RU2275895C2 - Method for treating chronic cervicitis - Google Patents

Abstract

FIELD: medicine, gynecology.

SUBSTANCE: the suggested innovation deals with etiotropic therapy, instillation of medicinal substance and endocervical vibromassage along vacuum-aspiration of cervical canal content. Moreover, vibromassage along with vacuum-aspiration should be carried out at impulse mode. Discharging value in cervical tip corresponds to 20-40 kPa, pneumo-impulse time is 2 sec, period for pause is 1 sec, duration of seance is about 1-5 min. The course includes about 10-15 seances carried out at 1-d-interval. Fulfillment of aspiration at impulse mode enables to decrease vacuum loading upon endocervix.

EFFECT: higher efficiency of therapy.

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Description

The invention relates to medicine, namely to gynecology, dermatovenerology, and can be used in gynecological, dermatovenereological, physiotherapeutic departments and offices of hospitals, clinics.

Chronic cervicitis (HC) is one of the most commonly diagnosed diseases in dermatovenereological practice.

Currently, complex therapy is used to treat HC, including the following drugs and methods: etiotropic (metronidazole, tinidazole, tiberal, atrican, naxojin, mcmiror), immunocorrective (pyrogenal, polyoxidonium, cycloferon, methyluracil, etc.), enzymatic (chymotrypsin, , lidase, wobenzym), local treatment (vaginal baths, tampons, endocervical installations with drugs), physiotherapy (drug electrophoresis, magneto-laser therapy, etc.) [1, 2, 3, 4].

But at the same time, these methods have significant drawbacks, since in case of HC, accompanied by endocervical cysts, which can serve as a reservoir of latent infection [5], they turn out to be ineffective due to the impossibility of draining and sanitizing these cavities with medications administered as transvaginally (cervical) and applied systemically (orally, parenterally) and physiotherapy.

Ultrasound examinations of the cervix using transvaginal access (TVUS) made it possible to establish that cystic microcavities are found in 60% of patients with chronic cholecystitis, and in 27% they are localized in the upper third of the endocervix.

Previously, we proposed a method for the treatment of HC, including etiotropic therapy, endocervical vibration massage with vacuum aspiration of the cervical canal, alternating with the installation of a sterile disinfectant solution 3-5 times each procedure (patent for invention No. 2185861).

This method is the closest to the proposed.

For the implementation of vibration massage and transcervical vacuum aspiration, the cervical VAC-01 vibroaspirator device (certificate for utility model No. 21345 of 11/24/2000), designed as a prefix to the Intramag apparatus, was previously developed.

But this method has several disadvantages. Firstly, the vacuum effect that occurs during the operation of the pump of this apparatus is static, which is a risk factor for increased vacuum load on the endocervix, which reduces the possibility for free outflow of venous blood and lymph from venous and lymphatic collectors. All this increases the possibility of blood stasis, edema and hemorrhages in the endocervix. Secondly, the method of vibrovacuum massage of the cervical canal involves increased labor costs, as throughout the procedure it is necessary to hold a vibrator pistol in your hands [6].

The author has developed a method for the treatment of HC, including etiotropic therapy and the installation of a drug substance, characterized in that the endocervical vibration massage with vacuum aspiration of the contents of the cervical canal is performed in a pulsed mode. It is possible to implement vibration vacuum massage in a pulsed mode, for example, by means of the AE-01-Sanos Aspirator-Electric Stimulator (this device is used in the treatment of chronic prostatitis for endourethral drainage). The mechanism of this effect is significantly different from the previously developed approach, primarily due to its dynamism. The rhythmic alternation of the rarefaction and pause phases ensures both a constant flow of arterial blood into the cervix and the outflow of venous blood and lymph, which also significantly reduces the vacuum load on the endocervix. The pulse mode is provided by the inlet valve in the vacuum pump. After turning on the vacuum pump, a vacuum appears in the central nervous system and is held at this level for 2 s, then the inlet valve is activated and after a second the repetition of the same cycle begins. With a pause duration of 1 s. the pressure in the central nervous system is equalized to atmospheric (which reduces the vacuum load on the endocervix). In the event of an unexpected increase in vacuum in the central nervous system above the maximum allowable value (50 kPa), a safety valve is activated and the device automatically turns off.

In addition, the presence of a vibration component in the rarefaction pulse allows you to abandon the use of a vibrator pistol and thereby simplify the procedure and reduce staff labor.

The method is as follows.

The position of the patient during the procedure - lying on the gynecological chair. The external genitalia and cervix, removed using a Cuzco mirror, are treated with a sterile swab moistened with a disinfectant solution.

Introduce a sterile cervical tip (CN) worn on a 20 ml Luer disposable syringe with a 3% hydrogen peroxide solution. Irrigate the endocervix, remove the syringe from the central nervous system. Re-insert the sterile CN attached to the connecting tube attached to the air tubing of the aspirator into the cervical canal, fix it at the desired level with a special holder. The diameter of the central nervous system is selected taking into account the size of the external pharynx in order to increase the tightness in the cervical canal. In this work, we used a central cylinder with a diameter of the working part of 3 mm, 4 mm, 5 mm, and 6 mm.

Then begin the procedure of endocervical vibration massage and vacuum aspiration of the contents of the cervical canal in a pulsed mode. When the neck is exposed in this mode, metered drainage and vacuum-vibromassage of the endocervix occur due to the connection of the pneumatic path of the vacuum pump to the replaceable connecting pipe of the central nervous system.

The aspirator provides a continuously adjustable amount of vacuum in the CN in the range from 20 kPa to 40 kPa. Pneumatic impulse time - 2 seconds, pauses - 1 second. Vibration of the central nervous system occurs due to the operation of the air valve during the pneumatic pulse.

The duration of the session is 10-15 minutes. The number of procedures is determined by clinical and laboratory parameters, data of TWESI, tolerance and is 10-15 sessions.

Procedures are prescribed daily, 2-3 days in a row, followed by a break of one day or every other day in cases when it is combined with other physiotherapeutic procedures.

The method is non-invasive, easy to implement and fully compatible with other treatment methods. It complements traditional therapy.

Side effects and complications were not noted.

According to indications, this technique can be combined with hyperthermia, electrophoresis, and other physiotherapy.

The above technology for the pathogenetic treatment of CTE is carried out before and in combination with etiotropic therapy.

Contraindications:

1. Acute colpitis, cervicitis, endomyometritis, salpingitis, oophoritis, urethritis, cystitis.

2. Pregnancy.

3. Menstruation.

4. Metrorrhagia.

5. Tumors of the genitourinary sphere.

6. Systemic blood diseases.

7. Toxic conditions.

In the presence of manifest forms of chronic cervicitis, endocervicitis, endomyometritis, adnexitis, etiotropic, immunostimulating, hyposensitizing, anti-inflammatory, local (vaginal baths with disinfectant solution, suppositories ginalgin, Klion D, terzhinan) are first prescribed. After elimination or a significant reduction in the manifestations of an active inflammatory process (pain in the projection of the genitals, dysuria, mucopurulent discharge from the endocervix, a decrease in the number of leukocytes in cervical swabs-scrapings), endocervix vibration massage with vacuum aspiration of its contents is usually added for 6-7 days. In the sub-manifest course of the disease, antibacterial and / or protistocidal therapy is prescribed for 2-3 days of the above procedure.

51 patients with HC at the age from 18 to 40 years old with the disease duration from 6 months to 7 years were under observation. The examination of the patients included general clinical methods, including colposcopy (KS colposcope) and TVUZI (Pie Medical 200 apparatus with a sectoral multi-plane sensor), cytomorphological, microbiological and molecular genetic (PCR) studies of the contents of the cervical canal.

In 25 of them (49%), along with HC, there were PID, in 25 people. (49%) - ectopia of the cervix.

Etiologically identified in 17 people. (33%) Trichomonas vaginalis, in 10 people. (20%) Chlamydia trachomatis, in 19 people. (37%) patients noted Trichomonas bacterial infection, 13 people. (25%) - bacterial vaginosis, in 11 people. (22%) - opportunistic flora.

According to TBUS data, anechogenic masses (CMs) were determined in 60% of patients before treatment.

Twenty-six patients (50%) were treated two or more times with various antiprotozoal agents and / or antibiotics with a temporary effect.

The observables were divided into 2 groups with similar clinical and laboratory research data and indicators of TBI and colposcopy.

Patients in the control group (n = 21) underwent etiotropic, immunocorrective, and enzyme therapy. Etiotropic therapy was prescribed in accordance with the identified infectious agents. As a local therapy, endocervix was irrigated with a 3% hydrogen peroxide solution, alternating with endocervical vibration massage and vacuum aspiration of the cervical canal (VAC-01 prefix to Intramag AMUS device) [6], intravaginal ginalgin (ICN, Poland), 1 tablet each 1 time per day for 10 days.

Patients of the main group (n = 30) underwent similar therapy, but after endocervical irrigation with a 3% hydrogen peroxide solution, endocervical drainage and vacuum-vibration massage of endocervix were applied in pulsed mode using the AE-01-Sanos apparatus.

Our complex therapy using the developed method for the treatment of chronic heart disease has allowed patients to achieve the main group of etiological cure - 25 people. (83%), clinical - 28 people. (93%). In patients of the control group, etiological cure occurred in 16 people. (76.2%), clinical - in 19 people. (90.5%).

The results of ultrasound studies testified to the complete involution of surface anechogenic formations in endocervix in the observed both groups.

Based on colposcopy, a statistically significant more pronounced positive dynamics was observed in the change in the area of the pathological focus of exocervix in the main group compared with the control group. Thus, a decrease in cervical stroma edema in the main group was observed in all patients, and in the control group - in 85.7%. All women in the main group showed a regression of the “mosaic”, a decrease in the focus of the “acetabular epithelium”, a decrease in the iodine-negative zone, and an involution of foci of thin leukoplakia, while in the control group, positive dynamics according to these indicators occurred, respectively, in 46.2% , 50%, 36.4% and 33.3% of patients.

Another important observation, indicating the advantage of pulsed vacuum-vibration massage of endocervix, is the fact of its better tolerance, apparently due to the possibility of objectively strict dosage of exposure. So, in the main group, none of the patients complained of discomfort. Sessions were comfortable with a feeling of light, pleasant vibration. In the control group, 4 people. (19%) patients noted discomfort, pulling pains in the lower abdomen during and some time after the procedure, one of them also showed slight bleeding.

Our treatment regimen, based on the use of vacuum-vibrational massage of the cervical canal in a pulsed mode during complex therapy with chemotherapy, also makes it possible to sanitize crypts and drain endocervix CM, which are foci of infection difficult for drugs to reach. As a positive point, one can not ignore that endocervical pulsed vacuum-vibration massage has a better effect on microcirculation due to a more physiological and gentle effect on the cervix. This helps to open reserve capillaries, improves not only blood flow, but also enhances lymphatic drainage, eliminates veno-lymphostasis, thereby affecting trophic tissue and regenerative processes in the cervix.

Thus, the use of endocervical drainage and vacuum vibratory massage in a pulsed mode allows you to increase the effectiveness of the treatment due to a strictly dosed, dynamic vibrovacuum - exposure to the cervix. In addition, this approach provides more comfortable treatment conditions, its better tolerance, safety and allows you to simplify the procedure, reduce the labor costs of medical staff. Subject to the methodology, the possibility of developing complications and side effects characteristic of static vacuum exposure is virtually eliminated.

Thus, the use of the treatment method developed by us at one of the stages of the complex therapy of HC allows to increase the therapeutic effect, tolerance and safety of the procedure.

EXAMPLE 1

Patient L.D., 26 years old, turned to the Medical Practice Medical Center with complaints of drawing pains in the lower abdomen, yellow discharge from the vagina.

During the year she underwent 3 courses of protistocidal and antibacterial therapy in various hospitals of the city due to urogenital trichomoniasis and chlamydia.

Unmarried, unprotected sex during the year denies.

With an objective study:

- on the mirrors: on the cervix ectopia with a diameter of 1.5 cm, pus discharge from the cervical canal;

- bimanual examination determined edematous, moderately painful appendages on the left.

With colposcopy: glandular ectopia of the cervix, diffuse colpitis.

With TWUSI: the body of the uterus is of normal size 4.8 × 3.0 × 4.3cm. The contour is even, the structure is homogeneous. The cavity is linear in shape. Endometrium 1 cm corresponds to phase 2 of the cycle (26 day cycle). In the thickness of the cervix, at the level of the internal pharynx, anechogenic masses with a diameter of 5.0 and 6.0 mm (echoes of endocervix cysts). The right ovary is 3.4 × 2.0 cm. The left ovary is 3.3 × 2.0 cm. The structure of the ovaries is not changed. Volumetric formations in the field of appendages were not identified.

Bacterioscopy: scraping from the cervical canal: Trichomonas, gonococci, gardnerella, fungi of the genus Candida not found; the number of leukocytes 20-40-60; epithelium - a significant amount; mucus - a significant amount; found sticks, cocci.

In sowing on T.vaginalis: Trichomonas found.

In a scraping from the cervical canal, C.trachomatis DNA was detected by PCR.

Based on complaints, anamnesis and clinical and laboratory examination, the diagnosis was established: urogenital trichomoniasis, chlamydia with complications, chronic left-side salpingoophoritis, cervicitis, glandular ectopia of the cervix, endocervix cysts.

The following therapy was performed:

- Polyoxidonium 0.006 i / m every other day No. 10.

- Metronidazole 0.5 g 3 times inside 14 days

- Rovamycin 3 million 3 times inside 14 days.

- Ginalgin 1 tab. 1 time vaginally 10 days.

- Vibro massage with vacuum aspiration of the endocervix in a pulsed mode (2 sec. Dilution, 1 sec. - pause) after the endocervical installation of a 3% hydrogen peroxide solution was carried out daily for 2-3 days in a row, followed by one day breaks. The course of treatment is 10 sessions.

On the 7th and 10th day of therapy, TWSI monitoring was performed.

TVUSI on the 7th day: endometrium 1 cm corresponds to the 2nd phase of the cycle (18 day cycle). One anechogenic mass with a diameter of 4 mm is visualized in the cervix.

TWUSI on the 10th day: the structure of the cervix is homogeneous. No echoes of endocervix cysts were noted.

- The cervical ectopia was processed (Surgitron apparatus, USA).

During two menstrual cycles (on the 6th day), control clinical and laboratory studies were performed.

At the same time, the observed complaints did not show, during a gynecological examination, a complete resolution of the inflammatory process in the uterine appendages was ascertained, the cervix was epithelized, which was confirmed by control colposcopy, the structure of the cervix was homogeneous in TBI, in smears and cultures from the cervical canal and vagina tvaginalis were not detected; no cervical scrapings of C.trachomatis DNA were detected.

Thus, this method of treatment allows you to:

1) increase the therapeutic effectiveness of the treatment of cervicitis;

2) significantly improve microcirculation, lymphatic drainage, eliminate lymphostasis and venous hyperemia, which accordingly accelerates regenerative processes and positively affects trophic tissue of the cervix;

3) the proposed method differs from the prototype in a significantly lower vacuum load on the endocervix, more physiological due to the objectively dosed, dynamic regime of vibro-vacuum exposure.

List of references

1. Skripkin Yu.K., Mordovtsev V.N. Skin and sexually transmitted diseases. A guide for doctors. M .: Medicine, 1999, v. 1; 652-653.

2. Borisenko K.K. Diagnosis, treatment and prevention of sexually transmitted diseases. Teaching materials. M., Sanam, 1998; 99-100.

3. Adaskevich V.P. Sexually transmitted infections. A guide for doctors. Nizhny Novgorod, NGMA; M .: Medical book, 1999; 184-187.

4. Malevich K.N., Rusakevich P.S. Treatment and rehabilitation for gynecological diseases. Reference manual. Mn .: Vysh. school, 1994; 128-129, 208-218.

5. Khachkuruzov S.G. Ultrasound in gynecology. Symptoms Diagnostic difficulties and errors. SPb., "ELBI", 1999, 411.

6. Churakov A.A., Suvorov A.P. Patent No. 2185861 "A method for the treatment of chronic trichomonas endocervicitis"

Claims (1)

A method for the treatment of chronic cervicitis, including etiotropic therapy, drug installation and endocervical vibration massage with vacuum aspiration of the cervical canal, characterized in that the vibration massage with vacuum aspiration of the endocervix is carried out in a pulsed mode, with a vacuum in the cervical tip of 20 to 40 kPa, time air pulse 2 s, pauses - 1 s, session duration 1-15 minutes, course 10-15 sessions conducted with a break of one day.