RU2238687C1 - Method for preventing for commissure process progress in small pelvis and ovario-menstrual cycle disorders in women subjected to endoscopic operations on ovary using electrocoagulation - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method involves administering remedy containing Diquertin and ascorbic acid taken in 1:2.5 proportion in selected mode on the background of basic antibacterial and anti-inflammation therapy in postoperative period.

EFFECT: enhanced effectiveness of treatment.

2 tbl

Description

The invention relates to medicine, specifically to gynecology, and relates to methods for preventing the development of adhesions in the pelvis and disorders of the ovarian-menstrual cycle (CMC) in women undergoing endoscopic surgery on the ovaries using electrocoagulation.

It was established that after laparoscopic operations on the ovaries, adhesions are formed in 55-90% of cases [1, 2, 3]. Adhesion is the main reason for the formation of tubal-peritoneal infertility (72%) [4, 5, 6]. High frequency electric current has a damaging effect on the follicular apparatus of the ovary, which entails menstrual irregularities in the postoperative period, and makes it difficult to restore the reproductive function of the female body [7, 8].

Known methods for preventing the development of adhesions in the pelvis, which include the use of anti-inflammatory drugs, anticoagulants, biogenic and proteolytic enzyme preparations, fibrinolytic drugs, isoniazid, sulfadimezin, physical therapy procedures, absorbable barriers, liquid barrier solutions, mechanical removal of exudate from the 9 abdominal cavity 10].

As a prototype for preventing the development of adhesions in the small pelvis for a positive effect, we have chosen the method [11], which consists in the appointment of verapamil calcium channel blocker against the background of basic therapy in the postoperative period. This method was used by the authors after endoscopic operations for ovarian cysts and is quite effective. However, due to the possibility of developing side effects, such as nausea, vomiting, dizziness, allergic reactions, as well as the presence of contraindications (hypotonic conditions, pregnancy), the use of this drug is limited and cannot be used in a certain category of patients. In addition, this method does not include the normalization of CMC in the postoperative period.

As a prototype for the prevention of CMC disorders for a positive effect, we have chosen a method [12], which consists in the appointment of Wobenzym, a derivative of interferon viferon, and novinet contraceptive in the postoperative period against the background of basic therapy. With this method, CMC normalization is observed in 93.4 ± 3.1% of cases. However, the presence of a number of contraindications to the use of drugs and the high cost of rehabilitation measures do not allow recommending this method of prevention in a wide outpatient network. In addition, this method does not affect the formation of postoperative adhesions, and their development can significantly reduce the effect of treatment in the long term after surgery.

Thus, the prevention of adhesions in the pelvis and CMC disorders in the postoperative period is an urgent task.

The problem solved by this invention is to reduce the risk of side effects and expand the scope of the method in women after endoscopic surgery on the ovaries using electrocoagulation.

The problem is solved by the method of preventing the development of adhesions in the pelvis and disorders of the CMC by prescribing funds containing dikvertin and ascorbic acid, with a ratio of components 1: 2.5, within 4-5 days before surgery and within 10-12 days after surgery against the background of basic antibacterial and anti-inflammatory therapy, 2 tablets 3 times a day, in a daily dose of 120 mg of dikvertin and 300 mg of ascorbic acid.

New in the invention is that. that in order to prevent the development of the adhesive process in the pelvis and disorders of the CMC, a drug containing dicvertin and ascorbic acid is prescribed with a ratio of components of 1: 2.5, for 4-5 days before surgery and within 10-12 days after surgery 2 tablets 3 times a day in a daily dose of 120 mg of dikvertin and 300 mg of ascorbic acid.

In the literature analyzed by the authors, this combination of distinctive features was not found. Thus, the method for preventing the development of the adhesive process in the pelvis and disorders of the ovarian-menstrual cycle meets the criteria of the invention of “novelty”.

In the scientific medical and patent literature analyzed by the authors, no information was found on the use of a drug with the ability to simultaneously prevent the development of adhesions in the pelvis and violation of the CMC in women who underwent endoscopic surgery on the ovaries using electrocoagulation. There is no information on the use of an agent containing dicvertin and ascorbic acid to prevent the development of adhesions in low gas and violations of the CMC. It is known to use an agent containing dikvertin and ascorbic acid with a component ratio of 1: 2.5 as a hemorheological agent [13] and a fortifying agent that positively affects the antioxidant status of the body and exerts a capillary-strengthening effect, registered as a biologically active food supplement “Antioxidant” [ 14].

This set of distinctive features does not follow for a specialist from the prior art. Thus, this meets the criteria of the invention of “inventive step”.

This method has passed a clinical trial and can be used in clinical practice. Thus, it meets the criteria of the invention “industrially applicable”.

The method is as follows. The patient additionally 4-5 days before surgery and within 10-12 days after surgery on the background of basic antibacterial and anti-inflammatory therapy prescribed a drug containing dikvertin and ascorbic acid with a ratio of components of 1: 2.5, 2 tablets 3 times a day daily dose of 120 mg of dikvertin and 300 mg of ascorbic acid.

Indications for using this method: endoscopic surgery on the ovaries:

- cystectomy;

- paraovariectomy;

- electrocoagulation of the ovaries;

- ovariolysis.

Specific examples of the method for preventing the development of adhesions in the pelvis and disorders of the CMC in women after endoscopic surgery on the ovaries using electrocoagulation.

Example 1

Extract from the medical history No. 4020/859. Patient Z. va T.O., 24 years old. Was admitted to the gynecological clinic of the SSMU on September 6, 2002 with a diagnosis of a cyst of the right ovary with hemorrhage. Abdominal syndrome.

Upon admission, she complained of pain in the lower abdomen more on the right, of medium intensity, aching in nature. She fell ill acutely, on the 14th day of the menstrual cycle, when, against the background of full health, pain appeared in the lower abdomen. I took painkillers on my own - analgin for 3 days. Due to the lack of effect from treatment, an increase in pain, she turned to the gynecological clinic of SSMU.

Objectively: general state of moderate severity. The skin is of normal color, moist. The tongue at the root is covered with a light coating. Body temperature 36.8 C, blood pressure 100/60 mm Hg

The vesicular breathing, no wheezing. Heart sounds are clear, rhythmic, heart rate - 90 beats per minute. The lower edge of the liver along the edge of the costal arch, painless on palpation. The abdomen of the correct form, participates in the act of breathing, with superficial palpation is soft, painful in the right hypogastric region. Symptoms of peritoneal irritation are negative.

Menarche at age 14, menstruation after 28 days, 4-5 days. moderate, painless. Sexual life since 17 years, barrier contraception. Pregnancy -3 (1998, 1999, 2000), ended with honey. abortion in the period of 5-6 weeks, without complications. Gynecological diseases denied. Currently planning a pregnancy.

Genital status on the 18th day of the menstrual cycle: the external genitalia are developed correctly, hair growth is of a female type, the vagina is narrow, nulliparous. In the mirrors: the cervix is clean. The uterus is in the correct position, not enlarged, pear-shaped, mobile, with a stiff consistency, painful with traction behind the neck. On the right is a palpable elastic formation 5 cm in diameter, with fuzzy contours, painful. Palpation of the left appendages is painless. Posterior palpation is moderately painful. White, mucous.

Complete blood count: Нb - 120 g / l, red blood cells 4.2 × 10 ¹² / l, white blood cells 8.4 × 10 ⁹ / l, ESR 18 mm / h. Segmented white blood cells 65%, stab 4%, eosinophils 2%, lymphocytes 20%. monocytes 9%. Coagulation analysis: PTI 84%, APTT 35 s, total fibrinogen 3.5 g / l, fibrinogen B negative. RFMC = 3.5 × 10 ^-2 . General urine analysis - b / o. The purity of the vaginal contents is II.

When ultrasound scanning of the genitals: the uterus is 55 × 43 × 49 mm in size, the structure is homogeneous, the contours are clear. M echo = 3.2 mm. The left ovary is not visible. In the right ovary, the cystic formation is 45 × 54 mm in diameter with a clearly defined capsule and the presence of echopositive signals. Liquid in the back arch in a small amount.

From September 6, 2002 (4 days before the operation), the patient was prescribed an agent containing dikvertin and ascorbic acid with a component ratio of 1: 2.5, 2 tablets 3 times a day for 4 days in a daily dose of 120 mg of dikvertin and 300 mg of ascorbic acid .

After appropriate preparation, September 10, 2002, an operation was performed - laparoscopy. When examining the pelvic organs: the uterus is 5 × 4 × 5 cm, visually unchanged, mobile. Left ovary 2 × 3 × 2 cm, typical structure. The fallopian tubes are 10 cm long, pink, fimbriae are pronounced. A cyst of the right ovary 4 × 5 cm with a thin smooth capsule is visualized. Adhesive process is absent. In a small pelvis, free fluid is approximately 10-15 ml. Performed right-sided cystectomy, chromohydrotubation (pipes are passable).

In the postoperative period, basic antibacterial and anti-inflammatory therapy was prescribed: penicillin 500,000 units intramuscularly 4 times a day, metronidazole 0.25 3 times a day, analgin 50% - 2 ml intramuscularly, diphenhydramine 1% - 1 ml intramuscularly, glucose 5% - 200 ml intravenously. Against the background of basic therapy, continued administration of an agent containing dikvertin and ascorbic acid, with a component ratio of 1: 2.5, 2 tablets 3 times a day for 10 days after surgery in a daily dose of 120 mg of dikvertin and 300 mg of ascorbic acid.

The postoperative period was uneventful. Body temperature returned to normal at the end of 1 day after surgery. Restoration of bowel function by the end of 1 day after surgery. Subjectively, the patient notes the disappearance of pain on the 3rd day after surgery. In objective status on the 5th day after the operation: satisfactory condition, natural integument, moderate humidity, tongue at the root covered with a light coating, body temperature 36.7 ° C, pulse - 72 per minute, blood pressure - 110/65 mm Hg Heart sounds are clear, rhythmic, heart rate -72 beats per minute. The vesicular breathing, no wheezing. The abdomen on palpation is soft, painless. Sutures removed, healing by first intention. Genital status: the uterus is in the correct position, not enlarged, pear-shaped, mobile, with a tight-elastic consistency, painless on palpation. On the right, moderate pain on palpation of the appendages. Palpation of the left appendages is painless. The posterior vault is painless on palpation. White, mucous.

When examining after a course of treatment, the patient does not show complaints. No changes were detected in the somatic and gynecological status. General clinical tests are within normal limits. Echoscopy revealed no pathology. The woman was discharged on the 6th day after the operation in satisfactory condition.

After 1 month, the woman was called for a checkup. No complaints. Menstruation has come on time. There are no deviations in the somatic and gynecological status. In connection with pregnancy planning, she was examined using functional diagnostic tests (TFD), the levels of FSH, LH and progesterone were determined (on the 22-24th day of the menstrual cycle). No changes found. Pregnancy occurred 2 months after the examination.

Clinical testing of an agent containing dicvertin and ascorbic acid with a component ratio of 1: 2.5 was preceded by an experimental justification of the developed method for preventing the development of adhesions in the pelvis and disorders of the CMC in the postoperative period.

The experiment was performed on 120 white mongrel female rats. The main group of animals (n = 45) performed monopolar coagulation of the ovaries at 4 points symmetrically, excluding the gate area, to a depth of 1.5-2 mm along the needle electrode limiter, 60 W power (SRCh-350 Electropulse apparatus, g. Tomsk, registration number 42 / 99-1038-1411, certificate of conformity No.ROSS RU. ME 41.B 02148). For 5 days, once daily, animals orally received a drug containing dikvertin and ascorbic acid at a component ratio of 1: 2.5, at a dose of 20 mg / kg of dikvertin and 50 mg / kg of ascorbic acid in 1% starch mucus, the first injection of the drug was carried out 2 days before surgery. In the comparison group (n = 60), only a similar surgical intervention was performed. Animals were removed from the experiment at different times of the experiment by decapitation under ether anesthesia. The severity of the adhesion process was evaluated according to the classification of Balatsenko D.N. (1956) and the scale of grading Mynbaev OA (1992). The ovaries and oviducts taken for the study were fixed in Carnoy fluid, 12% neutral formalin. Morphological and functional studies of the obtained material were performed using traditional histological, neurohistological and histochemical methods. Hormonal status was evaluated by colpositological picture. A morphological analysis of the generative apparatus of the ovaries and the study of interstitial relationships of the main structural and tissue elements of the ovary were performed. The data obtained were processed statistically.

The results of the study of animals of the comparison group indicate the presence of a pronounced common adhesive process in the abdominal cavity of the II-IV degree of severity. From the 3rd day of the postoperative period, an extensive area of perifocal aseptic inflammation with severe hemodynamic disturbances has been formed in the ovaries around the lesion zone. By the 15th day of observation, against the background of a change in hemodynamics, an increase in atretic processes and a decrease in the specific volume of growing follicles were expressed. By the 30th day, changes are characterized by the presence of an adhesion process in the abdominal cavity of experimental animals, a violation of parenchymal-stromal interactions in the direction of amplification of the latter. The development of these changes against the background of hemodynamic disturbances probably indicates a slowdown in reparative processes, pathological regeneration, and depletion of the compensatory capacities of the ovary [15, 16]. The colpocytological picture indicates lengthening of the diestrus [17]. Prescribing to animals an agent containing dicvertin and ascorbic acid with a component ratio of 1: 2.5 helps to reduce the severity of postoperative adhesions, normalize hemodynamic disturbances in the ovaries, and reduces atrethic processes in the ovaries. The dynamics of the colpocytological picture corresponds to that in intact animals.

The study of the mechanisms of the pharmacological action of an agent containing dicvertin and ascorbic acid in a ratio of components of 1: 2.5 indicates that the use of this agent meets the principles of pathogenetic therapy.

33 women aged 20 to 34 years were examined and treated in the gynecological clinic of the Siberian State Medical University, who underwent laparoscopy after appropriate preparation - cystectomy, piraovariectomy, ovarian electrocoagulation, ovariosalpingolysis (Table 1). Patients did not have a history of infertility.

The main group consisted of 16 women who received a drug containing dikvertin and ascorbic acid with a ratio of components of 1: 2.5, within 4-5 days before surgery and within 10-12 days after surgery against a background of basic antibacterial and anti-inflammatory therapy, 2 tablets 3 times a day in a daily dose of 120 mg of dikvertin and 300 mg of ascorbic acid. The control group consisted of 17 women who were not prescribed this drug.

The examination of women was carried out during treatment, 1, 2 and 4 months after the operation and included the study of complaints, medical history, gynecological examination, ultrasound of the pelvic organs, assessment of CMC by TFD determination of the levels of FSH, LH and progesterone (neither 22-24- day of the menstrual cycle), computer kimopertubation 1 month after surgery on days 9-11 of the menstrual cycle using the diagnostic complex DLTB-01.

In all women in both groups, the fallopian tubes were passable, but the indicators characterizing the condition of the fallopian-tubal and isthmic-ampullary departments, as well as the criteria reflecting the contractile activity of the fallopian tubes in the main group and the comparison group, were significantly different. In the main group, the corresponding indicators do not significantly differ from the control (Table 2).

Deviations from healthy women according to computer kimopertubation to one degree or another were expressed in all 17 women of the comparison group (100%) and in 13 women of the main group (76.9%).

When analyzing the hormone content 1-2 months after the operation, the comparison group was significantly lower (p <0.05) than in the patients of the main group, the progesterone content on the 22-24th day of the menstrual cycle was 16.80 ± 1.15 ng / ml and 22.57 ± 2.83 ng / ml, respectively. We have not revealed significant changes in the content of FSH and LH in the blood in both groups.

In the comparison group, 6 patients underwent repeated laparoscopy, the indications for which were primary and secondary infertility in combination with pelvic pain syndrome. The severity of the adhesive process was evaluated on a scale of the American Society for Fertility (1988). It was found that after laparoscopic ovarian surgery using electrocoagulation, an adhesion process in the pelvis takes place in all 6 women, with II and III degree of the process predominating (14.32 ± 0.32 points). In the main group, only 3 patients underwent laparoscopy, the indications were tubal pregnancy, hemorrhage in the corpus luteum cyst, and ovarian apoplexy. Adhesion process in all patients corresponded to I degree (4.32 ± 0.24 points).

The direct correlation between the data of computer kimopertubation and the severity of the adhesions in the pelvis during repeated laparoscopy in women of the comparison group is obvious. The absence of significant changes in computer kimopertubation in women of the main group indirectly reflects a less pronounced adhesion process in the small pelvis.

The obtained results confirm the high therapeutic effect when using this method for the prevention of the development of adhesions in the pelvis and disorders of the CMC in women who underwent endoscopic surgery on the ovaries using electrocoagulation.

It was found that the agent containing dicvertin and ascorbic acid in a ratio of components of 1: 2.5 prevents the development of adhesions in the pelvis and CMC disorders in women who underwent endoscopic surgery on the ovaries using electrocoagulation.

In addition to the above, in patients who included a remedy containing dicvertin and ascorbic acid in a ratio of components of 1: 2.5 in the complex of rehabilitation measures, the postoperative period was characterized by an earlier relief of pain, normalization of body temperature, restoration of bowel and bladder function.

Of the 12 women in the main group who planned pregnancy, 4 months after laparoscopy, the onset of pregnancy was noted in 7 (58.3%) and they are currently registered in the dispensary. In the comparison group, the pregnancy rate was 25% (4 out of 16 who planned).

The therapeutic result of the developed method for the prevention of adhesions in the pelvis and CMC disorders according to a combination of objective, laboratory and additional research methods was rated as very good in 8 women (50%), good in 5 (31.3%) and satisfactory in 3 patients (18 , 7%).

Thus, the appointment of an agent containing dikvertin and ascorbic acid with a ratio of components of 1: 2.5, 2 tablets 3 times a day for 4-5 days before surgery and 2 tablets 3 times a day for 10-12 days after operations in a daily dose of 120 mg of dikvertin and 300 mg of ascorbic acid in combination with basic therapy in women who underwent endoscopic surgery on the ovaries using electrocoagulation, helps to reduce the frequency of the above pathology. Achieved positive preventive effect is stable and lasts for 4 months from the time of surgery.

Sources of information

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Claims (1)

A method for preventing the development of adhesions in the pelvis and disorders of the ovarian-menstrual cycle in women who underwent endoscopic ovarian surgery using electrocoagulation, including the appointment of basic antibacterial and anti-inflammatory therapy in the postoperative period, characterized in that they also prescribe an agent containing dikvertin and ascorbic acid with a ratio of components 1: 2.5 for 4-5 days before surgery and within 10-12 days after surgery 3 times a day in a daily dose of 120 mg divertin and 300 mg ascorbic acid.