RU2397771C2 - Method of treating complicated forms of inflammatory diseases of uterine appendages - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to field of medicine, namely to gynecology, and deals with treatment of complicated forms of inflammatory diseases of uterine appendages. For this purpose, when performing abdominal operation from two sides between round ligament of the uterus and isthmic part of fallopian tube medicinal mixtures of the following medications are introduced: at first - lidase 16 U in 1 ml of 0.25% Novocain, after that without removing the needle prednisolone 15 mg, amikacin 0.25 mg in 1 ml of 0.25% Novocain. Drainage of small pelvis with gauze-glove pad on lateral pockets to retrouterine space and bed of remote mass is carried out. In post-operational period antimicrobial drug is introduced intravenously. Limphotropically from two sides from anterior commisure of large pudental lips introduced are medicinal mixtures of medications: first - lidase 16 U in 1 ml of 0.25% Novocain, after that without removing the needle - prednisolone 15 mg, amikacin 0.25 mg in 1 ml of 0.25% Novocain, slowly during 15 minutes. Such introduction is carried out 1 time a day for 7-8 days.

EFFECT: method ensures stimulation of interstitial humoral transport and lymphatic drainage and fast normalisation of clinical and laboratory parametres with reduction of course dose of antimicrobial drugs.

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Description

The invention relates to medicine, in particular to the field of treatment of human diseases, and can be used to treat patients with inflammatory diseases of the uterus.

Known methods for treating complicated forms of inflammatory diseases of the uterine appendages (purulent salpingitis, pyosalpinges, pyovar, purulent tubo-ovarian formation) by performing laparoscopy or surgical treatment using dialysis drains from semipermeable membranes in combination with intramuscular or intravenous administration of two or three antibacterial drugs (Krasnopolsky B. I. et al. Purulent inflammatory diseases of the uterine appendages. - M.: MEDpress, 1998. - 233 pp., (Kozlov V.V. Surgical treatment complicated forms of purulent inflammatory diseases of the uterine appendages using dialysis drainages from a semipermeable membrane: Abstract of thesis ... Ph.D. - Barnaul, 2002 - 22 p.). However, the above methods, in our opinion, have several disadvantages.

It is well known that with the development of an inflammatory disease, the role of the lymphatic system is especially significant, since it carries out drainage and detoxification of tissue fluid and lymph (Yu. I. Borodin, 1998). It is proved that with the traditional intramuscular and intravenous administration of an antimicrobial drug, the minimum amount of a medicinal substance enters the lymphatic system, which limits the clinical effect (Levin Yu.M. Fundamentals of therapeutic lymphology. - M .: Medicine, 1986. - 288 p.).

A known method of lymphotropic therapy, including the introduction of lidase in a solution of lidocaine (increases the permeability of the main substance of the connective tissue and directs the flow of fluid to the roots of the lymphatic system) and an antibacterial drug. The method allows you to create sufficient and stable concentrations of antimicrobial agents in the lymphatic system and regional lymph nodes. This achieves the maximum effect on the pathogen both in the focus and in the lymphatic system and contributes to the improvement of the treatment of purulent-inflammatory diseases (Buyanov V.M., Danilov K.Yu., Radzikhovsky A.P. Drug saturation of the lymphatic system. - Kiev, 1991 .-- 134 p.)

A known method of treating nonspecific metroendoietritis and acute inflammatory diseases of the uterus.

During laparoscopy, a microirrigator is installed between the leaves of the wide uterine ligament and fixed with one or two vicryl sutures. An antibiotic is injected lymphotropically through the microirrigator once a day for 3-5 days (Goldyreva E.V. Clinical and morphological substantiation of the method of lymphotropic therapy of acute nonspecific metroendometritis: Author. Dis .... Dr. med. - Novosibirsk, 2000. - 23 from.)

The method has several disadvantages:

- It cannot be used in cases of complicated forms of inflammatory diseases of the uterine appendages (with a combination of pyosalpinges, pyovar or a purulent inflammatory tumor of the uterine appendages with pelvic peritonitis), since the use of laparoscopic surgery can lead to incomplete sanitation of the abdominal cavity and to a pronounced generalization of the infectious process.

- With a prolonged stay in the parametria, the catheter during the purulent process can contribute to the spread of pathogenic microorganisms to the parametria, followed by suppuration and generalization of the process.

It is known the use of dialysis drainages from a semipermeable membrane in the treatment of complicated forms of purulent inflammatory diseases of the uterine appendages, which allows you to remove toxic substances and excess fluid from the abdominal cavity while maintaining the protein and electrolytes necessary for the body, and ensures the continuous flow of antibacterial drugs into the abdominal cavity (Kozlov V.V. Surgical treatment of complicated forms of purulent inflammatory diseases of the uterine appendages using dialysis drainage from the semi onitsaemoy membrane: Abstract Dis ... k.m.n - Barnaul, 2002 - 22).....

The method also has several disadvantages:

- Frequent dialysate changes should be carried out up to 2 times in the first day of the postoperative period, and up to 1 time in the following.

- The use of dialysis drainage is an expensive treatment.

There is a method of treating inflammatory diseases of the uterine appendages, including laparoscopy and the administration of an antimicrobial drug lymphotropically into the mesentery of the fallopian tube, and in the postoperative period, this antimicrobial agent is injected lymphotropically under the vaginal mucosa on both sides (Semenchenko S.I. Anatomical justification of the clinical use of the complex method of laparoscopy and lymphotropic antimicrobial therapy of inflammatory diseases of the uterine appendages. Thesis ... Ph.D. Medical Sciences Omsk. - 2005. - 207 p.).

The method also has the disadvantage of:

- it cannot be used in cases when the patient underwent abdominal surgery and for the first day of the postoperative period there is a restriction of the patient’s motor mode and there is no possibility of introducing the drug under the vaginal mucosa.

The objective of the invention is to improve the results of the treatment of inflammatory diseases of the uterus.

The problem is solved in that in a method for the treatment of complicated forms of inflammatory diseases of the uterus, including surgery and the administration of an antimicrobial drug lymphotropically, a cavity operation is performed, a drug mixture is administered between the uterine ligament and the isthmic section of the fallopian tube: lidase 16 units in 1 ml 0 , 25% novocaine, and then, without removing the needle, a mixture of prednisolone 15 mg, amikacin 0.25 mg in 1 ml of 0.25% novocaine in the parametrium of the uterus on both sides. Drainage of the small pelvis with a gauze-glove swab along the lateral pockets to the adjoining space and the bed of the remote formation, while in the postoperative period, an antimicrobial preparation is prescribed intravenously, another agent that was used during the operation is administered slowly for 15 minutes, lymphotropically from two sides from the front commissures of the big shameless lips for 7-8 days 1 time per day.

The rate of administration of the solutions was chosen as a result of the fact that upon slow administration of drugs in the interstitial tissue, the effect of stimulation of interstitial humoral transport and lymphatic drainage remains, but the duration of surgical treatment and the time of drug administration in the postoperative period increase.

The method is as follows.

Surgical treatment is performed for patients with complicated forms of inflammatory diseases of the uterus (pyosalpinges, pyovar, purulent tubo-ovarian formation in combination with pelvic peritonitis). At an early stage of surgery, an assessment is made of the degree of damage by the inflammatory process of the internal genital organs. After eliminating the purulent effusion, before removing the affected organ in the parametrium, between the round uterine ligament and the isthmic section of the fallopian tube, a drug mixture of drugs is administered: lidase 16 units in 1 ml of 0.25% novocaine, and then, without removing the needle, a mixture of prednisolone 15 mg, amikacin 0.25 mg in 1 ml of 0.25% novocaine on both sides. Drainage of the pelvis is performed with a gauze-glove swab in the lateral pockets on the circulation paths of the accumulation of peritoneal exudate and must be brought to the adjacent space and the bed of the remote formation.

In the postoperative period, along with the administration of one antimicrobial drug intravenously, another agent that was used during the operation is injected slowly for 15 minutes lymphotropically, on both sides of the anterior commissure of the large lipstick for 7-8 days once a day. For lymphotropic administration, antimicrobials are used that are approved for intravenous use.

Example.

Patient A., 45 years old (medical history No. 7280), was admitted to the first gynecological department of the MUZ MSCh No. 9 of Omsk on 08.08.05 with a diagnosis of Exacerbation of chronic adnexitis. Tubo-ovarian formation on the left, pyosalpinges on the right. Abscess of the mesentery of the sigmoid colon. Pelvioperitonitis. Menstrual irregularities. Metrorrhagia.

Upon admission, the patient complained of pain in the lower abdomen, febrile body temperature, spotting spotting, fever up to 39 ° C. A bimanual examination and ultrasound scanning in the area of the left appendages revealed the formation without clear contours of 7 × 6 cm in size. A general blood test noted: an increase in ESR up to 55 m / h, leukocytosis up to 13.8 × 10 ⁹ / L. The patient underwent surgical treatment: after eliminating the purulent effusion, before removing the affected organ in the parametrium, between the round uterine ligament and the isthmic section of the fallopian tube, a drug mixture of drugs was administered: lidase 16 DB in 1 ml of 0.25% novocaine, and then, without removing the needle, a mixture of prednisolone 15 mg, amikacin 0.25 mg in 1 ml of 0.25% novocaine on both sides. Drainage of the small pelvis was performed with a gauze-glove swab in the lateral pockets and brought to the adjacent space and the bed of the remote education.

In the postoperative period, along with the administration of one antimicrobial drug intravenously, another agent that was used during the operation was injected slowly for 15 minutes lymphotropically, on both sides of the anterior commissure of the large lipstick for 7-8 days once a day.

A positive result of treatment was noted: by 3 days of the postoperative period, body temperature returned to normal; leukocyte intoxication index was 2.6. The patient's treatment duration was 15 days.

This method treated 10 patients with complicated forms of inflammatory diseases of the uterus.

As studies have shown, the proposed method allows to increase the effectiveness of treatment of patients with complicated forms of inflammatory diseases of the uterus, to achieve normalization of clinical and laboratory parameters in the first day after surgery, to reduce the course dose of an antimicrobial drug, thereby reducing the cost of treatment of such patients.

Claims (1)

A method of treating complicated forms of inflammatory diseases of the uterine appendages, including surgical intervention and the administration of an antimicrobial drug lymphotropically, characterized in that they perform a cavity operation, a drug mixture of drugs is administered between the uterine round ligament and the isthmic section of the fallopian tube: first, lidase 16 units in 1 ml 0, 25% novocaine, and then, without removing the needle, prednisone 15 mg, amikacin 0.25 mg in 1 ml of 0.25% novocaine in the parametrium on both sides of the uterine appendages, drainage of the small pelvis marlevo-p a glove swab in the lateral pockets to the adjacent space and the bed of the remote education; in the postoperative period, an antimicrobial drug is administered intravenously, and a drug mixture of drugs is injected lymphotropically on both sides of the anterior commissure of the large lipstick lips: first, 16 U of lidase in 1 ml of 0.25% novocaine, and then, without removing the needle, prednisolone 15 mg, amikacin 0.25 mg in 1 ml of 0.25% novocaine, slowly over 15 minutes, for 7-8 days, 1 time per day.