RU2238098C2 - Method for treating chronic salpingooophoritis - Google Patents

Abstract

FIELD: medicine, gynecology.

SUBSTANCE: the present innovation deals with treating women with inflammatory diseases of internal reproductive organs. After the first balneoprocedure one should affect reflexogenic points with information-wave therapy from "Minitag" apparatus per 10 min daily, by changing the points for impact P12 and BM46 every other day, 10 procedures/course. Iodine-bromine balneotherapy as vaginal irrigations and common baths should be conducted either every other day or two days running at 1-d-long interval, 8 procedures/course. The method enables to shorten therapy terms and prolong remission due to activation of adaptive body capabilities, improved blood supply in pelvic organs, normalization for the values of cellular and humoral immunity and lipid peroxidation values.

EFFECT: higher efficiency of therapy.

1 ex, 6 tbl

Description

The invention relates to medicine, namely to gynecology, and can be used in medical practice in the treatment of women suffering from inflammatory diseases of the pelvic organs (VZOT).

According to modern concepts, VZOT combines inflammation of the uterus, its appendages (tubes and ovaries), pelvic fiber and peritoneum, as well as the nervous system. PIDs in women occur more often at a young age and in many cases acquire a severe or protracted course, as a result of which women often lose not only the ability to bear children, but also their ability to work. With the development of inflammation in the pelvis, the whole body of the woman suffers. First of all, the blood supply to the pelvic organs is disturbed, and vascular permeability increases. The initial signs of VZOT and the further course depend on the initial state of the organism, its protective and adaptive mechanisms and the ability to self-regulate. In recent years, a high frequency of asymptomatic and subclinical forms of the inflammatory process of the genital organs, which cause irreversible changes in the pelvis and disruption of the ovulation process, has been established. With a prolonged course and frequent relapses, the nervous, endocrine, vascular systems are gradually involved in the pathological process, and the disease becomes a polysystem process. Naturally, the successful treatment of such patients is achieved only by a complex and systemic effect on the whole organism. Despite certain successes achieved in the treatment of patients with VZOT, the effectiveness of therapy remains extremely low. In this regard, the development of new methods of healing this contingent of patients seems extremely relevant.

It is known the use of information-wave therapy from the apparatus "Minitag" to biologically active points (BAP) of general and local action in inflammatory diseases of the genitals [2]. However, when exposed to these points in some patients, local anti-inflammatory and absorbable effects were not expressed enough. The monograph does not provide data on the use of information-wave therapy directly on the organ-specific zones of the uterus and its appendages, and there is no data on a clinical examination of women with VZOT.

Closest to the proposed method is a method of treating inflammatory diseases of the internal genital organs by iodine-bromine balneotherapy in the form of vaginal irrigation and general baths, carried out every other day or two days in a row with a break [1].

The disadvantage of this method is that its use does not always give a good anti-inflammatory and absorbable effects.

The technical result of the invention is the creation of an effective comprehensive method for the treatment of inflammatory diseases of the pelvic organs in women, which will reduce treatment time and prolong remission by improving blood supply in the vascular basin of the pelvis, activating adaptive capabilities of the body, restoring the functional state of the immune and endocrine systems, peroxide lipid oxidation (lipid peroxidation) and antioxidant protection.

The specified technical result is achieved by the fact that after the first balneological procedure in the form of vaginal irrigation and general iodine-bromine baths, carried out every other day or two days in a row with a break day, information-wave therapy from the Minitag apparatus affects the reflexogenic points for 10 minutes daily, changing every other day, the exposure points of R-12 BM46, on a course of 10 procedures. Scheme vacation procedures are given in table 1.

The method is as follows.

From the third day from the patient’s admission for treatment, she is prescribed iodine-bromine balneotherapy in the form of vaginal irrigation and shared baths, and balneotherapy is carried out every other day or two days in a row with a break day: vaginal irrigation according to Yagunov or Morozov at a constant water temperature of 38-40 ° C, time exposure for 15 minutes; after 20 minutes of rest, the patient is given general iodine-bromine baths at a water temperature of 36-37 ° C, 10-15 minutes, for a course of 8 irrigation and 8 baths.

After the first balneological procedure, information-wave therapy from the Minitag apparatus is released daily:

- the mouthpiece of the installation is applied to the area of the skin point R-12 (da-he), 2-2.5 cm above the pubic joint, retreating 1.5-2 cm from the midline to the right; exposure time 10 min. Then the horn is transferred to a similar position on the left, exposure time 10 minutes. The total procedure time is 20 minutes;

- the next day, the mouthpiece of the installation is applied to the area of the point of the uterine appendages located 4-5 cm above the middle of the right inguinal ligament, approximately on the line separating the hypo- and mesogastria and the corresponding acupuncture extrameridian point VM-46; exposure time 10 min. Then the horn is transferred to a similar position on the left, exposure time 10 minutes. The total procedure time is 20 minutes.

The procedures are carried out daily, every other day changing the points of influence of P12 and BM46, for a course of 10 procedures. Scheme vacation procedures are shown in table 1.

Example: Patient K., 24 years old, was admitted to the clinic of the center on 03/27/02, was discharged on 04/20/2002.

From the anamnesis: From the age of 16, after the onset of sexual activity, pains in the lower abdomen, painful and irregular menstruation began to disturb (after 35-45 days). I didn’t go to the doctors. At 22, she applied for infertility in marriage. Examined, diagnosed with Chronic salpingoophoritis, menstrual irregularities of the type of opsomenorrhea. The last 2 years have been observed exacerbations of VZOT 2 times a year, treatment only in a hospital during exacerbations. Last exacerbation in October 2001

Upon admission to the clinic, the patient complained of periodic pain in the lower abdomen and lumbosacral region, irregular and painful menstruation, infertility.

The clinic was diagnosed with Chronic 2-sided salpingo-oophoritis (infiltrative-adhesive form) in the stage of unstable remission. Chronic perimetritis. Subfixed uterine bend. Violation of the menstrual cycle as opsomenorrhea. Primary infertility.

Blood test: hemoglobin - 120 g / l, red blood cells - 4.2 × l0 ¹² / l, color indicator - 0.86, white blood cells - 5.35 × 10 ⁹ / l, segmented neutrophils - 52%, stab - 2%, eosinophils - 2%, monocytes - 9%, lymphocytes - 35%, which corresponds to an inferior reaction of calm activation according to Garkavi.

Urinalysis is within normal limits.

Pelvic rheography. Ri - 0.17 cu, 1 / T - 18.3%.

Blood protein fractions: total protein - 88.2 g / l, globulins - 45.5 g / l, A / G - 1.20, alpha-1-globulins - 6.8%, alpha-2-globulins - 8, 7%, beta-globulins - 11.2%, gamma-globulins - 18.8%.

FLOOR: diene conjugates - 2.27 rel.ed., erythrocyte malondialdehyde (MDA) - 51.51 nmol / ml erythrocytes. mass, serum catalase - 32.5 μkat / l, ceruloplasmin (CP) - 0.236 g / l.

Immunogram: white blood cells - 5.0 × 10 ⁹ / l, lymphocytes - 39% - 1950 μl, monocytes - 11%, T-lymphocytes - 46% - 897.0 μl, B-lymphocytes - 20% - 390.0 μl, T-helpers - 21% - 409.5 μl, T-suppressors - 25% - 487.5 μl, TS - 0.84, PSA - negative, immunoglobulins: M - 1.36 g / l, A - 1, 84 g / l, G - 14.9 g / l.

According to the initial examination, a decrease in blood supply in the vascular basin of the pelvis, an inadequate reaction of calm activation, dysproteinemia, an increased content of alpha and gamma globulins, increased peroxidation processes and tension of the antioxidant defense function, relative lymphocytosis, and cellular immunity deficiency were revealed.

The patient was prescribed a course of treatment according to the proposed method (table 1). During treatment, the patient felt good, no complaints. By the middle of the treatment, pains in the lower abdomen have passed. At the end of treatment, the study of the genital organs was painless, no pastiness was noted, and uterine motility was restored. Menstruation came on the 34th day of the cycle, painless. According to the tests of functional diagnostics, insufficiency of the 1st and 2nd phases of the menstrual cycle was noted.

According to a gynecological examination, the diagnosis was made: Chronic bilateral salpingoophoritis. Menstrual irregularities. Hypofunction of the ovaries. Primary infertility.

Final survey data:

Complete blood count: hemoglobin increased slightly - 132.9 g / l, monocytes decreased to 7%, segmented to 48%, lymphocytes increased to 40%. Garkavi adaptation reaction - increased activation.

Urinalysis: no pathology.

Pelvic rheography - Ri - 0.19 cu, 1 / T - 15.9%.

Dysproteinemia decreased in blood serum - the A / G coefficient increased to 1.34. The level of alpha-1-globulins decreased to 5.2% and gamma globulins to 17.6%.

FLOOR: diene conjugates - 1.02 rel. Units, MDA - 47.83 nmol / ml erythrocytes, serum catalase - 29.9 μkat / l, CP - 0.317 g / l.

Immunogram: white blood cells 7.4 × 10 ⁹ / l, lymphocytes - 39% - 2886 μl, monocytes - 9.0%, T-lymphocytes - 51% - 1471.9 μl, B-lymphocytes - 30% - 8650.8 μl T-helpers - 27% - 776.2 μl, T-suppressors - 24% - 692.6 μl, TS - 1.125, immunoglobulins: M - 1.24 g / l, A - 1.84 g / l, G - 16.1%. According to the immunogram, a distinct positive dynamics was noted - humoral immunity was activated due to B-lymphocytes, immunoglobulins G, and cellular immunity was normalized.

Thus, after the treatment, an anti-inflammatory, analgesic effect was achieved, an improvement in the blood supply to the pelvic organs, a decrease in the activity of LPO and AOZ, and the immune status was normalized. The patient was discharged with significant improvement.

A total of 115 patients in two groups were examined and received treatment in the clinic of the center.

The first group - 32 women received treatment according to the proposed method (Table 1) - patients aged 20 to 38 years with chronic inflammation of the uterus and its appendages, the duration of the disease from 2 to 10 years and infertility in 91% of women.

The second group - 25 patients, received treatment according to the prototype by iodine-bromine balneotherapy in the form of vaginal irrigation at a water temperature of 38-40 ° C and common iodine-bromine baths with a temperature of 36-37 ° C, every other day or two days in a row with a break, for a course of 8 balneological procedures .

At the end of treatment, patients of both groups noted an improvement in their general condition. Pain in the lower abdomen and lumbosacral region disappeared in 80% of patients of the first group and in 65% of women of the second group. A decrease in pain during menstruation was observed in 72% of patients in the first group and in 58% in the second group. According to the vaginal examination, at the end of treatment, a more distinct positive dynamics was revealed in the group of patients who received IV therapy in combination with idobromic balneotherapy. The disappearance and softening of adhesions was recorded in 65% of women in the first group and in 45% of the second group. With the infiltrative-adhesive form of the inflammatory process, the complete disappearance of puffiness and pastiness in the area of the uterine appendages revealed 53% of women in the first group and in 22% of patients of the second group.

According to rheography of the small pelvis, the majority of patients showed a decrease in blood supply and vascular tone, difficulty in blood outflow. Under the influence of the treatment, an improvement in blood supply in the pelvic basin was noted, and more significant dynamics was achieved in patients who received iodine-bromine balneotherapy in combination with IWT (Table 2).

According to a study of total protein and protein fractions in the blood serum, dysproteinemia was noted due to an increase in globulins, alpha-1 and gamma-globulins, which indicates the presence of an inflammatory reaction and changes in proteolysis in these patients. At the end of treatment, more significant positive changes were achieved in patients receiving treatment according to the proposed method: the albumin-globulin coefficient increased from 1.14 ± 0.01 to 1.23 ± 0.03, p <0.01, and the alpha-1 content decreased -globulins from 6.3 ± 0.22% to 5.6 ± 0.12%, p <0.02 (prototype A / G from 1.12 ± 0.05 to 1.18 ± 0.04, alpha -1-globulins from 5.8 ± 0.21% to 5.9 ± 0.26%). The content of gamma globulins under the influence of various treatment complexes has not undergone significant changes.

Before treatment in patients of both groups, the initial period of peroxidation (LP), estimated by the level of diene conjugate, was more than doubled, and the final stage of lipid peroxidation (by the content of malonic aldehyde) also significantly exceeded the norm. The state of the antioxidant (AO) system was in a state of sharp tension - the activity of catalase was increased, and the content of ceruloplasmin was less than the lower limit of normal. Iodine-bromine balneotherapy even more stimulates the processes of lipid peroxidation and AO protection, and the inclusion of IWT in this balneological complex leads to a decrease in stress in these systems (Table 3).

In the course of the studies revealed a positive dynamics of adaptive blood reactions in both groups. However, in the first group there was an increase in the number of reactions of increased activation and a significant decrease in inferior reactions, and in the second group, an increase in the number of calm activation reactions and a slight decrease in the number of inferior reactions (Table 4). Moreover, the number of all reactions before treatment was approximately equal in both groups, but a marked increase in the body's resistance after treatment was achieved in the first group, and a decrease in inferior reactions indirectly indicates the normalization of the functioning of the endocrine glands when combined with the use of IV therapy and iodine-bromine balneotherapy.

The immune status of patients in the initial state was characterized by data indicating the presence of an inflammatory process - an increase in leukocytes, lymphocytes, and the absolute value of T and B lymphocytes. Under the influence of iodine-bromine balneotherapy, indicators of the immune status do not undergo significant changes. When information-wave therapy is included in the treatment complex, cellular and humoral immunity significantly increase: the content of class G immunoglobulins and lymphocytes increases due to T- and B-lymphocytes and T-helpers (Table 5).

Assessment of the effectiveness of treatment in percent was carried out according to the criteria developed and recommended by the Central Research Institute of KiR (Yu.E. Danilov, P.G. Tsarfis, 1973), and in points according to the criteria specified in the “Recommendations on the organization of the treatment process and assessment of the effectiveness of the sanatorium treatment of patients. ”, Sochi, 1989, p.40 and 41. Based on the analysis of the data obtained, the treatment efficiency in the first group is higher than in the second group (Table 6).

Assessment of the effectiveness of treatment in percent was carried out according to the criteria developed and recommended by the Central Research Institute of KiR (Yu.E. Danilov, P.G. Tsarfis, 1973) and in points, according to the criteria specified in the “Recommendations on the organization of the treatment process and the evaluation of the effectiveness of the sanatorium treatment of patients. ”, Sochi, 1989, p.40 and 41. Based on the analysis of the data obtained, the treatment efficiency in the first group is higher than in the second group (Table 6).

Thus, the use of a comprehensive spa method, including hydrogen sulfide balneotherapy with IV therapy, in the treatment of women with chronic salpingo-oophoritis can reduce treatment time to 14 days, achieve a significant anti-inflammatory and analgesic effect, improve blood supply to the pelvic organs, and increase non-specific resistance of the body, normalization of indicators of cellular and humoral immunity and indicators of LPO and AO protection.

Sources of information

1. Strugatsky V.M. Treatment with physical factors in obstetrics and genicology. - 1978. - 183 p.

2. Bessonov A.E., Kalmykova A.E. and others. Information-wave therapy. - 1999. - 592 p.

Claims (1)

A method for the treatment of chronic salpingo-oophoritis, including iodine-bromine balneotherapy in the form of vaginal irrigation and shared baths, a course of 8 procedures, performed every other day or two days in a row with a break day, and exposure to paired reflexogenic points of local action, characterized in that the information-wave effect therapy from the Minitag apparatus for 10 minutes daily to reflexogenic points after the first balneotherapy procedure, changing the exposure points P 12 and BM 46 every other day, for a course of 10 procedures.