RU2188681C1 - Method for treating genital endometriosis - Google Patents

Abstract

FIELD: medicine, gynecology. SUBSTANCE: at the background of medicinal therapy one should conduct intravascular blood irradiation with He-Ne laser for 20-30 min. Laser radiation power does nor exceed 1 mW at 0.63 mcm wave length. Moreover, 60 min before laser impact it is necessary to introduce an ozonized physiological solution. Concentration of dissolved ozone corresponds to 1-2 mg/l. Therapy is conducted daily once/d at one and the same period of time. Treatment course consists of 7-10 seances. The method enables to increase and prolong curative effect of conservative therapy in women of reproductive age. EFFECT: higher efficiency.

Description

 The invention relates to medicine, namely to the therapeutic treatment of gynecological diseases, and is intended to increase the effectiveness of conservative rehabilitation measures in patients with genital endometriosis (HE).

A known method of laser intravascular therapy of HE by percutaneous exposure to a neon beam (wavelength 632.8 nm with a dose of 12-47 J / cm ² ) on the projection of blood vessels for 8-10 days [1].

 However, with the transdermal effect of the laser on the blood in the blood vessel, the reflective abilities of biological tissues must be taken into account. It is known that the skin of humans and animals reflects 30-40% of the total fraction of helium-neon laser radiation incident on its surface. Some authors have established that the penetration depth of the radiation of a helium-neon laser does not exceed several millimeters [4,5]. In this regard, transdermal irradiation of blood is ineffective both for achieving any significant systemic changes in the body, and, therefore, in the treatment of endometriosis, in the pathogenesis of which shifts in the systems of immune and endocrine homeostasis, as well as the antioxidant potential of the body, are important ( Baskakov V.P., 1999).

A known method of treating endometriosis, combining transdermal laser irradiation with an intravascular helium-neon laser (wavelength 632.8 nm with a dose of 15 J / cm ² ) with betacarotene (Caroline) at 40-45 mg / day for 14 days [2 ].

 The disadvantage of this method can also be considered the transdermal effect of the laser beam on the blood, which requires longer courses of therapy and delays treatment, especially in inpatients, and there is no indication in the method description of a systematic approach to treating HE (Baskakov V.P., 1999) .

 The closest technical solution to the claimed invention is a method of rehabilitation of patients with internal endometriosis using laser radiation [3] (Obstetrics and gynecology, 1996, 2, p. 39-43). This method uses a combined laser effect (local and intravenous) on the body of patients operated on for internal endometriosis in the amount of supravaginal amputation or hysterectomy to activate the immune response in patients weakened by surgical stress. Intravenous laser blood irradiation (VLOK) was performed using the ATOLL helium-neon therapeutic apparatus daily for 7-10 days, starting from the 1st day of the postoperative period, with radiation power of 3-5 mW, exposure time of 20-30 minutes.

 However, in this method, laser therapy was carried out in patients deprived of a childbearing organ, with the aim of rehabilitation in the postoperative period, to prevent possible complications in patients who will never again face the issue of childbirth. In addition, patients with internal endometriosis (localization of HE in the uterus) were treated and approaches to laser treatment of patients with external or combined forms of HE (damage to the ovaries, fallopian tubes, rectovaginal fiber, Douglas space peritoneum, etc.) were not considered.

 The purpose of the invention is to increase the effectiveness of conservative treatment of HE in young patients with infertility, severe pain, menstrual dysfunction, asthenovegetative syndrome.

 This goal is achieved by the fact that after verifying the diagnosis and prescribing adequate hormonal therapy (norkolut, danazol, zoladex, etc.), antioxidants in patients with HE, infusion of ozonized physiological solution (OGF) was carried out with a concentration of dissolved ozone of 1-2 mg / l for 7 -10 days (for patients undergoing laparoscopy - from the first day of the postoperative period). Ozonation of physiological saline was carried out in standard 400 ml vials with the help of the domestic installation "MedOzon 806-MP" for 1-2 minutes at a given oxygen flow. FGM was administered intravenously in a dose of 400 ml 1 time per day at the same time. After 60 min after the end of the infusion of FGD (at the same time), intravenous laser blood irradiation (VLOK) was performed in order to mutually enhance and extend the therapeutic effect of both factors.

 VLOK was carried out as follows.

 Patients were placed on a couch in front of a laser unit. To summarize the beam, one-time optical fibers were used, which were inserted through the needle into the ulnar vein. A portable Mulat helium-neon laser apparatus of Tekhnika LLP company was used as a laser radiation source, generating laser radiation in the red spectrum with a wavelength of 0.63 μm and a power at the end of the fiber of not more than 1 mW. The course of treatment consisted of 7-10 procedures lasting 20 minutes, the first two, and the subsequent 30 minutes.

 60% of patients treated by our method required no more than 2 rehabilitation courses to achieve a lasting therapeutic effect (pain, cystalgia disappeared, health improved, sleep was restored, etc.). For 12.5% of patients, more than 2 courses of treatment were required with intervals between courses of 6–9 months, but radical surgery was also avoided in this group and the reproductive function was preserved in almost all patients.

 Example. Patient D., 28 years old, and / b 2143/5.

 DS: External and internal endometriosis.

 Upon admission - complaints of constant pain in the lower abdomen and lower back, acyclic bleeding, low-grade fever, cystalgia, insomnia. Pregnancy-1; Abortion-1; Rodov-0.

 From the anamnesis: a half-year ago a medical abortion was performed, after which pains in the lower abdomen began to increase, hiterthermia, violation of the menstrual cycle appeared. I went to the doctor only 2 months after the disease. Repeated courses of anti-inflammatory therapy did not bring relief. Cystalgia joined.

 During vaginal examination, the uterus is enlarged in the anteroposterior size, soft texture, sharply painful on palpation and displacement. Appendages on both sides are not clearly defined, pronouncedly painful on palpation, the arches on both sides are somewhat flattened. When viewed in the mirrors, hyperemia of the vaginal mucosa and cervix attracts attention. The discharge is scarce, bloody.

 Analysis of smears: white blood cells - up to 20 in the field of view, bacillary microflora, pathological microorganisms were not detected.

 Crops of urine and discharge from the uterine cavity are sterile.

 Ultrasound scanning of the genitals: the uterus is slightly larger than normal, M-ECHO 9 mm, myometrium of the cellular structure. The right ovary with a fluid inclusion of 2x2.5 cm, the left - with small follicles.

 In the study of immunological parameters in a patient found leukopenia, a decrease in the activity of T-lymphocytes, their number, an increase in the number of circulating immune complexes. In addition, in the study of LPO, its significant increase was noted.

 To clarify the diagnosis, hysteroscopy and laparoscopy were performed. When examining the uterine cavity, many endometrioid passages were found along the front and rear walls. When examining the pelvic cavity - a small amount of serous effusion, hyperemia of the sacro-uterine ligaments and Douglas space, endometrioid heterotopia in the same areas, ovaries on both sides are cystically altered 2x2.5 cm on both sides.

 A biopsy of the ovaries, coagulation of the endometrioid foci, and sanitation of the abdominal cavity with a concentration of ozone with an ozone concentration of 2-4 mg / L were performed.

 Drainage was left in the small pelvis, according to which the ODF of the same concentration was injected for 3 days.

 At the end of laparoscopy, the internal administration of OGF with an ozone concentration of 1-2 mg / l was started, followed by 60 minutes after the end of the infusion, VLOK for 20 min, a wavelength of a helium-neon laser of 0.63 μm, with a power of 1 mW at the end of the fiber. The course of treatment was 10 intravenous administration of OFR and VLOK. In addition, the patient was prescribed treatment: danogen 400 mg per day, intravenous sodium thiosulfate, pulsed magnetic therapy on the genital area.

 After two courses of therapy, the patient's condition improved significantly, persistent amenorrhea occurred, pain intensity decreased, sleep normalized, immune status was corrected, and LPO activity decreased. Against the background of general treatment, the patient received one course of radon baths.

 To consolidate the effect, after 1.5 years from the start of therapy, the patient underwent another course of VLOK and ozone therapy. Within six months before that, she had not taken hormonal drugs, pain regressed, menstrual function has not yet recovered.

 In vaginal examination: the uterus is normal in size, mobile, painless on palpation; appendages on both sides are not determined, painless; the vaginal arches are deep, loose. The discharge is scarce.

 Ultrasound scan: uterus of normal size, M-ECHO 4 mm, heterogeneous myometrium. The ovaries are not enlarged, with small follicles, 4-5 mm in diameter.

SOURCES OF INFORMATION TAKEN INTO ACCOUNT WHEN DRAWING IN THE APPLICATION
1. The journal "Obstetrics and Gynecology", 1989, 4. S. 43-45.

 2. Copyright certificate 2108757, cl. A 61 B 17/42, A 61 N 5/06, A 61 K 31/07.

 3. The journal "Obstetrics and Gynecology", 1996, 2, p. 39-43.

 4. Materials of the international congress "Laser and Health-99". Moscow, December 8-10, 1999

 5. Korepanov V.I. Polyzonal laser therapy technique: Pr. hand-in. M., 1995.

 6. The journal "Obstetrics and Gynecology", 1997, 6, p. 57-60.

 7. Korotkikh I.N., Khodasevich E.V. Modern technologies in the complex treatment of genital endometriosis. Sat scientific proceedings, ded. in memory of Professor A.I. Matsueva. "Scientists in Health Care of the 21st Century." Voronezh, 2000, p. 55-56.

Claims (1)

 A method for the treatment of genital endometriosis, including drug therapy, intravascular irradiation of blood with a helium-neon laser with a wavelength of 0.63 μm for 20-30 minutes, characterized in that the laser radiation power used does not exceed 1 mW and 60 minutes before laser exposure to blood intravenous administration of ozonized physiological solution with a concentration of dissolved ozone of 1-2 mg / l is carried out daily, once a day, at the same time, a course of 7-10 sessions.