RU2268044C1 - Method for treating genital fistulas - Google Patents

Abstract

FIELD: medicine, gynecology, surgery.

SUBSTANCE: one should introduce 3.5%-chitosan ascorbate gel into fistulous channel that contains metronidasol at the dosage of 2 mg/ml, at the volume up to 20 ml once/2 d till complete fistula's closing. The present innovation enables to activate reparative processes and fistulous epithelization that favors for closing fistulous channel in earlier terms.

EFFECT: higher efficiency of therapy conducted.

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Description

The invention relates to medicine, namely to obstetrics and gynecology, and can be used in proctology, urology, surgery and dermatovenerology.

Among the most serious diseases of women, leading not only to multiple organ dysfunctions, prolonged permanent disability, but also causing severe physical and mental suffering, menstrual and reproductive dysfunction, include genital fistula [1].

Known widely used surgical tactics for the treatment of genital fistulas, which consists in suturing the fistula no earlier than 4 months after its occurrence and after the edges of the fistula is no longer granulated, but healed [2]. The main stages of fistula closure are excision of the scar tissue bordering the edges of the fistula opening, and splitting of the edges of the fistula, suturing of the defect. For a certain localization of the fistula, there are methods of operational allowance, but all of them require time, very often leading a woman to disability, which reduces the quality and usefulness of her life [1]. The severity of clinical manifestations and the high frequency of relapses raise the issues of surgical treatment and prevention of genital fistulas as a number of primary problems [2].

Conservative therapy consists of local and general events. Local treatment consists in douching the vagina with a 1% solution of chlorhexidine or 1-3% solution of potassium permanganate, draining it, exposing the vestibule of the fistula with the help of mirrors and bringing a tampon to it or introducing a balsamic liniment into it according to A.V. Vishnevsky. The tampon is left for a day, after a day the procedure is repeated. After cleansing the wound, the liniment is replaced with jelly or solcoseryl ointment and they are used until the wound is completely epithelized [1].

However, the currently used locally balsamic liniment according to A.V. Vishnevsky along with the obvious positive effect on the course of the disease, as a rule, also causes a number of side effects: allergic reactions in the form of itching, swelling and hyperemia of the vaginal mucosa, many women cannot use due to severe hyperosmia [3]. The need for a long time to visit the treatment room daily for sanitation and dressing changes until the wound is completely epithelized makes a woman give up her usual way of life and activity.

The objective of the invention is to increase the efficiency of closing of genital fistulas, to reduce treatment time and reduce the percentage of relapse of the fistula.

The task is achieved due to the fact that after processing the walls of the vagina with an antiseptic solution, a 3.5% chitosan ascorbate gel containing metronidazole in a dose of 2 mg in 1 ml in a volume of up to 20 ml 1 time in 2 days is injected into the fistulous entrance until the fistula is completely closed. The treatment leads to the closure of the fistulous passage in the early stages according to the results of fistulography and wound healing.

The technical result of a high therapeutic effect consists of significant vascularization of the wound surface of the fistula and early epithelialization of the defect [4-6], as well as a selective antibacterial effect [7].

The method is as follows: in the treatment room, a woman is laid on a gynecological chair, sanitizing the external genital organs and vaginal walls with an antiseptic solution, injecting a Cuzco mirror into the vagina, exposing the vestibule fistula with the help of mirrors, introducing cannula with 3.5% ascorbate gel into the fistula. chitosan containing metronidazole in a dose of 2 mg in 1 ml, in a volume of up to 20 ml 1 time in 2 days.

The proposed method treated five patients aged 26 to 40 years. Based on typical clinical signs and results of fistulography, all women revealed genital fistulas (2 women had a celiac-sigmoid rectal fistula, 2 women had a genital fistula proper, and 1 woman had a cervical-vaginal fistula). The duration of the disease ranged from 2 weeks to 2 years. Patients with abdominal-sigmorectal fistula complained of suppuration from the fistula in the anterior abdominal wall and anus, in genital fistula itself, for pain in the perineum and purulent discharge from the vagina, and for cervical-vaginal fistula, for abundant homogeneous discharge from genital unpleasant odors, menstrual irregularities and miscarriage. The treatment results showed that when using the proposed method in the treatment of genital fistulas, the treatment time was 10-20 days.

Clinical example 1: patient P., 38 years old, was admitted to the gynecological department of the BSMP of Krasnoyarsk on November 21, 2003 with a diagnosis of exacerbation of chronic bilateral adnexitis with the formation of a tubo-ovarian tumor on the left and a pyosalpinx on the right against the background of an intrauterine device. The operation was performed - lower middle laparotomy, adnexectomy on the left, tubectomy on the right, dissection of the peritoneal adhesions, rehabilitation and drainage of the abdominal cavity. During surgery in the abdominal cavity, 50 ml of purulent contents, a massive adhesion process, purulent-infiltrative omentitis were detected, when the adhesions were separated, the rectosigmoid colon was deserted for 8 cm, sewn with separate nylon seams. On day 5, abundant intestinal contents stood out on the left drainage. On day 12, a suction-flow system according to Kanshin was installed in the area of the drainage hole. On the 24th day, the system was removed - a fistula was formed (moderate intestinal contents leave the drainage hole). A local examination revealed a fistulous opening on the skin measuring 5x3 cm, severe maceration and tissue infiltration around the fistula, a fistula depth of 14 cm along the probe, daily loss of up to 500 ml of intestinal contents. After processing the walls of the vagina with a solution of furatsillin, a cannula olive was introduced into the fistula with a 3.5% chitosan ascorbate gel containing metronidazole in a dose of 2 mg per 1 ml in a volume of 20 ml. The introduction of the gel was carried out 1 time in 2 days for 12 days. On day 36 according to the results of fistulography of the fistulous passage in the intestine was not found. On the skin in the area of the drainage hole on the left is soft scar healing. The patient received antibacterial, detoxification, immunocorrective therapy as a general treatment. During a local examination, against the background of using a 3.5% gel of chitosan ascorbate gel with metronidazole, tissue maceration disappeared, and the fistulous passage was absent. Thus, the six-time use of chitosan gel for 12 days led to the complete elimination of the fistulous course. The patient does not show complaints, was discharged home in satisfactory condition. After 9 months at the control examination - there is no fistulous course, no complaints, the woman leads a normal lifestyle.

Clinical example 2: puerpera S., 34, gave birth on March 23, 03 in r / house No. 5 of the city of Krasnoyarsk a live full-term boy. When examined by an obstetrician-gynecologist, a cervical-vaginal fistula was revealed, according to a woman, the fistula functions 2 years after the previous birth (cervical ruptures). Chitosan ascorbate gel containing metronidazole was treated with gel. After vaginal debridement with a 1% dioxidine solution, an olive cannula with a 3.5% gel in a volume of 10 ml 1 time in 2 days was introduced along the fistula until the fistula was completely closed. After discharge from the maternity hospital, treatment was continued in the antenatal clinic No. 3. On the 20th day from the start of treatment, fistulous passage according to fistulography was not found, when examined in the mirrors, the cervix and the mucous membrane of the vagina are pale pink, the mucous discharge is odorless, with a bimanual vaginal examination, the uterus is of normal size and consistency, uterine appendages not palpable. At the follow-up examination after 6 months - there is no fistulous course, the menstrual cycle is regular, there are no pains and pathological discharge. Woman on maternity leave to care for a child, the quality of life has improved significantly.

Thus, the proposed method for the treatment of genital fistulas by introducing a cannula with chitosan ascorbate gel and metronidazole into the fistula of the olive allows:

1. - To increase the efficiency of closing genital fistulas on the basis of vascularization of their wound surface and removal of pathogenic microflora from them, thus reducing or eliminating vaginal discharge, significantly reducing or removing pain in the 2-3rd procedure.

2. - Reduce treatment time to 20 days

3. - Eliminate recurrence of the opening of the fistulous course.

4. - To return women to their usual way of life, to give them the opportunity to have a second favorable pregnancy and delivery.

Used Books:

1. Krasnopolsky V.I., Buyanova S.N., Genital fistulas, M .: "Medpress", 2001, p.202.

2. Persianinov AS, Operational gynecology. M .: Medicine, 1976, p. 567.

3. Strelnikov V.N., Dultsev Yu.V., Salamov K.N. Surgical treatment of rectal-vaginal fistula (literature review) // Surgery. - 1980, - No. 9, - p.103-108.

4. Bolshakov I.N. et al. "A way to strengthen the sclera." Application for invention, A 61 K 31/722, priority from 07/01/04 for No. 2004120228 (021704).

5. Bolshakov I.N. et al. "A method of obtaining an artificial skin matrix." RF patent No. 2252787 dated 05/27/2005. Bull. No. 15 dated 05/27/2005.

6. Bolshakov I.N. et al. "Wound coating based on collagen chitosan complex." A positive decision on the application for an invention. Priority No. 2003130390 dated 4.10.2003.

7. Bolshakov I.N. et al. Antibacterial filler for feminine sanitary napkins or tampons “KMD-BOL”, method for its preparation and use. Application for invention. A 61 L 13/28. Priority No. 2005114248 (016342) dated 05/11/2005.

Claims (1)

A method of treating genital fistulas, including treating the walls of the vagina and introducing an antiseptic into the fistula, characterized in that a 3.5% chitosan ascorbate gel is introduced into the fistula, containing metronidazole in a dose of 2 mg in 1 ml, up to 20 ml 1 every 2 days until the fistula is completely closed.