RU2301691C1 - Method for reconstructive therapy in women of reproductive age with pelvic peritoneal adhesions either with fixed or subfixed uterine retrodeviation - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: it is necessary to fulfill daily impact with currents of supratonic frequency at rectal disposition of an electrode for about 20-25 min and a vaginally introduced mud tampon to be removed about 10-15 min after the procedure. The impact should be performed about 55-65 min after iodine-bromide bath, 10 procedures per a course. The innovation enables to carry out reconstructive therapy in women of reproductive age with pelvic peritoneal adhesions with either fixed or subfixed uterine retrodeviation.

EFFECT: higher efficiency of therapy.

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Description

The invention relates to medicine, in particular to gynecology, and may find application in spa and out-of-resort rehabilitation therapy for women of reproductive age with pelvic peritoneal adhesions with fixed or subfixed uterine retrodevasation.

A fixed or subfixed uterine retrodeviation is observed with pronounced peritoneal pelvic adhesions in the adjacent space and significantly aggravates the condition of patients, as they are accompanied by pain, dysmenorrhea, dyspareunia, impaired bowel movement and a decrease in the reproductive function of a woman due to a sharp restriction (with subfixed uterine retrodeduction or excursions of the uterus.

From resort physical factors that have found application in such a group of patients, a method for treating iodine-bromine waters and therapeutic silt mud is known: baths and gynecological irrigation (12 procedures per course) are alternated with applications of therapeutic silt mud on the “cowards” area, vaginal and rectal tampons, on a course of 10-12 procedures (Keshokova MP Spa treatment of endocrine infertility in women. Collection of scientific papers "Physical factors in the complex treatment of specific endocrine disorders in women", 1986, p.5-10).

The disadvantages of this method of treatment are its relatively low efficiency, possibly due to the fact that rectal tampons are not always held by patients for more than 10-15 minutes due to a strong urge to defecate, a significant duration (24 days). In addition, the use of applications requires a large amount of dirt and additional equipment of physiotherapy centers, which is economically and technically difficult in non-resort conditions.

Of the preformed (hardware) physical factors used in women of reproductive age with the indicated pathology, a method is known for treating supratonal frequency (TNF) currents with a vaginal electrode location (Panfilova E.L. Chronic inflammation of the uterine appendages: justification for intensive TNF therapy. Abstract. Diss. ... candidate of medical sciences, 1997, 24 pp.).

The disadvantages of this method include its relatively low efficiency (only 1 out of 7 women with fixed uterus retrodevation managed to restore its excursion in full, but 6 the uterus remained subfixed), possibly associated with insufficient influence on the posterior space, where commissures are concentrated structures with a fixed or subfixed uterine retrodeviation, as well as a very large number of procedures (30 procedures per course).

The objective of the invention is a more effective method of treating women of reproductive age with pelvic peritoneal adhesions with fixed or subfixed retrodevation of the uterus in women of reproductive age.

The problem is achieved by the method consisting in the fact that daily exposure to currents of supratonal frequency is carried out with a rectal location of the electrode for 20-25 minutes and a vaginally inserted mud swab removed 10-15 minutes after the procedure, and the effect is carried out 55-65 minutes after iodine-bromine bath for a course of 10 procedures.

In practice, the method is as follows.

Treatment begins from the 5-7th day of the menstrual cycle, it is carried out in the following sequence: a common iodine-bromine bath, an hour of rest, a mud vaginal tampon are combined with the simultaneous use of supratonal frequency currents with a rectal electrode location daily for 10 working days.

Methodology for using a general iodine-bromine bath: pour tap water at t = 37 ° C into a 200-liter bath, add 100 ml of 10% potassium iodide solution, 100 ml of 25% sodium bromide solution and 2 kg of sodium chloride. The position of the patient in the bath: lying on his back, the water level - to the armpits. Every day, for 15 minutes. A course of 10 procedures.

The technique of using a mud vaginal swab. The patient's position on the couch: lying on his back, legs bent at the knee and hip joints and slightly divorced. Using a Barzhansky syringe, slowly inject 200 ml of therapeutic silt mud at 42 ° C into the vagina and cover the patient with a blanket. The procedure is carried out daily one hour after the general iodine-bromine bath, the duration of the procedure is 30 minutes, 10 courses per course.

Technique of TNF-therapy. The procedure is carried out simultaneously with a vaginal tampon: immediately after the introduction of therapeutic mud into the vagina, without changing the patient’s position, the cavity electrode (EPI-15) is smoothly inserted into the rectum to a depth of 6-7 cm, the exposure intensity is from 3.5 to 8 W. The procedure lasts 20-25 minutes, then smoothly turn the handle to its original position and remove the electrode. The patient continues to lie on the couch with a vaginal swab for another 10-15 minutes.

This method of treatment is more effective than the known one, since along with a positive effect on the nervous system, it has a trophic, analgesic, and also pronounced defibrosing effect in the case of adjoining localization of adhesions. In addition, with this method of treatment, the uterine excursion is restored in full and the correct position of the uterus is achieved (confirmed by ultrasound data), since the extensibility and elasticity of the adhesive structures in the adjoining space increase. It is short-lived and available in resort and non-resort settings.

The method is illustrated by the following examples.

Example No. 1. Patient B., born in 1977 Diagnosis: Chr. endometritis. Peritoneal pelvic adhesions with subfixed uterine retrodevation. Chronic endometritis Syndrome of stagnation in the pelvis. Cervical erosion. Dyspareunia. Dysmenorrhea. Miscarriage. Emotional lability.

She addressed on 02.16.04 with complaints of pain in the lower abdomen and in the lumbosacral region with irradiation into the rectum, intensifying during sexual intercourse, on menstruation days, on profuse with clots of menstruation, on bowel movement disorders (constipation up to 4 days), on increased irritability and tearfulness. From the anamnesis: menstruation from 11 years, 5 days after 28-30 days, heavy with clots, painful on the eve and on the first day. Last menstruation 02/12/04. Sex life from 16 years old, marriage I, married 2 years. My husband is 30 years old, healthy. One pregnancy, in October 2003 ended in a miscarriage of 17 weeks. In 2002, she was treated with her husband about gardnerellosis, chlamydial and ureaplasma infections. Control smears are normal. With ultrasound diagnostics of the pelvic organs from 02.16.04, uterus retrodeviation, chronic endometritis. With extended colposcopy from 02.16.04 - ectopia of the cervix in the stage of incomplete epidermis, chronic colpitis. When EEG from 02.17.04, cerebral changes with signs of dysfunction of the mesodiencephalic structures of the brain with the involvement of limbic structures are noted. In a two-handed study, the retrodeduction of the uterus of normal size and consistency is determined, as well as pain on palpation and displacement of the uterus towards the womb, excursions are limited to adhesive structures in the adjoining space. Palpation of the walls of the pelvis is painful, the sacro-uterine ligaments are tightened, shortened and painful. Treatment began on March 16, 04 on the 5th day of the menstrual cycle (last menstruation, March 12, 04). Every day, the patient took general iodine-bromine baths in combination with mud vaginal tampons, conducted simultaneously with supratonal frequency currents with a rectal electrode. Methodology for conducting a general iodine-bromine bath: tap water of t = 37 ° C was poured into a 200-liter bath, 100 ml of 10% potassium iodide solution, 100 ml of 25% sodium bromide solution and 2 kg of sodium chloride were added. The position of the patient in the bath: lying on his back, the water level - to the armpits. Duration 15 minutes. The technique of using a mud vaginal swab: a patient lying on a couch with knees and hips bent and slightly spread legs was slowly injected with a Barzhansky syringe 200 ml of therapeutic silt mud into a vagina for a course of 10 procedures. TNF therapy was performed 55-65 minutes after the bath. Immediately after the introduction of therapeutic mud into the vagina, without changing the position of the patient, the cavity electrode (EPI-15) was smoothly inserted into the rectum to a depth of 6-7 cm, the intensity of exposure from 3.5 to 8 watts. The duration of the procedure is 20-25 minutes, but the patient remained on the couch with a vaginal swab for another 10-15 minutes. The duration of treatment was 10 working days. By March 25, 2004, that is, by the middle of the course of treatment, the patient noted an improvement in overall health and mood, and relief of pain. In a two-handed study, palpation of the walls of the pelvis was painless, softening and an increase in the elasticity of adhesive structures in the adjacent space, an increase in the excursion of the uterus to the womb were noted. 03/30/04 two-handed study was painless, uterine excursion in full. With extended colposcopy, there were no signs of colpitis. On EEG from 04/13/04 positive dynamics was noted - an improvement in the metabolic processes of the brain. 2 months after treatment, the patient noted an improvement in the psycho-emotional state, the absence of pain during sexual intercourse, good bowel function and regular emptying, reduction of pain on the eve and on the days of menstruation. 06/11/04 with extended colposcopy, a complete epidermization of ectopy was noted. With a two-handed study, the body of the uterus is in the correct position, its excursions in full, painless. Palpation of the posterior fornix and sacro-uterine ligaments is painless. Ultrasound diagnosis of the pelvic organs from 06/11/04 revealed no pathology. The treatment results were rated by us as “good” and contraception was canceled for the patient. 08/31/04 the patient complained of a delay in menstruation: last menstruation 07/07/04. In a two-handed study, the body of the uterus was increased to 8 weeks, which corresponded to the period of pregnancy by menstruation; the diagnosis is confirmed by ultrasound. 04/06/05 the pregnancy ended with an urgent delivery, a boy was born weighing 3570 grams, 52 cm.

Example No. 2. Patient P., b. 1978 Diagnosis: Peritoneal pelvic adhesions with fixed uterine retrodevation. Chronic salpingoophoritis. Cervical erosion. Dyspareunia. Infertility I. Emotional lability.

She turned on 07.06.05 with complaints of pain during sexual intercourse in the depth of the pelvis with irradiation into the rectum, absence of pregnancy for 4 years of regular sexual life in marriage without protection, violation of bowel movement (constipation up to 2-3 days) and painful defecation, increased irritability and tearfulness, unstable mood. From the anamnesis: menstruation from 13 years, 5 days after 28 days, moderate, slightly painful. Last menstruation 06/01/05. Sex life from 18 years old, married 4 years (husband 43 years old, healthy, has a son 13 years old from his first marriage). A year after marriage, cervical erosion was diagnosed, and chlamydia and ureaplasma were revealed during examination in vaginal smears. She was treated with her husband, control smears are normal. With ultrasound diagnosis of the pelvic organs from 06.06.05 - uterine retrodeviation, chronic salpingo-oophoritis. With extended colposcopy - ectopy of the cervix (in the area of the external pharynx cylindrical epithelium). In a two-handed study, the retrodeduction of the uterus of normal size and consistency is determined, as well as severe pain when trying to displace it, excursions are sharply limited by adhesions in the adjacent space, the appendages on both sides are painful, in numerous adhesions, the arches are shortened, in the adjacent space they are planar and sharply painful commissures.

Every day, the patient took general iodine-bromine baths in combination with mud vaginal tampons, conducted simultaneously with supratonal frequency currents with a rectal electrode. Methodology for conducting a general iodine-bromine bath: tap water of t = 37 ° C was poured into a 200-liter bath, 100 ml of 10% potassium iodide solution, 100 ml of 25% sodium bromide solution and 2 kg of sodium chloride were added. The position of the patient in the bath: lying on his back, the water level - to the armpits. Duration 15 minutes. The technique of using a mud vaginal tampon: a patient lying on a couch with knees and hips bent and legs slightly diluted was slowly injected with a Barzhansky syringe with 200 ml of therapeutic silt mud at t = 42 ° C and covered with a blanket. The procedure was carried out daily after 55-65 minutes after the general iodine-bromine bath, for 30 minutes, in a course of 10 procedures. TLC therapy was carried out immediately after the introduction of therapeutic mud into the vagina: without changing the position of the patient, the cavity electrode (EPI-15) was smoothly injected into the rectum to a depth of 6-7 cm, the exposure intensity from 3.5 to 8 watts. The duration of the procedure is 20-25 minutes. The mud swab was removed after 10-15 minutes. The duration of treatment was 10 working days. After 4 days of treatment, the patient noted a decrease in pain and an improvement in the psychoemotional state. By the 5th day of treatment, a two-handed study was less painful, softening of adhesive structures in the adjacent space and the appearance of a uterine excursion were noted. Immediately after the course of therapy (06/22/05), a two-handed study was not painful, in the area of the uterine appendages and in the posterior space, the juiciness and elasticity of the adhesive structures were determined, and the excursion of the uterus to the womb increased. With extended colposcopy, signs of epidermisation of ectopia were noted. 09/27/05 (2.5 months after treatment) notes an improvement in bowel movement, pain during intercourse and bowel movements are absent. With extended colposcopy - complete epidermization of ectopia. The data of a two-handed study without negative dynamics in comparison with the study 06.22.05. The patient is canceled contraception.

In the gynecological department of restorative treatment of the State University of Nuclear Medicine AG and P of the Russian Academy of Medical Sciences, 34 women aged 20 to 36 years with peritoneal pelvic commissures and fixed (subfixed) uterine retrodevasation were treated in this way. All of them complained of pain in the lower abdomen with radiation to the rectum, aggravated by sexual intercourse and on the days of menstruation. Most (29) patients had abundant, with clots of menstruation. 2/3 had some signs of irritable bowel syndrome. Only one woman did not complain of reproductive function, since she did not have a permanent partner and was protected from unwanted pregnancy. All the rest (33) suffered from infertility, mainly (29) primary. In patients with secondary infertility, pregnancy ended in miscarriage due to an undeveloped pregnancy and in two cases ectopic pregnancies; only two women had children. In 12 (more than 30%) of the examined, certain signs of an allergic reaction to medications, food products or household chemicals were revealed. Therapy was started from the 5-7th day of the menstrual cycle and was carried out for 10 days. Clinical reactions to the treatment were adequate, indicating a good tolerance to physiotherapy. After the period of aftereffect of factors (after 2 months after treatment), with a two-handed examination, the body of the uterus is in the correct position (which is confirmed by ultrasound), its excursions in full, painless, palpation of the amputee space is also painless. The data of extended colposcopy, indicating the complete epidermization of ectopia, confirm the pronounced trophic effect of the applied method of treatment. In addition, after complex treatment with general iodine-bromine baths, mud vaginal tampons and currents of supratonal frequency, all patients noted an improvement in their psychoemotional state; 98.3% relief or a significant reduction in pain, including during sexual intercourse and on the days of menstruation; 72% reported an improvement in bowel movement. Dynamic monitoring of patients after treatment ranged from 1 month to 1.5 years. During this time, the treatment results were stable, no pain exacerbation was observed in any patient. 7 women restored reproductive function, as evidenced by normal childbirth in 2 and progressive pregnancy in 5 patients.

Thus, the proposed method of treatment gives a higher positive and lasting effect compared with the known; it is short-lived and easy to implement not only in resort, but also in extra-resort conditions.

Claims (1)

A method of restorative treatment of women of reproductive age with pelvic peritoneal adhesions with fixed or subfixed uterine retrodevation, including the use of supratonal frequency currents, characterized in that the daily exposure to supratonal frequency currents is carried out with a rectal electrode location for 20-25 minutes and a vaginally inserted mud swab removed 10-15 minutes after the procedure, and the effect is carried out 55-65 minutes after the iodine-bromine bath for a course of 10 procedures.