • h. General urine analysis data from 10/11/1990: straw-yellow color; uv 1025; white blood cells 0-1 in pz squamous epithelium 0-1 in the pz The results of the vaginal smear from 10/11/1990: “U” -leukocytes are single in the pz. squamous epithelium 4-3-6 in p.z. gram / - / sticks, cocci. "sh" of leukocytes 0-1 in p.z. squamous epithelium 3-4-6 in p.z. gram / - / sticks, cocci. 10/15. the patient was discharged home. 9.4.1991 in the antenatal clinic N 2, Tyumen, a uterine pregnancy is determined in a period of 7 weeks. Taken to the dispensary registration for pregnancy. On 19.4.1991, in the maternity hospital No. 4 of Tyumen, childbirth occurred with a live full-term female fetus weighing 3100 g and a height of 50 cm. The postpartum period was uneventful.

 Example N 2. Extract from the medical history N 125.

 Patient N., 26 years old, was admitted to the office of laser therapy of the women's consultation No. 3 of the maternity hospital No. 3 of Tyumen on 12.4.1990 with complaints of a lack of pregnancy for 3 years, pain in the lower abdomen. In 1987, she underwent surgery for a left-sided ectopic pregnancy with removal of the left fallopian tube. For 5 years, suffers from chronic adnexitis. Repeatedly received anti-inflammatory therapy in outpatient settings. Last exacerbation 6 months ago. Menses from 14 years to 5-6 days. in 29 days established within six months. Date of last menstruation 6.4.1990. Sexual life since 20 years in marriage. Second marriage in the last two years. Objective status. The constitution is normosthenic. The nutritional condition is satisfactory. The skin and mucous membranes are clean. On the part of organs and systems, there is no pathology. The mammary glands are soft. Gynecological status. The external genitalia are formed correctly. The mucous membranes of the external genitalia and vagina are pink in color. The cervix is cylindrical, clean. The uterus is medium-sized, dense, painless, in anteflexia-verse, somewhat shifted to the left. On the right, the fallopian tubes are sealed, shortened, slightly painful on palpation. Left pipes are not palpable. Vaults and parametries are free. Data from a general blood test dated 16.4.1990: hemoglobin 120 g / l, red blood cells 4.6 million cp 0.9, white blood cells - 6.0 t. E-1, p-1, S-60, L-29, M-9, ESR-14. The data of the general analysis of urine dated 16.4.1990, the color is straw yellow, at. in. 1025, no protein, white blood cells 0-1 in p.z. Vaginal smear from 04.16.1990: "at" white blood cells 0-1 in p.z. squamous epithelium 5-6-6 in p.z. grams / - / sticks: / w / white blood cells 3-5-8 in p.z. squamous epithelium 4-6-8 in the pz gram / - / sticks. The result of hysterosalpingography from 03.3.1990, the right fallopian tube is impassable in the ampullar section. Diagnosis: secondary infertility. Chronic adnexitis without exacerbation. Ampoule obstruction of a single tube.

Treatment started in the first phase of the menstrual cycle. 12.4.90, the first session of laser therapy. For 2 min, the ampullar section of the right fallopian tube was irradiated with the incident beam power density cyclically changing at a frequency of 1 2 Hz from 20 to 60 mW / cm ² . The energy density, respectively, varied within 2.4 7.2 J / cm ² . 13.4. 14.4. 16.4. 17.4. 18.4. daily laser therapy sessions were conducted in the above mode. The patient tolerated the treatment sessions well, pains in the lower abdomen gradually stopped. Data from a vaginal examination dated 19.4.1990. The mucous vagina and cervix are of a normal color. Allocations "milk". The uterus is not enlarged, dense, painless in anteflexia-verse along the midline of the body. The right fallopian tube is softened painless on palpation. On the left, the tube is not palpable. The ovaries on both sides are not enlarged. Vaults and parametries are free. Diagnosis: Secondary infertility. Chronic adnexitis without exacerbation. Ampoule obstruction of a single tube. The woman was transferred to the gynecological department of the maternity hospital N 3 to continue laser therapy in combination with tubal tubing. 04/19/1990, the first procedure was performed for hydro-pumping the fallopian tube under a pressure of 120 mm Hg. treatment mixture consisting of 8 ml of 0.5 novocaine solution. 0.5 g of kanamycin sulfate, 64 units of lidase. The woman did not make complaints. On April 20, 1990, the 7th laser therapy session was conducted with cyclic fluctuation of the incident power density from 1 to 10 mW / cm ² (energy density 0.1-1.2 J / cm ² ) for 2 minutes with a frequency of 1-2 Hz. No complaints. 04/21/1990, the II procedure of hydro-pumping of the pipe was carried out, no complaints were made. 23.4.90 The 8th session of laser therapy in the same mode as the 7th session. On April 24, 1990, the III hydro-pumping procedure was performed as well as the II and III procedures. 25.4.90 9th session of laser therapy. 26.4.90. IV hydroboosing procedure. 27.4.90. 10th session of laser therapy. 28.4.90. V hydroboosing procedure. 30.4.90. conducted the 11th session of laser therapy. The woman did not make complaints. The patient was released home for two days. 3.5.90 g. Produced 10 ml of chromohydrotubation. 0.04 solution of indigo carmine. Urine turned blue when taken after 6 and 12 hours, which indicates the restoration of patency of the fallopian tube. General blood test data from 3.5.90 g. Hemoglobin 120 g / l; c.p. 1.0; red blood cells 4.3 million leukocytes 4.3 thousand E-4; P-2; S-46; L-40; M-8; ESR-4 mm h. General urine analysis data from 3.5.90 g. Color straw yellow; uv 1029; no protein; white blood cells 3 4 in p.z. The results of a vaginal smear from 3.5.90 g. "Y" of leukocytes 0-2-2 in p.z. ep pl. 0-1-1 in p.z. gram / - / sticks, cocci; "sh" of leukocytes 1-2-4 in pz ep pl. 1-3-5 p.z. gram / - / sticks, cocci. 4.5.90 the patient was discharged under the supervision of an infertility clinic at the women's consultation No. 3. On 8.9.90, a uterine pregnancy was diagnosed in a period of 6 weeks. Registered for pregnancy. On 24.4.1991, in the maternity hospital No. 1 of Tyumen, delivery took place with a living full-term male fetus weighing 3000 g and a height of 49 cm. The postpartum period was uneventful.

 Thus, the proposed method of treatment is highly effective and is indicated for the treatment of female tubal infertility of restorative origin in the infertility rooms of antenatal clinics, in specialized centers "family and marriage".

 The method is contraindicated in the period of exacerbation of chronic adnexitis and with generally accepted contraindications for the appointment of physical methods of treatment.

Claims (1)

A method for the treatment of tubal infertility of inflammatory origin by exposing the fallopian tubes to the fallopian tubes through the vaginal arches, characterized in that the impassable sections of the tubes are irradiated with aiming, cyclically varying the incident power density first from 20 to 60 mW / cm ² and vice versa for 2 to 4 minutes respectively, with an energy density of 2.4 7.2 J / cm ² with a cycle frequency of 1 2 Hz 5 7 sessions, then every other day with an incident power density of 1 to 10 mW / cm ² and vice versa with an energy density of 0.1 1.2 J / cm ² with the same frequency and August 6 sessions alternating gidrobuzhirovaniem with pipes under a pressure of 120 to 130 mm Hg novocaine, kanamycin, lidase, course 6 8 procedures.

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