RU2493863C1 - Method of treating chronic non-specific endometritis - Google Patents

Abstract

FIELD: medicine.SUBSTANCE: invention refers to medicine, namely gynaecology, and may be used for treating the patients with chronic non-specific endometritis. The method is implemented as follows: a therapeutic agent that is polyvalent complex pyobacteriophage in a dose of 4-7 ml is introduced in a female patient with a completely empty bladder on the 5-7postmenstrual day. There are 5 procedures of administering pyobacteriophage required. That is followed by the exposure to low-intensity infrared pulse laser at wave length 0.89 mcm, frequency 80 Hz, pulse power 5 Wt; the cutaneous daily 10-minute exposure covers the underbelly. For the 5 of 10 minutes, the exposure covers a projection of the uterus, while for the rest 5 minutes, a projection of the annexes are exposed. The therapeutic course is 10 procedures. Besides, the underbelly exposure is combined with the daily exposure covering a projection of the cubital vessels and the suprasternal notch for 2-3 minutes with the therapeutic course making 10 procedures. The exposure on a projection of the cubital vessels and the suprasternal notch may be both combined with the underbelly exposure, and follow the same.EFFECT: method provides the clinical effectiveness and provides ensures reducing the clinical manifestations of the disease, improving the ultrasound, doppler and laboratory parameters, normalising the genital micro-biocoenosis, optimising the female reproductive functions in a combination with a low rate of potential systemic side effects.3 cl, 3 ex

Description

The proposed method relates to medicine, namely to gynecology, and can be used to treat patients with chronic non-specific endometritis.

It is known that with chronic endometritis (CE) the following morphological features are observed: leukocyte infiltration of the endometrium, the appearance of plasma cells, proliferation of local connective tissue (fibrosis and sclerosis), leading to vascular microcirculatory disorders, edema, compaction of the stroma, focal hemorrhage, ischemia occurs . Such changes are the cause of violations of the functional state of the endometrium - disorders of the menstrual function, impaired embryo implantation processes, resulting in infertility, miscarriage, IVF failures, aggravated pregnancy and childbirth.

In the treatment of chronic endometritis, it is necessary to maximize the trophism of the inner lining of the uterus by restoring microcirculation, normalizing the rheological properties of blood, eliminating edema and infiltration, optimizing local immunity factors, as well as local specific effects on a possible etiological agent, while reducing the likelihood of systemic side effects.

Known methods of treating chronic endometritis: antibiotic therapy to suppress pathogenic microflora, vasotropic drugs to improve blood supply to the pelvic organs, immunocorrection, desensitization, stimulation of receptors for sex steroids, and various types of physiotherapy.

The recommended physiotherapy includes, depending on the course and duration of chronic endometritis: pulsed ultrasound, zinc electrophoresis, potassium iodide electrophoresis, pelvic decompression, diadynamic currents, pulsed low-frequency electrostatic field, supratonal frequency current (1-3). The need for sanitation of the endometrium is not in doubt, however, the traditional antibiotic treatment of chronic endometritis by parenteral or oral administration of drugs is ineffective in most cases, given the gradual development of antibiotic resistance and their low concentration in the focus of inflammation. In addition, the use of antibiotics often leads to the development of dysbiosis, superinfection (auto-infection by conditionally pathogenic microbes) and aggravation of an existing inflammatory process in the uterus.

At the present stage, sparing tactics in the treatment of chronic nonspecific inflammation in the endometrium, in particular antibiotics, which can be used only when signs of exacerbation of endometritis, including those arising in response to physiotherapeutic procedures, are recognized as the most appropriate. In the period of remission, the appointment of antibiotics and sulfa drugs is unreasonable.

Taking into account these positions, it is proposed to carry out the treatment of CE by means of intrauterine therapeutic manipulations, as a result of which there is a local effect of medications in the immediate focus of inflammation.

So in (4) it was recommended to carry out intrauterine irrigation with a liquid bacteriophage at a dose of 20 ml (in accordance with the identified pathogen) daily for 5 days. At the same time, the authors cite data on the rather high efficiency of phagotherapy in the treatment of chronic endometritis.

A known method of treating chronic endometritis by conducting intrauterine ozone laser therapy, which includes both intrauterine installations of ozonized physiological solution with a concentration of from 2 to 3 mg / l in an amount of up to 10 ml, with a course of 6 to 10 procedures, and intrauterine laser therapy of the endometrium with using radiation from a He-Ne laser. This method is effective in women with infertility and miscarriage due to the uterine factor (5, 6).

There is also a method of treating patients with chronic endometritis by intrauterine administration of the antimicrobial drug Instillagel (7).

The main disadvantages of these methods are their lack of effectiveness, a significant number of relapses of the disease and secondary exacerbations, the duration of the endometrial restoration processes, the possible resistance of the pathogenic flora to antibiotics, their poor tolerance by patients, the low concentration of the antibiotic directly in the focus of inflammation, the presence of systemic side effects (during antibacterial therapy), and in some cases - poor tolerance of preformed factors ( in particular, electrophoresis), an inhibitory effect on the processes of folliculogenesis (drugs based on potassium iodide).

The closest set of essential features to the proposed method is a known method for the treatment of chronic endometritis, which the authors have chosen as a prototype.

This method involves intramuscular administration of 1 ml of a 1% nicotinic acid solution after 15 minutes. after that, a low-intensity infrared pulsed laser radiation with a wavelength of 0.89 μm, a pulse repetition rate of 600 Hz, and a pulse power of 5 W for 8-10 minutes is applied to the lower abdomen. daily, a course of treatment of 10-12 procedures (8).

The method allows to treat patients with chronic endometritis.

However, this method is not effective enough in the treatment of chronic non-specific endometritis. And, in addition, individual intolerance to the drug of nicotinic acid by some patients is possible, as well as a high frequency of possible systemic side effects due to the possible potentiation of the systemic antihypertensive effect with the combined use of nicotinic acid and exposure to low-intensity infrared pulsed laser radiation.

The objective of the invention is to provide an effective method for the treatment of chronic non-specific endometritis, with a low frequency of possible systemic side effects.

The problem is solved by the proposed method for the treatment of chronic non-specific endometritis, including the introduction of a medicinal product and subsequent exposure to the lower abdomen with low-intensity infrared pulsed laser radiation with a wavelength of 0.89 μm, a pulse power of 5 W, daily for 10 minutes, with a course of treatment 10 procedures according to the invention, as a therapeutic drug, use a multivalent complex pyobacteriophage, which is administered intrauterine in an amount of 4-7 ml every other day, with a treatment course of 5 cedure, the effect of low intensity infrared pulsed laser radiation frequency of 80 Hz is carried out, affecting the data further radiation and projection cubital vessel and jugular notch daily for 2-3 min. with a course of treatment of 10 procedures.

It is preferable that the exposure to the skin on the lower abdomen is performed cutaneously for 10 minutes, of which: 5 minutes on the projection of the uterus and 5 minutes on the projection of the appendages.

Preferably, the radiation exposure on the projection of the cubital vessels and the jugular notch can be carried out both simultaneously with the radiation exposure on the lower abdomen, and after its exposure.

The technical result is to increase the effectiveness of the proposed method by inhibiting the growth of nonspecific opportunistic microflora, which is an etiological factor in the development of chronic nonspecific endometritis, the absence of intolerance to the drug in patients and a decrease in the frequency of likely systemic side effects of treatment.

The technical result is achieved by the fact that a multivalent complex pyobacteriophage is used as a therapeutic drug, which is administered intrauterine in an amount of 4-7 ml every other day, during a course of treatment of 5 procedures, exposure to low-intensity infrared pulsed laser radiation is carried out at a frequency of 80 Hz, affecting this radiation additionally on projection of cubital vessels and jugular tenderloin daily for 2-3 minutes, with a course of treatment of 10 procedures.

This technical result is due to the fact that:

- the introduction of an intrauterine device as a therapeutic drug of a multivalent complex pyobacteriophage, leads to a more pronounced anti-inflammatory and immunomodulating effect, due to the suppression of the growth of nonspecific opportunistic microflora;

- the additional effect of low-intensity infrared pulsed laser radiation on the projection of the cubital vessels and jugular notch also affects the severity of the anti-inflammatory and immunomodulating effect;

- exposure to low-intensity infrared pulsed laser radiation with a frequency of 80 Hz leads to improved microcirculation in the pelvic organs, trophism of the uterine lining, elimination of edema and endometrial infiltration, optimization of local and general immunity factors.

The proposed method is as follows

A patient on the 5-7th day of the menstrual cycle, after emptying the bladder, 4-7 ml of the multivalent complex pyobacteriophage therapeutic agent is intrauterine injected, every other day, during the course of treatment, 5 procedures, after which they are exposed to low-intensity infrared pulsed laser radiation with a wavelength of 0.89 μm, with a frequency of 80 Hz, a pulse power of 5 W, cutaneous on the lower abdomen daily for 10 minutes, of which 5 minutes. on the projection of the uterus and 5 min. on the projection of the appendages, with a course of treatment of 10 procedures, and daily, along with exposure to the lower abdomen, this radiation affects the projection of cubital vessels and jugular tenderloin for 2-3 minutes, with a course of treatment of 10 procedures. In this case, the radiation exposure on the projection of the cubital vessels and jugular notch can be carried out both simultaneously with the radiation exposure on the lower abdomen, and after its exposure.

The proposed method was treated 23 patients with chronic non-specific endometritis.

As a result of the treatment, the menstrual function quickly returned to normal, the pain symptom was stopped, the pathological discharge from the genital tract stopped, the general state of health improved, with the subsequent restoration of the reproductive function in the treated women.

Examples of specific performance of the proposed method

Example 1

Patient B., 26 years old.

Complaints about the absence of pregnancy, aching pains in the lower abdomen, unpleasant discharge from the genital tract, dark brown discharge after menstruation. A year ago, therapeutic and diagnostic curettage of the uterine cavity was made in connection with an undeveloped pregnancy of short duration and repeated curettage for the remains of the ovum. Subsequently, anti-inflammatory therapy and a comprehensive examination of the couple were carried out. According to hysteroscopy and morphological findings - chronic non-specific endometritis, an increase in IL-6 was noted in cervical mucus. It was examined for urogenital infections, reproductive hormones, AFL syndrome - no pathology was detected. At the time of examination, somatic and gynecological status without features. Functional diagnostic tests revealed ovulatory cycles with a complete second phase. The patient was treated with the proposed method.

For this, the patient, starting from the 5th day of the menstrual cycle, after emptying the bladder, 4 ml of the drug - polyvalent complex pyobacteriophage (“Pyobacteriophage complex liquid” R No. LS-000700, manufacturer: FGU NPO Microgen MH RF) was intravenously injected through day, during the course of treatment, 5 procedures, then they were exposed to low-intensity infrared laser radiation with a wavelength of 0.89 μm, a frequency of 80 Hz, and a pulse power of 5 W per skin on the lower abdomen daily for 10 minutes, of which: 5 minutes on the projection of the uterus and 5 minutes Datko at 10 course of treatment procedures, as well as daily, along with the action on the abdomen, simultaneously exposed to radiation projection data cubital jugular vessels and cutting for 2 minutes, at 10 course of treatment procedures.

After treatment, the patient did not complain, the content of IL-6 in cervical mucus decreased by half within a month and a half, positive dynamics of the cytomorphological characteristics of aspirate from the uterine cavity was noted, there were no sonographic and dopplerometric signs of chronic endometritis, and the dynamics of the increase in endometrial thickness was adequate. 3.5 months after completion of treatment, pregnancy occurred without clinical and ultrasonic signs of a threatened miscarriage.

Example 2

Patient R., 26 years old.

Complaints about the absence of children due to failure of the IVF and PE procedures, aching pains in the lower abdomen. For 5 years, suffers from infertility of tubal-peritoneal genesis. For bilateral hydrosalpinxes, laparoscopic removal of the fallopian tubes and then IVF, which did not give an effect, were previously performed (2 attempts). According to hysteroscopy and morphological studies of endometrial scrapings, chronic non-specific endometritis, hypoplastic variant. In the cervical mucus, an increase in IL-6 was noted, according to immunohistochemical studies, a decrease in the expression of estrogen receptors. Somatic and gynecological status without features.

The patient was treated with the proposed method as in example 1.

In this case, the patient was injected with the medicinal product on the 7th day of the menstrual cycle in the amount of 7 ml, and radiation exposure on the projection of the cubital vessels and jugular excision was carried out for 3 minutes after exposure to the lower abdomen.

After treatment, the content of IL-6 in cervical mucus within a month and a half decreased to normal values, there are no echographic and dopplerometric signs of chronic endometritis, and the dynamics of the increase in the thickness of the endometrium are adequate. 4 months after completion of treatment after IVF and PE, pregnancy occurred.

Example 3

Patient I., 30 years old.

Complaints of miscarriage, aching pain in the lower abdomen. A history of three spontaneous miscarriages followed by curettage of the uterine cavity. The last miscarriage 1.5 years ago, complicated by endometritis. Subsequently, anti-inflammatory therapy and a comprehensive examination of the couple were carried out. The husband is healthy. According to the cytomorphological conclusion of the aspirate from the uterine cavity, chronic non-specific endometritis, an increase in IL-6 was noted in cervical mucus. It was examined for urogenital infections, reproductive hormones, AFL syndrome - no pathology was detected. There is concomitant type 1 diabetes mellitus. At the time of examination, gynecological status without features. Functional diagnostic tests revealed ovulatory cycles with a complete second phase. Diabetes at the time of pregnancy planning is compensated.

The patient was treated with the proposed method as in example 1.

In this case, the patient was injected with the medicinal product on the 5th day of the menstrual cycle in the amount of 7 ml, and the exposure to radiation on the projection of the cubital vessels and jugular excision was carried out for 2 minutes simultaneously with the exposure to radiation on the lower abdomen.

After treatment, the patient had no complaints of pain, the content of IL-6 in cervical mucus returned to normal within a month, positive dynamics of the cytomorphological characteristics of aspirate from the uterine cavity were noted, there were no sonographic and dopplerometric signs of chronic endometritis, and the dynamics of the increase in the thickness of the endometrium were adequate.

2 months after completion of treatment, pregnancy occurred without clinical and ultrasonic signs of a threatened miscarriage, which ended in a successful emergency delivery. The baby is healthy.

As can be seen from the obtained results, the proposed method is effective in treating women with chronic nonspecific endometritis, which allows to achieve: stopping the clinical manifestations of the disease, improving ultrasound, Doppler and laboratory parameters, normalizing the genital tract microbiocenosis, optimizing the woman's reproductive function, at a low frequency of probable systemic side effects.

Information sources

1. Strugatsky V.M. and other Physiotherapy in the practice of an obstetrician-gynecologist MEDpress-Inform, 2005, p.208.

2. Entin B.V. et al. Frequency and characteristics of the course of chronic non-specific endometritis in infertile women. Obstetrics and Gynecology, 1985, No. 7, p. 35.

3. Arslanyan K.N. et al. Importance of rheographic studies in patients with chronic inflammation of the uterus. Bulletin of the Russian Association of Obstetricians and Gynecologists, 2000, No. 1, p. 72.

4. Padrul M.M. etc. The use of bacteriophages in the treatment of chronic endometritis. Materials of the V Russian Forum "Mother and Child", M., 2003, p. 287.

5. Zuev V.M. and other Intrauterine ozone laser therapy of chronic endometritis. Materials of the IV All-Russian scientific-practical conference "Ozone and methods of efferent therapy in medicine", 2001, p.108.

6. Zuev V.M. and other new technologies in the treatment of inflammatory diseases of the female genital organs. Materials of the first regional scientific forum "Mother and Child", Kazan, 2007, p.246.

7. Tkachenko L.V. and other medical aspects of the use of the drug "Instillagel" in chronic endometritis. Scientific Bulletin of the Tyumen Medical Academy, 2000, No. 2, p.115.

8. The prototype. RF patent No. 2233186, application No. 2003106889/14 dated 12.03.2003 for “A method for the treatment of chronic endometritis”, author. Sandakova E.A. and etc.

Claims (3)

1. A method of treating chronic nonspecific endometritis, comprising administering a drug and subsequent exposure of the lower abdomen with low-intensity infrared pulsed laser radiation with a wavelength of 0.89 μm, a pulse power of 5 W, for 10 minutes daily, with a course of treatment of 10 procedures, characterized the fact that a multivalent complex pyobacteriophage is used as a therapeutic drug, which is administered intrauterine in an amount of 4-7 ml, every other day, with a course of treatment of 5 procedures, the effect of low-intensity infra asnym pulsed laser radiation frequency of 80 Hz is carried out, affecting the data further radiation and projection cubital vessel and jugular notch daily for 2-3 min at 10 course of treatment procedures. 2. The method according to claim 1, characterized in that the exposure to cutaneous radiation on the lower abdomen is carried out for 10 minutes, of which 5 minutes on the projection of the uterus and 5 minutes on the projection of the appendages. 3. The method according to claim 1, characterized in that the exposure to radiation on the projection of the cubital vessels and jugular notch can be carried out both simultaneously with the exposure to radiation on the lower abdomen, and after its exposure to the lower abdomen.