RU2284820C1 - Method for treating bilateral purulent tumor-like neoplasms of uterine adnexa - Google Patents

Abstract

FIELD: medicine, gynecology.

SUBSTANCE: before operation it is necessary to sample patient's blood to divide it into plasma and blood cells. Blood plasma should be divided into three parts and frozen. After operation one should intravenously reinfuse by drops erythrocytic mass incubated for 30 min at 37° C with 2 g lendacyn followed by further lendacyn injection per 1g intramuscularly during the next 6 d. Blood plasma should be portionally defrosted, incubated at 37° C with: 10000 U trasilol, 0.15 g lisozyme, 0.02 g novocain, after incubation it is necessary to add 100 ml gelatinol to be reinfused for a patient on the 2^nd, 4^th and 6^th d against the onset of therapy course through microirrigator withdrawn out of posterior arch during operation. The innovation provides combined impact of antibiotics upon pathological focus biotransformed with erythrocytic mass and local immunomodulating and resolving effect and, thus, decreased formation of adhesions, fistulas and cicatrices.

EFFECT: higher efficiency of therapy.

1 ex

Description

The invention relates to medicine, namely to gynecology, and can be used to treat diseases of the pelvic organs in women.

It is known that the method of choice for purulent-inflammatory tumors of the uterus appendages that are not associated with abortion and the presence of an intrauterine device is the supravaginal amputation of the uterus with appendages (Beznoschenko GB Non-operative gynecology. M .: Medical book. N. Novgorod: ed. in NGMA. 2001. - P.319). In this case, it is necessary to completely remove all tissues of the inflammatory formation. A mandatory component of the surgical guide in these patients is drainage. To limit and drain the contents, plugging and drainage are combined. Using a flow-draining system (double-lumen tube) hermetically connected to the cavity, or several tubes, an adequate outflow is created. Tampons and drains are best removed through separate incisions, and not through the surgical wound with clear marking and marking in the protocol of the operation (the skin is fixed with sutures). Drainage is carried out through bilateral contrapertures. In the postoperative period, antibiotic therapy is performed. In this case, broad-spectrum antibiotics are prescribed in combination with metronidazole.

However, the conduction of drainage tubes through the anterior abdominal wall to the lower corner of the postoperative wound is associated with a number of inconveniences and complications, especially the outflow of fluid, as the flat parts of the abdomen are located significantly below the level of the anterior abdominal wall. The drainage tube is a foreign body, and this is fraught with the formation of fistulas. Often, after a purulent inflammation of the uterine appendages and surgical intervention, complications arise (sclerosis, scars, adhesions). Therefore, patients need additional non-drug treatment (thermal absorbable therapy) for at least a year.

A known method of treating bilateral purulent inflammation of the uterine appendages, including surgical treatment in the amount of extrusion or supravaginal amputation of the uterus with appendages and postoperative rehabilitation, we selected as a prototype (Malevich K.I., Rusakevich P.S. Treatment and rehabilitation for gynecological diseases. - Mn: Vysh.Sk., 1994 .-- P.157). Surgery is performed with mandatory drainage. The preferred method is the introduction of drainages transvaginally through the open dome of the vagina after hysterectomy. Drainages, microirrigators are administered for intraperitoneal drip infusion with continuous evacuation of pathological exudate according to the type of peritoneal dialysis using double-lumen silicone tubes and the vacuum apparatus OP-01. Antibacterial therapy in the postoperative period is recommended to be carried out simultaneously by two or more antibiotics. The following methods of antibiotic use are recommended: intramuscular, intravenous, via drainage, in severe cases - endolymphatic.

However, when choosing a method of drug therapy for various diseases, the localization and degree of the process’s prevalence, as well as the pharmacokinetics of the drugs used, including determining the rate of binding to plasma proteins (with all methods of administration), time to reach maximum plasma concentration, elimination half-life, are of greatest importance. full withdrawal time. The determination of these parameters and their comparison with the dynamics of the therapeutic effect make it possible to establish optimal doses and regimens (frequency and duration) of drug administration, and evaluate the advantages of different routes of its administration. Once in the blood, the medicine is not only in the lesion, but also spreads throughout the body, partly binding to healthy tissues. The use of several antibiotics leads to the development of dysbiosis and immunosuppression, which requires additional therapeutic measures. The opinion that the introduction of drugs into the lymphatic system weakens their general toxic effect can create a false impression of the safety of endolymphatic infusions of high doses of toxic drugs. Infusion into the lymphatic vessel of a maximum single dose, for example, gentamicin, creates a concentration in the regional and some other nodes that exceeds the therapeutic by about 25 times. Naturally, this leads to a pronounced local toxic effect, suppresses not only the pathogenic principle, but also the protective functions of the lymphatic system. It is characteristic that even in this case the lymph nodes remain even on the pathways of the antibiotic's movement through the lymphatic system, in which the accumulation of the drug may be absent. In other nodes into which it enters, its toxic effect is exacerbated by the extremely slow nature of the lymphatic flow compared to blood flow, which determines the long-term contact of the administered drug with the surrounding tissue. The procedure for endolymphatic administration of drugs involves the stage of "minor" surgery, which consists in the detection and exposure of the lymphatic vessel of the foot. However, with varicose vessels of the lower extremities, which often occurs in older women, this procedure becomes not feasible. Endolymphatic administration of drugs is also contraindicated in case of violation of the blood coagulation system. Lymphangitis remains a fairly frequent complication.

The aim of the present invention is to improve the results of treatment of patients with purulent tumor-like formations of the uterine appendages.

The goal was achieved by the fact that for patients with purulent-inflammatory formations of the uterine appendages, the first step is to perform an operation in the amount of supravaginal amputation of the uterus with appendages and the formation of a drainage system with the removal of the drainage tube through the cervical canal and microirrigator through the back arch. The second stage of treatment for patients with an installed drainage system is drug therapy. To do this, 250 ml of blood is taken from the ulnar vein on an empty stomach to a sterile standard vial with glucicir, blood plasma is obtained by sedimentation. The red blood cell after incubation with antibiotics is returned to the patient by intravenous drip. In the next day, antibiotics are administered daily intramuscularly for up to 7 days. Blood plasma is divided into 3 portions of 50 ml and frozen at -18 ° C. On days 2, 4, and 6, blood plasma is thawed portionwise, incubated with a mixture of drugs, and the patient is reinfused through a microirrigator removed through the posterior arch.

An analysis of the known methods of treating patients with purulent-inflammatory formations of the uterine appendages and the developed one allows us to state that the proposed method has novelty, which consists in combining systemic intravenous administration of antibiotics, biotransformed with erythrocyte suspension, and introduced directly into the bloodstream, with therapy delivered directly to the region of distribution purulent process, which allows you to affect all lesions not visible to the eye, remaining in the abdominal polo sti, and with immunomodulatory and absorbable action.

There are no indications of a similar method for improving the direct results of treating patients with purulent-inflammatory formations of the uterine appendages with accessible objective reduction in the number of complications associated with the formation of adhesions, fistulas and additional scars in accessible sources of information from Russia, the CIS countries and abroad.

The invention is industrially applicable, as it can be repeatedly reproduced and repeated in medical institutions with a surgical profile.

The method is as follows.

After a bimanual, ultrasound examination of the pelvic organs and cytological analysis, detection of the widespread purulent-inflammatory process of the uterus appendages, the patient undergoes the first stage of surgical treatment in the amount of supravaginal amputation of the uterus with appendages. Before surgery, 250 ml of blood is taken from an ulnar vein on an empty stomach from a patient in a standard sterile vial with glugicir. Immediately after supravaginal amputation of the uterus with appendages from the abdominal cavity into the cervical stump canal, a drainage tube with a diameter of 0.5-0.7 cm and a length of 50 cm is carried out from top to bottom in the vagina. The tube from the side of the vagina is clamped and extended until it leaves it. The upper end of the tube from the side of the abdominal cavity in the final position lags behind the upper edge of the stump of the cervix so that after suturing, the tube is 1.5-2 cm above the suture line. Drainage through the cervical canal was combined with a microirrigator removed through the back arch. For better fixation of the drainage tubes, a horizontal jumper is used - a ligature, which, resting on the back wall of the cervical stump, holds the drainage in a given direction. The microirrigator serves to bring the solutions of drugs into the abdominal cavity, and the drainage discharged through the cervical canal - for an adequate outflow of fluid from the abdominal cavity.

By sedimentation, the blood taken before surgery is divided into plasma and cell suspension. The erythrocyte mass is incubated for 30 min at a temperature of 37 ° C with 2 g of lendacin and the patient is returned intravenously drip immediately after the operation; in the next 6 days, lendacin continues to be administered 1 g intramuscularly. Blood plasma is divided into three portions of 50 ml and frozen at a temperature of -18 ° C (freezer in a domestic refrigerator). On the 2nd, 4th and 6th day from the start of treatment, a portion of the blood plasma is thawed, incubated at a temperature of 37 ° C for 30 minutes with a mixture of drugs: 10,000 units. trasilol, 0.15 g of lysozyme, 0.02 g of novocaine. After incubation, 100 ml of gelatinol is added to the mixture of plasma and drugs and the patient is reinfused through a microirrigator withdrawn from the posterior fornix.

In accessible sources of information from Russia, the CIS countries and abroad, we did not find any indications of a similar method for the treatment of patients with purulent-inflammatory tumor-like diseases of the uterus.

To prove this, we provide an extract from the medical history confirming the clinical effect of the treatment by the proposed method.

Clinical Example

Patient I., b. 1946, source.ball. No. 5916 / е was received on 06/17/97 from an open admission to the RNII with complaints of intense pain in the lower abdomen with irradiation into the rectum, urogenital discharge from the genital tract, chills, body temperature of 37.8 ° C, frequent urination.

Considers herself a patient for 2 months, when after a medical abortion these complaints appeared and intensified, despite the conservative detoxification and antibiotic therapy carried out at the place of residence.

Upon admission, the patient's condition is moderate, pallor of the skin. Vesicular breathing, tachycardia - pulse of 110 beats per 1 minute, rhythmic blood pressure of 100/60 mm RT. Art. The tongue is wet, coated with a white coating. The abdomen is involved in the act of breathing, soft. On palpation, soreness and slight tension of the muscles of the anterior abdominal wall in the iliac regions, where the weakly positive Shchetkin-Blumberg symptom is determined.

Genital status: the cervix is formed, without a tumor, from the cervical canal a bloodstream, serous-purulent discharge. The tension of the arches is determined. The uterus is slightly larger than normal, its contours are not clearly defined. Soreness during examination and traction for the cervix. Uterine appendages are enlarged on both sides, tuberous, painful when examined more on the right.

Ultrasound of the pelvic organs from 06/17/97 - the size of the uterus is 9.8 × 6.3 × 4.4 cm. The uterine cavity is expanded due to the liquid contents. In the zone of the median M-echo, hyper- and hypoechoic areas of various sizes and shapes are determined. In the basal layer of the endometrium from 0.1-0.2 cm hyperechoic areas of fibrosis and calcification. Appendages enlarged on the right 8.1 × 6.4 × 5.1 cm, on the left 6.7 × 5.4 × 5.3 cm.

HB 124 g / l, Er - 3.8 × 1012 / l CPU 1.0; Lake - 9.4 × 109 / l, eos. - 1%, myel. - 2%; fell. - 21%, seg. - 55%, lymph - 16%, mon - 5%, ESR 24 mm / hour.

Diagnosis: bilateral salpingoophoritis, metroendometritis. Given the age of the patient and the prevalence of the process, surgical treatment is indicated.

Before surgery, 250 ml of blood was taken from an ulnar vein on an empty stomach from a patient into a standard sterile vial with glugicir. Surgical treatment was performed in the amount of supravaginal amputation of the uterus with appendages. Immediately after supravaginal amputation of the uterus with appendages from the abdominal cavity into the cervical stump canal, a drainage tube with a diameter of 0.5-0.7 cm and a length of 50 cm is carried out from top to bottom in the vagina. The tube from the side of the vagina is clamped and extended until it leaves it. The upper end of the tube from the side of the abdominal cavity in the final position lagged behind the upper edge of the cervical stump so that after suturing, the tube was 1.5-2 cm above the suture line. Drainage through the cervical canal was combined with a microirrigator removed through the posterior arch. For better fixation of the drainage tubes, a horizontal lintel was used - a ligature, which, leaning on the back wall of the cervical stump, kept the drainage in a given direction. The microirrigator was used to bring the drug solutions into the abdominal cavity, and the drainage discharged through the cervical canal was used to adequately drain the fluid from the abdominal cavity. Histological analysis: No. 479929-34 - chronic salpingo-oophoritis with exacerbation; No. 479938-9 chronic inflammation with exacerbation.

By sedimentation, the blood taken before surgery was divided into plasma and cell suspension. The erythrocyte mass after 30 min of incubation at a temperature of 37 ° C with 2 g of lendacin was injected intravenously by the patient immediately after the operation. In the next 6 days (from 18.06. To 23.06. Inclusive), lendacin was administered 1 g intramuscularly. Blood plasma was divided into three 50 ml portions and frozen at -18 ° C (freezer in a domestic refrigerator). On the second (06/18/97), fourth (06/20/97) and sixth (06/06/97) days from the start of treatment, each portion of blood plasma was thawed, incubated at 37 ° C for 30 min with a mixture of drugs: 10,000 units. trasilol, 0.15 g of lysozyme, 0.02 g of novocaine. After incubation, 100 ml of gelatinol was added to the mixture of plasma and drugs and the patient was reinfused through a microirrigator withdrawn from the posterior fornix.

The clinical recovery of the patient was established. Exacerbations of the chronic inflammatory process have not been observed for 7.5 years.

The proposed method was carried out the treatment of 34 patients with purulent-inflammatory tumor-like diseases of the genitals. Before and after treatment, all patients underwent examination in the mirrors, rectovaginal examination, general and biochemical blood tests, chest X-ray and kidney function examination, ultrasound examination of the pelvic organs, biopsy with cytological examination.

The technical result from the use of the "Method for the treatment of bilateral purulent tumor-like formations of the uterine appendages" is that:

- patients tolerate this procedure without complications;

- toxic side effects of drug therapy are reduced;

- regression of the pathological focus is achieved and in a shorter time;

- there are no fistulous passages, additional scars, adhesions.

Claims (1)

A method of treating bilateral purulent tumor-like formations of the uterine appendages, including surgery and drug administration, characterized in that the patient is taken blood from the patient before the operation, it is divided into plasma and shaped elements, the blood plasma is divided into three parts and frozen, the surgical treatment is completed by excretion of drains through the cervical canal and posterior arch, after the operation, the erythrocyte mass incubated for 30 min at 37 ° C with 2 g of lendacin is intravenously dripped, and then the administration of lendacin is continued 1 g intramuscularly for the next 6 days, the blood plasma is thawed portionwise, incubated at 37 ° C with: 10000 units. trasilol, 0.15 g of lysozyme, 0.02 g of novocaine, after incubation add 100 ml of gelatin and the patient is reinfused through a microirrigator withdrawn from the posterior fornix, the procedure is carried out on the second, fourth and sixth days from the start of treatment.