RU2764367C1 - Method for hysterosalpingography using a foley catheter under visual control in fixed positions and with digital radiography - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely gynecology and radiology. A Foley catheter is used, which does not require fixation on the cervix, followed by taking pictures in fixed positions in the following order: image 1, in an anterior-posterior projection lying on the back without contrast. Image 2, in an anterior-posterior projection lying on the back with the introduction of 2-3 ml of contrast, the uterine cavity and the process of filling the tubes with contrast are contrasted. Images 3-4, in left and right oblique projections: lying on the back with the left and right sides raised successively at an angle of 30-45°; then, if necessary, the remaining part of the contrast is injected: up to 4 ml. At the same time, the patient first turns on her side, where the tube is less passable, 3-5 minutes after the first picture. Image 5: lying on the stomach, while the turn on the stomach is carried out through the side where the fallopian tube is poorly passable. Images 6 and 7, 3-5 minutes after the fifth shot: left and right oblique projections: lying on the stomach with the left and right sides raised successively at an angle of 30-45°.

EFFECT: method makes it possible to clearly standardize the number of images, their projections and the position of the patient, indicates the projections in which the series of images are used, indicates what needs to be studied in these projections, makes it possible to compare pathological changes and the dynamics of changes in the positions in which they were recorded during a control study.

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Description

The invention relates to medicine, in particular to gynecology and radiology. The purpose of the invention is to improve the quality of the image and at the same time, with a decrease in traumatization of the soft tissues of the genital organs and radiation exposure, obtaining information about the state of the fallopian tubes, the uterine cavity and the prevalence of adhesions during the study.

According to the literature data, the first Hysterosalpingography was performed in 1910, when Rindfleisch introduced a solution of bismuth through the cervix and performed a survey radiography of the abdominal organs. In 1925, Heuser applied Lipiodol and hysterosalpingography became the standard for initial examination of the uterine cavity and fallopian tubes. Since 1947, fluoroscopy has replaced static images, and since that time the technique has practically not changed. For hysterosalpingography, many different devices have been invented and used.

They can be divided into two types. The first is the Schulze device, which is a syringe onto which a metal cannula with a tip is screwed, or a uterine probe, which is inserted into the uterine cavity and a contrast is injected through the adapter with a syringe. In this case, the tightness is ensured by bullet tongs or a Muzo clamp. The method is traumatic and painful, but provides 100% tightness.

The second type - devices made of polymeric materials such as: Catheter for hysterosalpingography SFR / 25 or CGSG and other brands, Set for hysterosalpingography BALTON.

Device for hysterosalpingography (RF Patent 2363503).

US Pat. Nos. 4,430,076 and 5,372,584 and EP 0 630 658 describe catheters provided with discs as limiters fixed at the required level by projections on the catheter tube. However, according to a number of authors, it has a significant drawback, since its use does not exclude the possibility of extrusion of the catheter tip from the cervical canal into the vagina during the procedure.

Less traumatic, according to other authors, is the device described in US patent US 4,089,337, in which the limiting disk with the help of a special spring can move within certain limits along the axis of the catheter and, resting against external organs, hold the catheter tip at the moment it is inserted to the required depth .

A similar disadvantage is inherent in the technical solution described in US patent US 5104377, where, in order to achieve a completely atraumatic procedure, a separate elastic cuff is used as a limiter, which is inflated autonomously through the third independent channel of the catheter.

The closest in essence to the proposed invention is the research methodology proposed by A.N. Kotelnikov and S.N. Bryazgunov (Republican Clinical Hospital of Ulan-Ude, "A modified method of hysterosalpingography using a Foley catheter" described in the "Bulletin of the VSNC SO RAMS, 2009 No. 3 (67))".

The methodology is as follows:

The neck is fixed with bullet forceps;

A probe is inserted

A Foley catheter is inserted through the tube

The cuff inflates up to 2-3 cm ³

The second channel introduces contrast

Evaluation of the result is carried out according to subjective feelings

Pictures are taken immediately, then after 10-15 minutes. And if necessary after 24 hours.

In our opinion, the disadvantage of this technique is that the positions in which the images are taken are not clearly fixed, it is not indicated how the drug is administered simultaneously or discretely. There are big doubts about the x-ray after 24 hours (the water-soluble drug will be absorbed and excreted from the body during this period), as well as a small number of observations. We have not received registration information for this technique.

The difference between our methodology is that:

1. To reduce the traumatization of soft tissues, we use single-bullet forceps or do not use them at all.

2. In our methodology, when conducting research, a nurse is not in the procedural X-ray room during the period of hysterosalpingography.

3. The technique does not require special devices, is not expensive and is easy to use, as it is performed using tools that are commercially available already sterile and atraumatic. (For example: BALTON hysterosalpingography kit only).

4. With our technique, the consumption of contrast is 5-7 ml. in Abramova's monograph Μ Μ "Atlas of hysterosalpingography" M. Medicine 1963 p. 7 consumption is 4-5 ml, and in the monograph VG Bychenkov, A Η Sencha “Hysterosalpingography from A to Z “Atlas” Μ MEDpress-inform 2020 p. 22 total consumption 15 ml (maximum 25 ml).

The technique we propose, firstly, clearly standardizes the number of images, their projections and the position of the patient. Secondly, it specifies the projections in which the series of images are applied. Thirdly, it indicates what needs to be studied in these projections. Fourthly, it makes it possible to compare pathological changes and the dynamics of changes in the positions in which they were recorded during a control study.

The research technique according to our methodology is as follows.

The technique is carried out in the supine position, lying on the back with the left side raised, lying on the back with the right side raised, lying on the stomach, lying on the stomach with the left and then the right side raised, towards the image receiver. The contrast is introduced fractionally, starting from 2.5-4.0 ml, which corresponds to the average volume of the uterine cavity, which achieves tight filling. Then the remaining amount is slowly introduced, sometimes under visual control, if complaints of distension or other complaints of discomfort in the lower abdomen appear during the introduction of contrast, and pictures are taken in the above projections.

1 picture: survey R-graphy assesses the skiological picture of the small pelvis;

2 shot: (or a series of shots in modes 4 shots in 2 seconds) with the introduction of 2-3 ml of contrast. The shape, position of the uterus, its size, position in the pelvic cavity, developmental anomalies, the presence of synechia, postoperative scars, filling of the tubes with contrast and their shape, location are assessed.

3rd and 4th pictures: left and right oblique projections. Lying on the back with the left and right side raised sequentially at an angle of 30°-45°. Introduce, if necessary, the remainder of the contrast. In this case, the patient turns on her side, where the tube is less passable. After 3-5 min. after the first picture.

The magnitude of anteflexio&retroflexion, the condition of the tubes, the level of obturation, and variants of contrast spreading in the abdominal cavity are studied.

5th shot: lying on the stomach. Moreover, the turn on the stomach is carried out through the side where the fallopian tube is poorly passable.

6th and 7th shots: (series of shots in modes 4 shots in 2 sec.) left and right oblique projections. Lying on the stomach in successively raised left and right side at an angle of 30°-45°. They study the condition of the tubes, variants of contrast spreading in the abdominal cavity in the prone position. 3-5 minutes after the fifth shot.

Clinical example No. 1.

FULL NAME. patient P.T.A., age 30 years, Dose 0.4 Mv

A hysterosalpingogram is presented with the conclusion: obturation of both tubes in the intramural sections.

When performed hysterosalpingography is determined:

The uterus is usually located

The contours of the cavity are even, clear;

filling defects: not determined

the volume of the uterine cavity is 2.5 cm ³ ;

on the right, the tube is contrasted throughout, expanded in the ampulla, passable under pressure;

on the left, the pipe is contrasted throughout, passable;

Cott's test is weakly positive on the right;

Cott's test is positive on the left;

Conclusion: X-ray signs of an adhesive process on the right according to the type of ventral sactosalpinx.

Clinical example No. 2.

Echo - HSG data are presented: no pathology was detected.

FULL NAME. patient T.A.M, age 29 years, Dose 0.3 Mzv

When hysterosalpingography is determined:

The uterus is usually located

The contours of the cavity are even, clear;

filling defects: not determined

the volume of the uterine cavity is 3.5 cm ³ ;

on the right, the tube is contrasted throughout, passable.

In the supine position, contrast is deposited in the posterior Douglas space. When turning on the stomach, the spreading of the contrast is normal;

on the left, the tube is contrasted, obturated in the infundibulum;

Cott's test is positive on the right;

Cott's test is negative on the left;

Conclusion: indirect signs of adhesions. (Confirmed by laparoscopy.)

After the rehabilitation of the adhesive process, pregnancy occurred.

Clinical example No. 3.

The description is presented: hysterosalpingography: obturation of both tubes in the intramural sections.

FULL NAME. patient, C Μ C age 21 g Dose 0.25 Mv

When hysterosalpingography is determined:

Uterus in retroflexion position (retroflexio)

The contours of the cavity are even, clear;

filling defects: not determined

the volume of the uterine cavity 3.0 cm ³ ;

on the right, the tube is contrasted throughout, expanded in the ampulla, obturated in the infundibulum;

on the left, the tube is contrasted throughout, expanded in the ampulla, obturated in the infundibulum;

Conclusion: 2-sided sactosalpinx.

Clinical example No. 4.

FULL NAME. patient C.M.A. age 27 years, dose 0.5 Mzv

When hysterosalpingography is determined:

The uterus is deviated to the left

The contours of the cavity are even, clear;

filling defects: not determined

the volume of the uterine cavity is 3.5 cm ³ ;

on the right, the tube is contrasted throughout, obturated in the infundibulum;

on the left, the tube is contrasted throughout, obturated in the infundibulum;

Cott's test is negative on both sides;

3 ml of contrast was additionally injected under pressure. The patency of both pipes was restored.

After the described manipulation, pregnancy occurred.

Claims (6)

A method for performing hysterosalpingography using a Foley catheter under visual control and digital radiography, characterized in that it uses commercially available devices: a Foley catheter that does not require fixation on the cervix, followed by taking pictures in fixed positions in the following order: 1 shot in the anterior-posterior projection lying on the back without contrast; 2 picture in the anterior-posterior projection lying on the back with the introduction of 2-3 ml of contrast, the uterine cavity and the process of filling the tubes with contrast are contrasted; 3-4 picture in the left and right oblique projections: lying on the back with the left and right side raised sequentially at an angle of 30-45 °; then, if necessary, the rest of the contrast is injected: up to 4 ml, while the patient first turns on her side, where the tube is less passable, 3-5 minutes after the first shot; 5 picture: lying on the stomach, and turning on the stomach is carried out through the side where the fallopian tube is poorly passable; 6 and 7 shot 3-5 minutes after the fifth shot: left and right oblique projections: lying on the stomach with the left and right side raised sequentially at an angle of 30-45 °.