RU2231374C1 - Method for postoperational rehabilitation in patients with tuboovarian neoplasms - Google Patents

Abstract

FIELD: medicine, rehabilitation.

SUBSTANCE: on the 2^nd d after surgical interference one should prescribe combined microwave therapy intravaginally at the power of 15 W, duration of 10 min and in 4 h percutaneously onto hypogastric area at the power of 20 W, duration of 10 min, at 8 seances/course every 24 h.

EFFECT: higher efficiency of postoperational rehabilitation.

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Description

The invention relates to medicine and relates to methods for postoperative rehabilitation of patients with tubo-ovarian formations.

Known methods of rehabilitation of patients with tubo-ovarian formations in the postoperative period, including the appointment of physiotherapeutic procedures that improve the regeneration and repair processes in the field of surgical intervention [1, 2, 3]. The disadvantages of these methods are low efficiency, poor tolerance of procedures and a large number of side effects.

The closest clinical effect (prototype) is the method of rehabilitation of patients with tubo-ovarian formations, including the appointment of electrophoresis according to the abdominal-sacral technique (anode above the pubis, cathode on the sacrum) and microclyster with dry brine [4].

However, the use of this complex method is associated with the occurrence of complications: allergic reactions, short-term arterial hypotension, hot flashes and reflex tachycardia. In addition, a sufficiently long course of treatment is required - 15 procedures.

The problem solved by the invention is the elimination of the disadvantages of the prototype, the reduction of side effects, which leads to an increase in the effectiveness of treatment and a reduction in the length of stay of the patient in the bed due to the property of microwave therapy to influence the cytokine profile and metabolic activity of neutrophils.

This object is achieved by the fact that according to the method of postoperative rehabilitation of patients with tubo-ovarian formations, pharmacotherapy in combination with physiotherapy in the form of 8 combined sessions of microwave therapy intravaginally with a power of 15 W, lasting 10 minutes and after 4 hours on the hypo-gastric is prescribed after the postoperative rehabilitation of patients with tubo-ovarian formations area of 20 watts, lasting 10 minutes every 24 hours.

These distinguishing features are unknown in the medical, scientific and patent literature. Thus, the proposed method meets the criteria of the invention of “novelty”.

The combination of distinctive features does not follow explicitly for a specialist from the prior art. Thus, the proposed method meets the criterion of "inventive step".

Clinical trials of the method of postoperative rehabilitation of patients with tubo-ovarian formations prove that combined microwave therapy can be successfully used in clinical gynecology as a method that stimulates regenerative and reparative processes in the field of surgical intervention in the form of intravaginal exposure, followed by, after 4 hours, external irradiation of the hypogastric region 2, 3, 4, 5, 6, 7, 8, and 9 days after surgery. Thus, the proposed method meets the criteria of the invention “industrially applicable”.

The method is as follows. Immediately after surgery, the patient is prescribed traditional drug therapy (antibiotics, infusion, antihistamine therapy). 24 hours after the operation, procedures are beginning to rehabilitate patients with tubo-ovarian formations, including microwave therapy (ultra-high frequency electromagnetic field in the decimeter range) using a cavity emitter in the morning and after 4 hours external irradiation of the hypogastric region. To obtain microwaves, you can use a portable device of the type “Runet DMV 20-1” with an operating frequency of 460 MHz and a maximum output power of 25 watts. For skin application to the hypogastric region, a contact technique is used, in which a cylindrical microwave emitter with a diameter of 100 mm is located in the lower abdomen, directly above the pubic joint. The irradiation mode is low thermal at an output power of 20 watts. Duration of exposure is 10 minutes. For intravaginal exposure, an intracavitary emitter with a replaceable protective cap is used. The irradiation mode is low thermal at an output power of 15 watts. Duration of exposure is 10 minutes. The procedures are carried out daily for 8 days. It is shown that the combined use of intravaginal and cutaneous exposure to microwave therapy in the early postoperative period in patients with purulent tubo-ovarian formations significantly contributes to an increase in the effectiveness of postoperative rehabilitation and increases the frequency of reproductive function recovery. The use of microwave therapy in the postoperative period in patients with purulent tubo-ovarian formations is accompanied by the fast dynamics of normalization of biochemical markers of acute inflammation, the metabolic activity of leukocytes and the content of pro-inflammatory cytokines in the blood serum, cervical canal and endometrium.

The properties of microwave therapy to influence the cytokine profile and metabolic activity of neutrophils in the postoperative period and, thus, lead to the rehabilitation of menstrual and reproductive functions, are not described in the literature [5, 6, 7, 8].

Justification of the regime. The mode of application of the physiotherapeutic technique is based on clinical observation data for the period from 1996 to 2002. Weak-thermal irradiation at an output power of 20 W for external irradiation and 15 W for intravaginal exposure is sufficient for a phased effect on the area of surgical intervention in order to improve blood flow, reduce swelling of tissues, and eliminate symptoms of inflammation by reducing the activity of inflammatory mediators (cytokines). An interval of 24 hours is optimal for procedures, since a shorter interval between sessions can cause a pronounced balneoreaction and, as a result, pain and hyperthermia syndromes, and lengthening the interval will lead to insufficient effect. The multiplicity of procedures is 8 times due to the need to completely eliminate the inflammatory manifestations of the underlying disease and the reaction to surgery to prevent adhesions, chronic pelvic pain syndrome and relapse of the disease and confirmed by clinical observations. Namely, the appointment of fewer procedures did not give a clinical effect, the use of more procedures is impractical. The technique of the procedures (a combination of cutaneous and intravaginal irradiation) allows you to enhance the effect of microwaves on the surgical area and reduce the severity of balneoreaction.

Microwave therapy is characterized by a large (8-9 cm) penetration depth into the tissues. The specificity of the action of microwaves is due to the selective absorption of their energy by the molecular structures of cells with the formation of endogenous heat in the tissues. This leads to an increase in blood flow due to vasodilation, increased capillary pressure and vascular permeability, improved metabolic processes, as well as reparative regeneration. Microwave therapy has a pronounced analgesic effect, it is used in the treatment of duodenal ulcer, in the rehabilitation treatment of cardiovascular diseases, to reduce the icteric phase of viral hepatitis, with the aim of immunomodulation in rheumatoid arthritis [9, 10, 11, 12].

The use of microwaves for the purpose of postoperative rehabilitation of patients with tubo-ovarian formations became possible due to the results obtained in a clinical trial. A survey of 3 groups of women. The total number of examined was 88 people.

The first group is the main group, it included 36 women who underwent complex drug treatment using combined microwave therapy in the postoperative period (intravaginal treatment using a 15 W cavity emitter for 10 minutes in the morning and after 4 hours, cutaneous irradiation of the hypogastric region for 10 20 W minutes). The course dose is 8 treatments.

The second group is the comparison group, it included 32 women who underwent standard drug therapy in the postoperative period without using physical factors.

The third group is the control, it included 20 clinically healthy non-pregnant women of childbearing age.

The study was carried out according to the following parameters:

1. General analysis of blood counting the number of leukocytes (according to E.A. Kost, 1975).

2. The erythrocyte sedimentation rate (according to Panchenkov, 1972).

3. The concentration in the peripheral blood of C-reactive protein and ceruloplasmin (photometric immunoturbodimetric quantitative method).

4. The content of sialic acids in blood plasma (quantitative photometric method).

5. The level of fibrinogen (colorimetry).

6. Determination of the content in the blood serum, cervical canal and endometrium of TNF-α, IL-β and IL-6 (enzyme-linked immunosorbent assay using horseradish peroxidase as an indicator enzyme).

7. Phagocytic activity of neutrophils (according to V. M. Berman, E. M. Slavskoy, 1958).

8. Metabolic characteristics of leukocytes (HCT test, chemiluminescence method).

9. Ultrasound examination of the pelvic organs (apparatus "Acuson-128 XP / 10" using transvaginal and abdominal sensors in real time).

10. After 18 months, the incidence of chronic inflammatory diseases of the pelvic organs, pelvic pain syndrome, menstrual irregularities, and pregnancy were assessed.

All women of the main group received physiotherapy as part of a comprehensive treatment (antibiotic therapy, infusion therapy, non-steroidal anti-inflammatory drugs) as postoperative rehabilitation. Microwave therapy was carried out by combining intravaginal exposure with a cavity emitter and external irradiation of the hypogastric region. To obtain electromagnetic waves, the Ranet DMV 20-1 portable apparatus with an operating frequency of 460 MHz and a maximum output power of 25 W was used. For intravaginal exposure, a cavity vaginal emitter with a replaceable protective cap was used. During the procedure, the emitter with a sterile protective cap was lubricated with glycerin and inserted into the vagina. The mode of exposure is low thermal at an output power of 15 watts. Duration of exposure is 10 minutes. For skin application to the hypogastric region, a contact technique was used, in which a radiator with a diameter of 100 mm was located in the lower abdomen directly above the pubic joint. The mode of exposure is low thermal at an output power of 20 watts. Duration of exposure is 10 minutes. The combination of vaginal and external exposure with microwaves was carried out in the following order — intravaginal and in the morning after 4 hours cutaneous exposure was performed. The procedures were performed daily, the first procedure was carried out 24 hours after surgical treatment. The total number of combined sessions is 8.

The study revealed a sufficiently pronounced anti-inflammatory effect of microwaves on the area of surgical intervention as one of the most important elements of postoperative rehabilitation. An earlier disappearance of the clinical manifestations of inflammation and a reduction in hospital stay can be attributed to an improvement in blood supply and a decrease in the level of inflammatory mediators in the pelvic organs (table 1).

During clinical observation, there was a significant decrease in the amount of sialic acids, fibrinogen and ceruloplasmin in the peripheral blood in the dynamics of the postoperative period (table 2) and the level of pro-inflammatory cytokines in the blood serum (table 3) in patients of the main group. There were no significant differences in the pathological symptom complex (table 4) before surgery and in the age of the patients (table 5).

Specific examples confirming the rehabilitative effect of microwave thearpy in the postoperative period.

Clinical example 1.

Patient K., 29 years old. Diagnosis: Acute salpingitis. Tubo-ovarian formation on the right. 08.09.00 surgical treatment. When examined one day after the operation, the body temperature was 37.3 ° C, leukocytosis 9.8 G / l, CRP content 42.5 mg / l, ESR 31 mm / h. The contents of sialic acids, fibrinogen, and ceruloplasmin in this period were 9.5 mmol / L, 14.3 mmol / L, and 12.3 mmol / L, respectively. High concentration of TNF-alpha, IL-1 beta and IL-6 in blood serum was noted (500, 230 and 35 pg / ml, respectively). In the postoperative period, in addition to drug therapy (cephalosporins, infusion media, non-steroidal anti-inflammatory drugs, vitamins, antiplatelet agents, antihistamines), after 24 hours, a physiotherapeutic effect was started using a combined cutaneous (20 W power) and intravaginal (15 W power) microwave radiation. In the dynamics of therapy, the clinical manifestations of inflammation rapidly disappeared. Normalization of body temperature was observed on the 2nd day, the total leukocyte count did not differ from the norm on the 5th day of the postoperative period. On day 5, the level of CRP and ESR were 15 mg / l and 22 mm / h, respectively. The levels of sialic acids, fibrinogen, and ceruloplasmin decreased by 7 days of the postoperative period to 3.7, 8.1, and 2.3 mmol / L, respectively. The level of pro-inflammatory cytokines at 7 days did not differ from normal values, amounting to 75, 40 and 5 pg / ml for TNF-alpha, IL-1 beta and IL-6, respectively. When a vaginal examination on the 5th day of the postoperative period, moderate pain was noted in the area of surgical intervention, while other pathological symptoms were not detected. Sutures on the skin of the anterior abdominal wall were removed on day 8, healing by primary intention. Discharged under the supervision of a doctor of antenatal clinics on the 9th day after the operation.

When assessing the long-term results of treatment after 18 months, the woman does not show active complaints. Within 8 months after surgical treatment she was protected from pregnancy with the help of OK, after the abolition of which she had a pregnancy, which ended in an urgent delivery on 02.21.2002.

Clinical example 2.

Patient G., 25 years old. Was admitted to the gynecology department of the Central Clinical Hospital of Surgut on 09/11/1999. Diagnosis: Chronic salpingitis in the acute stage. Tubo-ovarian formation on the right. Surgical treatment was performed - right-sided adnexectomy.

24 hours after surgery, in addition to drug therapy (aminoglycosides, infusion media, non-steroidal anti-inflammatory drugs, antiplatelet agents, antihistamines), microwave exposure was initiated according to our methodology by combining external exposure to the hypogastric region (20 W power) and intravaginal (15 W power) using a cavity emitter.

A day after the operation, a decrease in body temperature to 37.5 ° C was noted, the intensity of peritoneal phenomena significantly decreased. The total leukocyte count in peripheral blood 24 hours after surgery was 9.6 G / L, CRP 32.8 mg / L, ESR 31.8 mm / h. Analysis of the results of biochemical studies showed that a day after surgery, the content of sialic acids, ceruloplasmin and fibrinogen in the patient's blood serum was higher in comparison with normal values (9.3, 14.4 and 12.9 mmol / l, respectively). When assessing the blood serum content of a patient with TNF-alpha, IL1-beta and IL-6 one day after surgical treatment, a significant increase in the level of all three studied cytokines was noted relative to normal values (800, 340 and 65 pg / ml, respectively). In the study of phagocytosis indicators, it was found that the patient a day after surgical treatment, the number of active neutrophils was increased to 92%. The absorption capacity of neutrophils and the rate of completion of phagocytosis was significantly lower than normal (2.1 mic. Tel / cell and 28.3%, respectively).

On the 5th day from the start of the postoperative period, the patient did not complain. With external palpation of the abdomen, pain was not noted. During vaginal examination, moderate painful sensations remained in the area of surgical intervention and with cervical displacement. In the dynamics of complex treatment using microwaves, the patient showed a rapid decrease in CRP and ESR, which on the 7th day of the postoperative period amounted to 8.3 mg / l and 19 mm / h, respectively. On the 7th day of therapy, the level of sialic acids, fibrinogen, and ceruloplasmin was 3.8, 8.3, and 3.2 mmol / L, respectively. The concentration of pro-inflammatory cytokines in serum on the 7th day of treatment was 110, 70 and 10 pg / ml, respectively.

In the course of complex therapy using microwave radiation, the normalization of all studied indicators of the phagocytic activity of neutrophils began by the 7th day of the postoperative period.

Sutures were removed on day 8, healing by first intention. In satisfactory condition was discharged from the hospital.

After 18 months, the long-term results of therapy using microwave radiation were evaluated. A woman is at the dispensary for chronic salpingitis, exacerbations of which have not been observed over the past period of time. The woman was not protected from pregnancy, which despite an active sex life did not occur. Three months ago, a laparoscopic examination was performed that revealed obstruction of the remaining fallopian tube. Preparing for in vitro fertilization.

Thus, the results obtained allow us to conclude that microwaves have the ability to stimulate reparative and regenerative processes in women with tubo-ovarian formations in the postoperative period. This effect is realized through the restoration of the quantitative characteristics of blood leukocytes, the normalization of the concentration of C-reactive protein and other acute phase parameters in the blood serum, and the reduction of pro-inflammatory cytokines. A positive effect is achieved due to the proposed optimal regimen and method of physiotherapy (microwaves intravaginally and to the lower abdomen).

Thus, the use of the proposed method in clinical practice for postoperative rehabilitation of patients with tubo-ovarian formations made it possible to achieve a new technical result by means of a specific original microwave prescribing scheme, namely reducing side effects (adhesions, pelvic pain syndrome, menstrual dysfunction, infertility) and increasing efficiency treatment.

Sources of information

1. Korolev Yu.N., Giniyatulina N.S., Popov V.I. Changes in intracellular regeneration, indicators of endocrine function and microcirculation of the heart under the influence of decimeter wavelengths // Vopr. balneology, physiotherapy and exercise therapy. - 1993. - N 5. - S. 4-9.

2. Sidorov V.D., Bogolyubov V.M. et al. Effect of the electric field of UHF of bitemporal and decimetric waves on the spleen region in the complex therapy of patients with rheumatoid arthritis // Vopr. balneology, physiotherapy and exercise therapy. - 1993. - N 3. - S. 1-8.

3. Makhmutkhodjaev A.Sh. Metabolic features of the functional status of neutrophils in patients with acute salpingo-oophoritis in the dynamics of laser therapy / Diss. Cand. honey. sciences. - Tomsk. - 1997 .-- 176 p.

4. Ayusheeva T.D. Electrophoresis and microclysters of solutions of “dry” brine in the complex treatment of patients with chronic salpingo-oophoritis / Diss. Cand. honey. sciences. - Odessa. - 1991 .-- 143 p.

5. Ishenko A. I., Schukina N. A. Postoperative intracavitary laser therapy in the treatment of patients with tubal infertility // Actual issues of laser medicine: Abstract. Reports of the I All-Russian Conference. - M. - 1991. - S. 96-97.

6. Korolev Yu.N., Frenkel I.T., Zagorskaya N.E. Biological effect and therapeutic use of physical factors. - M. - 1981. - S. 17-20.

7. Strelkova N.I., Musaev A.V. Journal of Neuropathology and Psychiatry. - 1986. - N 4. - S. 491-495.

8. Strizhakov A.N., Podzolkova N.M. Purulent inflammatory diseases of the uterus. - M.: Medicine. - 1996 .-- 250 s.

9. Buyanova S. N., Kashina E. A., Schukina N. A. Conservative-surgical approach to the treatment of purulent tubo-ovarian formations in women of reproductive age // Proceedings of the 1st North Caucasus, Congress of Obstetricians and Gynecologists. - 1994 .-- S. 89-90.

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12. Leshchinsky A.F., Eater B.C. Comprehensive use of drugs, physical and therapeutic factors for various pathologies. - Kiev. - 1989. - 175 p.

Claims (1)

A method of postoperative rehabilitation of patients with tubo-ovarian formations, consisting in the appointment of pharmacotherapy in combination with physiotherapy, characterized in that on the 2nd day after surgery, combined microwave therapy is prescribed intravaginally with a power of 15 W, lasting 10 minutes and after 4 hours, cutaneous on the hypogastric region with a power 20 watts, lasting 10 minutes, for a course of 8 sessions, every 24 hours

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