RU2262929C1 - Method for treating patients with acute inflammatory diseases of uterine adnexa - Google Patents

Abstract

FIELD: medicine, gynecology.

SUBSTANCE: one should perform laparoscopy, drain purulent foci, remove destructive tissues and wash abdominal cavity with great amount of "Baliz-2" introduced into abdominal cavity by fractional portions per 1-1.5 l at exposure up to 3 min either once or up to three times. The method provides complex impact as antibacterial, antioxidant and immunocorrecting actions of the preparation in area of lesion and, thus, quick interruption of acute stage by preventing the development of adhesions and saving reproductive function in this category of patients.

EFFECT: higher efficiency of therapy.

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Description

The invention relates to medicine, in particular to gynecology. It can be used in the clinic for the treatment of patients with acute inflammatory diseases of the fallopian tubes and ovaries.

There is a method of treating patients with acute inflammation of the uterus by traditional antibacterial and detoxification therapy in combination with surgical intervention (Krasnopolsky V.I., Buyanova S.N., Schukina N.A. Purulent inflammatory diseases of the uterus appendages. - M .: Medpress, 1999).

The use of the endoscopic surgical method for the treatment of acute inflammatory diseases of the uterine appendages is known, which allows you to actively intervene during the pathological process, while performing organ-preserving operations - the most relevant for women of reproductive age, in combination with rehabilitation and drainage of the pelvic cavity (Savelyeva G.M., Fedorov I.V. Laparoscopy in gynecology. - M.: GEOTAR Medicine, 2000, p.218-228).

The disadvantage of this method is that during endoscopy, sanitation of the abdominal cavity (removal of pathological exudate, destructive tissue) is combined with washing the pelvis with several liters of fluid, for which sterile physiological saline is traditionally used, much less often furatsillin, which contribute only to mechanical leaching, followed by removal of the pathological exudate and do not have a therapeutic therapeutic effect.

The essence of the proposed method consists in the fact that patients with acute inflammatory diseases of the uterine appendages undergo laparoscopy with debridement and drainage of purulent foci, removal of destructive tissues and washing of the abdominal cavity, while washing the abdominal cavity with Baliz-2 preparation in 1-1.5 fractional portions. liter with an exposure of up to 3 minutes from one to three times.

The use of endoscopic sanitation of the abdominal cavity with Baliz-2 and the administration regimen provides faster clinical recovery and preservation of reproductive function, which is extremely important for women of the reproductive period. Sanitation of the abdominal cavity after eliminating the cause of pelvic peritonitis with Baliz-2, which has a powerful antibacterial, antistress and antioxidant effect, helps to more quickly cleanse purulent surfaces, stop the inflammatory process, heal and restore damaged tissues. One of the main components of Baliz-2 is comenic acid, which provides the antioxidant properties of the drug, which makes it most relevant for the treatment of inflammatory processes of the pelvic organs, taking into account the pathogenetic features of the development of an acute inflammatory reaction in the body.

The method is as follows: when performing endoscopic intervention in patients with acute inflammatory processes of the pelvic organs and inflammation of the peritoneum of the pelvis after active surgery and eliminating the cause of pelvic peritonitis in the form of opening and draining purulent foci (pyosalpinx), removing destructive tissues, fibrin plaque, pathological exudate is carried out fractional summing in the abdominal cavity of 1-1.5 liters of the drug Baliz-2 with an exposure of up to 3 minutes from one to three times with taking into account the severity and prevalence of the inflammatory process. If necessary, a repetition of abdominal sanitation by Balizom-2 is possible during dynamic laparoscopy.

Example 1

Patient P. 17 years. Case history No. 1358. Diagnosis at admission: "Acute bilateral salpingoophoritis. Pelvioperitonitis."

Was admitted to the hospital with complaints of intense aching pain in the lower abdomen, nausea, weakness, fever up to 39 ° C.

The onset of the disease is acute, during the last day, after the end of menstruation.

Upon receipt of the general condition of moderate severity, the skin is of normal color. HELL 115/70 mm RT. Art., pulse 96 in 1 minute, t - 39 ° C. The abdomen is involved in the act of breathing, on palpation it is soft, painful in the lower parts, positive symptoms of peritoneal irritation in hypogastrium. Stool, urination without features. With a vaginal examination, enlarged sharply painful appendages of the uterus on both sides are palpated.

Data from additional research methods.

1. Ultrasound examination according to the transvaginal technique: the uterine body is not enlarged 44 × 27 × 39 mm, the usual echostructure, M-echo 2 mm, corresponds to the first phase of the menstrual cycle. The ovary on the right is enlarged 56 × 26 mm, of a hypoechoic structure, with a fuzzy “blurred” contour, sharply painful during examination. The ovary on the left is also enlarged 42 × 24 mm, of a hypoechoic structure, with a fuzzy “blurred” contour, sharply painful during examination. Free fluid in the pelvis was not detected.

2. General blood test: Er. - 3.6 × 10 ¹² / l, Hb - 107 g / l, C.p. - 0.89, L - 24.6 × 10 ⁹ / L, E - 1%, P - 2%, C - 69%, Lf - 5%, M - 3%, ESR - 8 mm / h.

3. Blood test for the degree of endogenous intoxication: III degree.

The patient underwent antibacterial, detoxification and anti-inflammatory therapy for several hours, while fever, pain, symptoms of peritoneal irritation in the lower abdomen, leukocytosis persisted, which was an indication for endoscopic intervention.

Laparoscopy revealed purulent salpingitis, characterized by thickening, edema, hyperemia of the serous cover, purulent discharge from the ampullar sections of both fallopian tubes, oophoritis in the form of edema and hyperemia of the ovaries, pelvic peritonitis with pronounced vascular pattern and hyperemia of the pelvic peritoneum. The abdominal cavity was sanitized with Baliz-2, which was introduced into the abdominal cavity in fractional portions three times in a volume of 1.5 liters and was evacuated from the abdominal cavity after a 3-minute exposure. In the postoperative period, comprehensive anti-inflammatory, antibacterial, detoxification therapy was continued.

As a result, the pain syndrome stopped on the second day, the body temperature also returned to normal by the end of the second day, leukocytosis decreased to 12 × 10 ⁹ / L on the second day, to 8x10 ⁹ / L on the third day. The patient is active from the first day after the operation, sleep, appetite, physiological administration are not disturbed. Discharged from the hospital on the 5th day in satisfactory condition. At discharge, an ultrasound examination of the pelvic organs was performed - pathological changes in the internal genitalia were not detected.

Example 2

Patient G. 35 years. Case history No. 2227. Diagnosis at admission: "Acute bilateral salpingitis. Pelviperitonitis."

She was admitted to the gynecological department No. 4 of the KBSMP in Smolensk in a moderate state with frogs for pain throughout the abdomen, nausea, general weakness, dizziness. She got sick the night before after hypothermia.

Upon receipt, body temperature 38.6 ° C, pulse 94 per minute, blood pressure 120/60 mm RT. Art. The skin is of normal color, the tongue is clean, dry. Breathing through the nose, free. The abdomen is painful in all departments, more on the right, swollen, symptoms of peritoneal irritation in the lower parts, more on the right. Physiological administration without features. With a vaginal examination, it is impossible to palpate the uterus and appendages due to sharp pain and tension in the muscles of the anterior abdominal wall. During transvaginal ultrasound examination, the uterine body is without features, the ovaries are slightly enlarged, the area of the uterine appendages on both sides is sharply painful during the study, free fluid is not detected, the intestinal loops are swollen, active peristalsis.

In the general analysis of blood leukocytosis 27.1 × 10 ⁹ l, accelerated ESR - 51 mm / h. General analysis of urine without features, yeast fungi were found in a smear from the vagina. Endogenous intoxication according to the state of the erythrocyte membrane corresponds to the II degree. An imbalance of oxidative homeostasis was revealed due to a high level of lipid hydroperoxides (395.24% to normal) and a decrease in antioxidant activity (89.16% to normal).

Given the clinical and laboratory data, against the background of the started antibacterial and detoxification therapy, the patient underwent laparoscopy in order to clarify the severity of the inflammatory process and exclude acute surgical pathology.

During laparoscopy, the diagnosis of acute bilateral catarrhal salpingitis, pelvioperitonitis was confirmed, the appendix was not changed. The abdominal cavity was sanitized, the drug Baliz-2 was administered in divided doses of 1.0 liter in three doses, evacuated after a 3-minute exposure, the abdominal cavity was drained.

The postoperative period was uneventful, body temperature returned to normal by the end of the second day, the number of blood leukocytes by the third day, was discharged on the 7th day in a satisfactory condition, ultrasound data at discharge without features.

Under observation were 23 patients with acute inflammatory diseases of the uterine appendages, 15 of which were the main group, 8 - the control. The average age of the patients was 22.3 ± 2.6 years. In addition to traditional clinical and laboratory examinations, all patients underwent transvaginal ultrasound examination of the pelvic organs, determined the degree of endogenous intoxication by the state of erythrocyte membranes, indicators of oxidative stress by the level of lipid hydroperoxides and antioxidant system activity. The treatment of patients of the main and control groups was traditionally carried out in the form of complex antibacterial, anti-inflammatory, detoxification therapy. Patients of the main group additionally underwent laparoscopy, debridement and drainage of the abdominal cavity. For rehabilitation of the abdominal cavity, Baliz-2 was used, which was fractionally injected into the abdominal cavity of 1-1.5 liters with an exposure of up to 3 minutes from one to three times, taking into account the severity of the inflammatory process of the fallopian tubes, ovaries and pelvic peritoneum.

As a result of treatment of patients of the main group with additional sanitation of the abdominal cavity with Baliz-2 drug, which has a powerful antibacterial, antistress and antioxidant effect, contributing to faster purification of purulent surfaces, relief of the inflammatory process, healing and restoration of damaged tissues, the patients' clinical recovery was noted much earlier than in the control group. Symptoms of endogenous intoxication (fever, leukocytosis, the state of erythrocyte membranes, and indicators of oxidative stress) also stopped earlier than in the control group. The relatively rapid clinical effect and the normalization of laboratory parameters in patients of the main group contributed to a reduction in the length of hospital stay.

Using this method provides the following benefits:

- laparoscopy allows not only to clarify the form and severity of the inflammatory disease of the pelvic organs, but also to actively intervene during the pathological process;

- the use of Baliz-2 during laparoscopy for sanitation of the abdominal cavity contributes to a more rapid relief of the inflammatory process of the pelvic organs;

- timely sanitation of the abdominal cavity and pelvic organs prevents the formation of adhesions in the pelvis, chronic inflammatory process, thereby contributing to the preservation of reproductive function in young patients;

- active intervention during the pathological inflammatory process in the uterine appendages and treatment of the pelvic organs with the powerful antibacterial, antioxidant drug Baliz-2 contributes to a faster clinical recovery of patients;

- the introduction of modern technologies in the treatment of patients with acute inflammatory diseases of the uterine appendages: laparoscopy and sanitation of the abdominal cavity with the introduction of Baliz-2 reduces the length of hospital stay.

Claims (1)

A method for the treatment of patients with acute inflammatory diseases of the uterus by laparoscopy, drainage of purulent foci, removal of destructive tissues and washing of the abdominal cavity, characterized in that Baliz-2 is used as a rinse preparation, which is introduced into the abdominal cavity in fractional portions of 1-1, 5 l with an exposure of up to 3 minutes from one to three times.