RU2253491C1 - Method for treating chronic salpingo-oophoritis - Google Patents

Abstract

FIELD: medicine, non operative gynecology.

SUBSTANCE: the present innovation deals with treating and preventing exacerbations of chronic salpingo-oophoritis. At the background of antibacterial therapy one should conduct low-frequency (26.5 kHz) ultrasound sanitation of vulva and vagina twice by changing the solution through ozonized physiological solution at 3-5 mg/l at amplitude of fluctuations of emitting edge of wave-guide being 50-60 mcm at distance against sonicated surface of 5-10 mm at constant mode of sonication being 1-2 sec/sq. cm for 30-80 sec and vaginal exposure of solution being 8-10 min. Then one should heat the skin of anterior abdominal wall in projection of right-hand adnexa at 55-60 C for 90-180 sec. Heated surface should be cooled up to 25-30 C for 30-45 sec through a napkin impregnated with ozonized physiological solution followed by ultrasound phonophoresis at the above-mentioned modes for 30-45 sec. The whole procedure should be repeated from the left side, then, on the 5^th d after sonication with ozonized physiological solution one should sonicate vagina with lactobacterin solution in physiological solution. All the above-mentioned physiological procedures should be repeated daily 8-12 times at 10-d-long course of therapy. The method enables to prolong remission period, decrease the frequency of relapses, quickly interrupt pain syndrome and normalize vaginal flora.

EFFECT: higher efficiency of therapy.

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Description

The invention relates to medicine, in particular to non-surgical gynecology, and may find application for the treatment and prevention of exacerbations of chronic salpingo-oophoritis.

The most widely known method of treating chronic salpingoophoritis is the use of paraenteric antibiotic therapy [1].

The disadvantages of this method are the need to use large doses of drugs to create a therapeutic concentration in the focus of inflammation; the formation of cross-resistance of pathogens to antibacterial drugs, allergization, toxic effects on the kidneys, liver, gastrointestinal tract, intestinal dysbiosis, vaginal candidiasis, which is difficult to recover from the use of antibacterial drugs.

Another well-known method combines antibacterial therapy with physiotherapy with an alternating magnetic field [2].

The disadvantages of the method are not always expressed the effectiveness of the treatment, as it does not ensure the penetration of drugs into the deeper layers of biological tissues; the complexity of the methodological execution of procedures and applied specialized equipment.

Closest to the proposed method is a method of treating salpingoophoritis by combining antibiotic therapy with intravenous ozone therapy [3]. The course of treatment consists of 5 procedures for intravenous administration of an ozonated 1200 mcg / l solution against 7 days of antibacterial therapy.

The disadvantages of the method are the relatively high frequency of relapses and short periods of remission, the duration of the relief of pain.

The objective of the invention is a method of treating salpingo-oophoritis, which allows to reduce the number of relapses and lengthen periods of remission, to quickly stop the pain syndrome.

The problem is solved by the method consisting in the fact that against the background of antibiotic therapy, low-frequency 26.5 kHz ultrasound sanitation of the vulva and vagina is carried out twice with a solution through an ozonated 3-5 mg / l saline solution with an oscillation amplitude of the radiating end of the waveguide of 50-60 microns distance from the voiced surface is 5-10 mm with a continuous voicing mode of 1-2 sec / cm ² for 30-80 sec and the exposure of the solution to the vagina for 8-10 min, then the skin of the anterior abdominal wall in the projection of the right appendages is heated at a temperature of 55-6 0 ° C for 90-180 sec, then the heated surface through a napkin moistened with ozonized saline solution, cooled to a temperature of 25-30 ° C for 30-45 sec and ultrasonic phonophoresis is carried out at the above modes for 30-45 sec, the whole procedure repeat on the left side, then from the fifth day after voicing with ozonized saline, the vagina is voiced with a solution of lactobacterin in saline and all of the listed physical procedures are repeated 8-12 times daily with a ten-day course.

In practice, the method is as follows. A method of treating salpingo-oophoritis is a multi-stage biomedical technology, which consists of two main stages, which are carried out both in outpatient and inpatient settings using, for example, the Prolong-Gineton-O3 device complex.

STAGE 1: carried out using the apparatus "GINETON-O3”.

In the position of the patient on the gynecological chair, sanitation of the vulva is carried out using a special limiter. Under the influence of low-frequency ultrasound through an intermediate ozonated saline solution with an ozone concentration of 3-5 mg / l for 30-60 s. Then, a perforated extender-limiter is introduced into the vaginal cavity, the vagina is filled with ozonized physiological solution, a waveguide tool with a radiating end beveled at a 45-degree angle is passed through the limiter, the vagina is voiced twice with a change of solution for 30-80 seconds with a frequency of ultrasonic vibrations of 26, 5 kHz; the oscillation amplitude of the radiating end of the waveguide tool is 50-60 microns; the distance from the radiating end of the waveguide of the instrument to the voiced surface is 5-10 mm; exposure of ultrasonic exposure - 1-2 s / cm ² voiced surface. Starting with the fifth procedure, biocorrection of the vaginal microflora is carried out by ultrasonic impregnation of 5 doses of lactobacterin, dissolved in 60 ml of physiological sodium chloride solution, into the vaginal mucosa, for 30-60 s at the parameters and modes given above. The exposure of the spent solution to the vagina is 8-10 minutes (during the entire second stage).

STAGE 2: carried out using the apparatus "PROLONG".

The skin of the anterior abdominal wall at the projection points of the uterine appendages (or in the area of greatest pain) is heated using a heat chamber to a temperature of 55-60 ° C for 90-180 s until developed hyperemia or sweating from the skin surface occurs. Then, on a heated surface of the skin, a gauze pad soaked with ozonized physiological saline solution is laid, a cooling chamber is installed on it and the temperature is maintained at 25-30 ° C for 30-45 s. Then, an ultrasound head is installed on the gauze pad and, by circular or reciprocating movements, a contact action is performed by low-frequency ultrasound (NchUZ phonophoresis) for 30-45 seconds. The total duration of the procedure is 10-15 minutes.

Clinical example. Patient B., 19 years old, turned to the clinic of obstetrics and gynecology with a diagnosis of chronic bilateral sluggish salpingoophoritis. Upon admission, she complained of periodic pulling pain in the lower abdomen, itching, burning, hyperemia of the vaginal mucosa, copious discharge from the genital tract with an unpleasant odor.

Menarche from the age of 14. There is a violation of the menstrual cycle as oligomenorrhea with menarche. Menstruation is moderate, painless. Sexual life since 16 years. A history of 2 pregnancies, both ended with an artificial abortion at the request of a woman (curettage). The last abortion in 2001 was complicated by acute bilateral salpingo-oophoritis and endometritis, after which a comprehensive paraenteric antibiotic therapy was carried out under stationary conditions. Within 2 years, he noted regular exacerbations of salpingo-oophoritis in combination with cystitis (up to 8 times a year). During the illness, 5 courses of antibacterial therapy, 2 hospitalizations were carried out. Inoculation on the vaginal flora revealed gardanerella in titer 10 (6), candida 10 (5), lactobacillus 10 (4). Urogenital urellazmosis was detected in titer 10 (3).

From the day of treatment (the fifth day of the menstrual cycle), the patient was prescribed oral antibacterial therapy taking into account the sensitivity of the pathogen. The patient received Unidox-solutab for 7 days at 200 mg / day. Against the background of antibiotic therapy, a course of treatment was carried out using the “Prolong-Gineton-O3” hardware complex. In the position of the patient, a low-frequency 26.5 kHz ultrasonic sanitation of the vulva was performed through an ozonated 3-5 mg / l saline solution with an oscillation amplitude of the emitting end of the waveguide of 50-60 μm, the distance from the voiced surface of 5-10 mm with a continuous sounding mode of 1-2 sec / cm ² for 60 sec using a special limiter for sanitation of the perineum. Then, a perforated dilator-limiter was introduced into the vaginal cavity, the vagina was filled with ozonized physiological saline, a waveguide tool with a radiating end beveled at a 45-degree angle was passed through the limiter, and the vagina was voiced for 60 s. The spent solution containing a large number of secretions was removed, then the vagina was re-filled with ozonized physiological saline and voiced for 80 seconds at the parameters and modes given above. The expander limiter from the vagina was not removed. The exposure of the solution to the vagina was 10 minutes At this time, using the PROLONG apparatus, a heating chamber was installed on the skin of the anterior abdominal wall in the projection of the uterus on the right and the skin was heated to a temperature of 60 ° C for 120 s until developed hyperemia or sweating from the skin surface occurred. Then, a gauze pad impregnated with ozonized physiological saline was placed on the heated surface of the skin, a cooling chamber was installed on it, and the temperature was kept at 30 ° C for 45 s. Then, an ultrasound head was mounted on the gauze pad and, by circular and reciprocal movements, contact action was performed by low-frequency ultrasound for 45 seconds. The procedure was repeated on the left side. Then, the expander-limiter was removed from the vagina. Starting from the fifth procedure, after the inflammatory phenomena subsided and the pathological discharge stopped, the patient underwent biocorrection of the vaginal microflora by ultrasonic impregnation of 5 doses (1 ampoule) of lyophilized lactobacterin dissolved in 60 ml of physiological solution into the vaginal mucosa during 60 sec The procedures were carried out immediately after ultrasonic sanitation of the vagina with ozonized saline. 6 procedures were performed to restore the vaginal flora.

The total duration of the procedure was 15 minutes. The procedures were carried out daily for 10 days. No side effects noted. After the second procedure, the symptoms of colpitis in the patient were not observed. After the third procedure, the patient stopped complaining of pain in the lower abdomen. Observation of the patient was carried out for 18 months. No recurrence of salpingoophoritis, cystitis, and colpitis was noted during this time. The patient did not notice pain in the lower abdomen. Inoculation of flora from the vagina immediately after and after 3, 6 and 18 months after treatment of pathological flora was not detected. Lactobacillus in titer 10 (7). In a smear on the flora from the vagina and cervical canal, 2-3 leukocytes were detected in the field of view.

This method was used to treat 60 patients with chronic salpingo-oophoritis. For comparison, we used a group of 60 people who received complex paraenteric antibacterial therapy in combination with physiotherapy using an alternating magnetic field. Examination of patients with chronic salpingo-oophoritis included: microbiological and bacteriological examination of the contents of the vagina and cervical canal, determination of pathogens of sexually transmitted diseases in the contents of the cervical canal by the cultural method, study of the acid-base state of the blood, immunological examination.

Upon treatment, all patients complained of periodic pulling pain in the lower abdomen, itching, burning in the genital area, copious discharge from the genital tract with an unpleasant odor. The duration of the disease ranged from 1 to 24 years. The rate of recurrence ranged from once a month to 2 times a year. With the same frequency, exacerbations of cystitis occurred in 25% of patients. When a vaginal examination was noted sensitivity, heaviness, swelling of the appendages, 52% of patients went to the clinic with severe pain. Against the background of treatment according to the proposed method, after the second or third procedure, all patients had a pain syndrome stopped, the phenomena of colpitis disappeared. In the control group, patients complained of pain in the lower abdomen until 7-8 days of antibiotic therapy.

In the main group of patients, all had restored vaginal flora / lactobacillus in a titer of 10 (7-8) /, in no case was candidiasis detected. In the control group, lactobacilli were detected in the diagnostic titer only in 45% of patients, candidiasis was detected in 24%. In the patients of the main group, the best indicators of the immunogram and acid-base balance were determined in comparison with the control group. Relapses were noted in the main group in 3 (5%) patients, in the comparison group - in 8 (14%). There were no complications during treatment. The follow-up period was 18 months.

Thus, the use of the proposed method of antibiotic therapy and ozone-ultrasonic sanitation of the vulva and vagina in combination with thermocontrast and low-frequency ultrasound exposure to the skin of the anterior abdominal wall at the projection points of the uterine appendages allows, in comparison with the prototype method, to prolong the remission period in patients with chronic salpingo-oophoritis, to prevent relapse, quickly stop the pain, normalize the vaginal flora.

LIST OF REFERENCES

1. Zanko S.N., Kosinets A.N., Sprun L.Ya. Chronic inflammatory diseases of the uterus. Vitebsk, 1998, 168 p.

2. Grigoriev VN, Pedder VV, Borodin Yu.I. The rationale for a new non-invasive method of drug administration at the level of the prelimphatic link. Biomedical technology and instrumentation. Sat scientific works - Vol. No. 5, Omsk, 1996, - 124 p.

3. Shakhova N.M. The use of medical ozone in the complex treatment of the acute course of inflammatory diseases of the internal genital organs of women. Abstract. diss. honey. sciences. - Ivanovo, 1996, - 17 p.

Claims (1)

A method for the treatment of salpingo-oophoritis, including antibacterial and ozone therapy, characterized in that, against the background of antibiotic therapy, a low-frequency 26.5 kHz ultrasound sanitation of the vulva and vagina through ozonated 3-5 mg / l saline solution with an oscillation amplitude of the radiating end of the waveguide of 50-60 is performed twice with a solution change μm, the distance from the voiced surface of 5-10 mm with a continuous mode of sounding of 1-2 s / cm ² for 30-80 s and the exposure of the solution to the vagina for 8-10 minutes, then the skin of the anterior abdominal wall in the projection of the right appendages tissue is heated at a temperature of 55-60 ° C for 90-180 s, the heated surface through a napkin moistened with ozonized saline solution is cooled to a temperature of 25-30 ° C for 30-45 s and ultrasonic phonophoresis is performed under the above conditions for 30- 45 s, the whole procedure is repeated on the left side, on the fifth day after voicing with ozonized saline, the vagina is voiced with a solution of lactobacterin in saline and all of the listed physical procedures are repeated 8-12 times daily with a 10-day course.