RU2831483C2 - Method for selecting optimal concentration of ozone-oxygen mixture in sclerotherapy of breast cysts - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to mammology, and can be used for selection of concentration of ozone-oxygen mixture in sclerotherapy of breast cysts. Ultrasonic examination of mammary gland is performed. Cystic wall thickness is determined. Size of the cystic cavity in the largest section is determined. Content of the cystic cavity is aspirated. 1 ml of cyst content is weighed. Density of the aspirate is determined. Ozone-oxygen mixture is selected on the basis of wall thickness, size of cyst and density of aspirate; volume of injected gas is 1/3 of volume of obtained aspirate.

EFFECT: method enables increasing the effectiveness of treating breast cysts and reducing the rate of recurrent breast cysts due to sclerotherapy of the cystic cavity with an ozone-oxygen mixture of optimum concentration.

1 cl, 4 dwg, 1 tbl, 6 ex

Description

The invention relates to medicine, namely to mammology, and concerns a minimally invasive method for treating breast cysts in fibrocystic mastopathy (FCM) by sclerosing the cystic cavity with an ozone-oxygen mixture.

Analogues, prototype.

There are many options for sclerotherapy of breast cysts. One of the traditional methods is fine-needle aspiration biopsy of the breast cyst with the introduction of an ozone-oxygen mixture into the residual cavity [Ozone-oxygen mixture in the treatment of breast cysts - an alternative to surgical treatment / R.B. Mumladze, N.T. Dzukaeva, S.B. Zapirova [et al.] // Bulletin of the Russian Scientific Center of Roentgenology and Radiology. - 2012. - No. 12-1. - P. 2. - EDN PBTFUJ; Zapirova, S.B. Ozone therapy - a new method of conservative treatment of breast cysts / S.B. Zapirova, M.V. Budanova, N.I. Rozhkova // Bulletin of the Russian Scientific Center of Roentgenology and Radiology. - 2010. - No. 10-1. - P. 21. - EDN NBXSJP]. The technique is as follows: under ultrasound navigation, a needle is inserted into the cavity of the mammary gland cyst in order to aspirate the contents, after which the cystic cavity is washed with saline using a 2-milligram syringe and, without removing the needle, an ozone-oxygen mixture in the required concentration is injected with a 5 or 10 ml syringe in a volume of up to 1/3 of the amount of aspirate obtained [Combined conservative treatment of mammary gland cysts after cosmetic endoprosthetics / I. I. Burdina, S. B. Zapirova, N. I. Rozhkova [et al.] // Medical Science and Education of the Urals. - 2020. - Vol. 21, No. 3 (103). - P. 6-11. - DOI 10.36361/1814-8999-2020-21-3-6-11. - EDN EIEQJE].

The use of ozone-oxygen mixture concentrations from 40 mg/ml to 80 mg/ml is known [Analysis of the effectiveness of minimally invasive treatment methods for breast cysts under ultrasound navigation / M. I. Arabachyan, A. V. Borsukov, V. I. Soloviev, I. A. Timashkov // Oncological journal: radiation diagnostics, radiation therapy. - 2018. - Vol. 1, No. 3. - P. 71-74. - EDN IYHVRF; Arabachyan, M. I. Clinical significance of ultrasound diagnostics in the algorithm of minimally invasive treatment of breast cysts / M. I. Arabachyan, V. I. Soloviev, A. V. Borsukov // Palliative medicine and rehabilitation. - 2019. - No. 2. - P. 44-46. - EDN FVHVQC].

However, the authors do not describe the criteria for selecting concentration in this range. The subjective method of selecting the concentration of the ozone-oxygen mixture has a number of disadvantages, leading to relapses and the need for repeated punctures of the cystic cavity.

The claimed invention is aimed at systematizing the criteria for selecting the optimal ozone concentration depending on the physical properties of the aspirate and the ultrasound parameters of the cystic cavity.

The specified technical (therapeutic) results in the implementation of the invention can be achieved due to the fact that, as in the known method, an ultrasound examination of the mammary gland is carried out, the contents of the cystic cavity are aspirated, and an ozone-oxygen mixture is introduced.

The peculiarity of the claimed method is that the optimal concentration of the ozone-oxygen mixture is calculated according to the following criteria: the thickness of the wall of the cystic cavity is determined; the size of the cystic cavity in the largest cross-section is determined; 1 ml of the cyst contents is weighed and the density of the aspirate is determined according to the formula:

,

where: ρ is the density of the substance, m is the mass, V is the volume,

and if:

- the wall thickness is more than 0.5 mm, the cyst size is less than 1.5 cm, the density of the contents is 1012-1024 g/l, then the concentration of the injected ozone-oxygen mixture is 60 mg/ml;

- the wall thickness is more than 0.5 mm, the cyst size is 1.6-2.5 cm, the density of the contents is 1012-1024 g/l, then the concentration of the injected ozone-oxygen mixture will be 60 mg/ml;

- the wall thickness is more than 0.5 mm, the cyst size is more than 2.5 cm, the density of the contents is 1012-1024 g/l, then the concentration of the injected ozone-oxygen mixture is 80 mg/ml;

- the wall thickness is less than 0.5 mm, the cyst size is less than 1.5 cm, the density of the contents is 1012-1024 g/l, then the concentration of the injected ozone-oxygen mixture is 60 mg/ml;

- the wall thickness is less than 0.5 mm, the cyst size is 1.6-2.5 cm, the density of the contents is 1012-1024 g/l, then the concentration of the injected ozone-oxygen mixture is 60 mg/ml;

- the wall thickness is less than 0.5 mm, the cyst size is more than 2.5 cm, the density of the contents is 1012-1024 g/l, then the concentration of the injected ozone-oxygen mixture is 70 mg/ml;

- the wall thickness is more than 0.5 mm, the cyst size is less than 1.5 cm, the density of the contents is 1025 - 1034 g/l, then the concentration of the injected ozone-oxygen mixture is 70 mg/ml;

- the wall thickness is more than 0.5 mm, the cyst size is 1.6-2.5 cm, the density of the contents is 1025 - 1034 g/l, then the concentration of the injected ozone-oxygen mixture is 70 mg/ml;

- the wall thickness is more than 0.5 mm, the cyst size is more than 2.5 cm, the density of the contents is 1025 - 1034 g/l, then the concentration of the injected ozone-oxygen mixture is 80 mg/ml;

- the wall thickness is less than 0.5 mm, the cyst size is less than 1.5 cm, the density of the contents is 1025 - 1034 g/l, then the concentration of the injected ozone-oxygen mixture is 60 mg/ml;

- the wall thickness is less than 0.5 mm, the cyst size is 1.6-2.5 cm, the density of the contents is 1025 - 1034 g/l, then the concentration of the injected ozone-oxygen mixture is 60 mg/ml;

- the wall thickness is less than 0.5 mm, the cyst size is more than 2.5 cm, the density of the contents is 1025 - 1034 g/l, then the concentration of the injected ozone-oxygen mixture is 80 mg/ml;

- if the density of the contents of the cystic cavity is 1035 - 1042 g/l, then regardless of the wall thickness and size of the cyst, the optimal concentration of ozone-oxygen is 80 mg/ml.

The invention is explained by a detailed description, a clinical example and an illustration, which shows:

Fig. 1 - Determination of the weight of the aspirate on high-precision laboratory scales - DA-4202C (4200 g x 0.01 g) BEL Engineering for the purpose of calculating the density.

Fig. 2 - photo illustration of ultrasound of the cystic cavity before treatment of patient A.I.: a) cyst No. 1: size - 3.1 cm in maximum dimension, wall thickness - 0.6 cm; b) cyst No. 2: size 1.9 cm, wall thickness 0.5 mm.

Fig. 3 - photo illustration of the needle in the cavity after aspiration of the cyst contents.

Fig. 4 - photo illustration of the introduction of an ozone-oxygen mixture into the residual cavity.

The method is carried out as follows.

At the first stage, the ultrasound characteristics of the cystic cavity are assessed: its size and wall thickness. In the absence of contraindications (complex cysts, cysts with a parietal component), fine-needle puncture aspiration of the cystic cavity contents is performed under ultrasound control, with a 21 G needle, the needle is left in the cystic cavity and the density of the aspirate is determined as follows: 1 ml of aspirate is taken from the obtained fluid using a laboratory dispenser, the weight of 1 ml of aspirate is measured on high-precision laboratory scales (e.g., DA-4202C, 4200 g x 0.01 g, BEL Engineering) (Fig. 1). Then the density of the aspirated fluid (mass to volume ratio) is calculated using the formula:

,

Where:

ρ is the density of the substance,

m - mass,

V volume) is calculated.

Our clinical study of 38 patients revealed a relationship between the criteria: wall thickness, cyst size and content density, and the minimum optimal concentration of the ozone-oxygen mixture. This relationship is summarized in Table 1.

Table 1.

Determination of the concentration of ozone-oxygen mixture depending on the ultrasound characteristics of the cystic cavity and the density of the aspirate

Wall thickness
>0.5 mm
<0.5 mm Size of the cystic cavity <1.5 cm 1.6 - 2.5 cm > 2.5 cm Aspirate density 1012 - 1024 g/l 60 mg/ml 60 mg/ml 80 mg/ml
70 mg/ml 1025 - 1034 g/l 70 mg/ml
60 mg/ml 70 mg/ml
60 mg/ml 80 mg/ml 1035 - 1042 g/l 80 mg/ml 80 mg/ml 80 mg/ml

According to Table No. 1, the optimal concentration of the ozone-oxygen mixture required for effective adhesion of the cyst walls is calculated, which is introduced into the residual cavity of the cyst in a volume of 1/3 of the amount of aspirate obtained.

So if:

- the wall thickness is more than 0.5 mm, the cyst size is less than 1.5 cm, the density of the contents is 1012-1024 g/l, then the concentration of the injected ozone-oxygen mixture is 60 mg/ml;

- the wall thickness is more than 0.5 mm, the cyst size is 1.6-2.5 cm, the density of the contents is 1012-1024 g/l, then the concentration of the injected ozone-oxygen mixture will be 60 mg/ml;

- the wall thickness is more than 0.5 mm, the cyst size is more than 2.5 cm, the density of the contents is 1012-1024 g/l, then the concentration of the injected ozone-oxygen mixture is 80 mg/ml;

- the wall thickness is less than 0.5 mm, the cyst size is less than 1.5 cm, the density of the contents is 1012-1024 g/l, then the concentration of the injected ozone-oxygen mixture is 60 mg/ml;

- the wall thickness is less than 0.5 mm, the cyst size is 1.6-2.5 cm, the density of the contents is 1012-1024 g/l, then the concentration of the injected ozone-oxygen mixture is 60 mg/ml;

- the wall thickness is less than 0.5 mm, the cyst size is more than 2.5 cm, the density of the contents is 1012-1024 g/l, then the concentration of the injected ozone-oxygen mixture is 70 mg/ml;

- the wall thickness is more than 0.5 mm, the cyst size is less than 1.5 cm, the density of the contents is 1025 - 1034 g/l, then the concentration of the injected ozone-oxygen mixture is 70 mg/ml;

- the wall thickness is more than 0.5 mm, the cyst size is 1.6-2.5 cm, the density of the contents is 1025 - 1034 g/l, then the concentration of the injected ozone-oxygen mixture is 70 mg/ml;

- the wall thickness is more than 0.5 mm, the cyst size is more than 2.5 cm, the density of the contents is 1025 - 1034 g/l, then the concentration of the injected ozone-oxygen mixture is 80 mg/ml;

- the wall thickness is less than 0.5 mm, the cyst size is less than 1.5 cm, the density of the contents is 1025 - 1034 g/l, then the concentration of the injected ozone-oxygen mixture is 60 mg/ml;

- the wall thickness is less than 0.5 mm, the cyst size is 1.6-2.5 cm, the density of the contents is 1025 - 1034 g/l, then the concentration of the injected ozone-oxygen mixture is 60 mg/ml;

- the wall thickness is less than 0.5 mm, the cyst size is more than 2.5 cm, the density of the contents is 1025 - 1034 g/l, then the concentration of the injected ozone-oxygen mixture is 80 mg/ml;

- if the density of the contents of the cystic cavity is 1035 - 1042 g/l, then regardless of the wall thickness and size of the cyst, the optimal concentration of ozone-oxygen is 80 mg/ml.

An aseptic dressing is applied to the puncture site. The mammary glands are bandaged with an elastic bandage for 12 hours.

Clinical examples.

Example 1 - wall thickness is greater than 0.5 mm, cyst size is greater than 2.5 cm, density of contents is greater than 1035 mg/ml, concentration of injected ozone-oxygen mixture is 80 mg/ml.

Patient A.I., born in 1982, consulted the Clinical Diagnostic Department of the State Institution of the Russian Academy of Gynecology and Orthopedics with complaints of a painless formation in the upper outer quadrant of the right mammary gland and periodic mastalgia. It is known from the anamnesis that about a year before the examination she discovered the above-described formation, and had previously been treated by a gynecologist for benign mammary dysplasia (BMD). During an ultrasound examination, two anechoic formations with smooth, clear contours and distal pseudo-enhancement of the echo signal are located in the upper outer quadrant of the right mammary gland at 10 o'clock - round and oval in shape, measuring 3.1 cm x 1.2 cm; 1.9 cm x 1.4 cm, without blood flow during EDC (Fig. 2, Fig. 3). Given the size of the cystic cavities and the lack of positive dynamics with conservative drug treatment, indications were given for aspiration of the contents of the cystic cavity with sclerotherapy of the latter with an ozone-oxygen mixture. Consent for the manipulation was obtained.

Before the manipulation, the ultrasound characteristics of the cystic cavities were assessed: cyst #1 (Fig. 2 a) size - 3.1 cm in maximum dimension, wall thickness - 0.6 cm; cyst #2 (Fig. 2 b) size - 1.9 cm, wall thickness - 0.5 mm. Under ultrasound navigation, puncture aspiration of the contents of cystic cavity #1 was performed with a 21 G needle. The needle was not removed (Fig. 3), puncture of the adjacent cystic cavity was continued. In parallel, the nurse determined the density of the aspirate of cyst No. 1. The density was determined using the following method: 1 ml of aspirate was collected from the obtained liquid (9 ml) using a laboratory dispenser, followed by measuring its weight on high-precision laboratory scales DA-4202C (4200 g x 0.01 g, BEL Engineering).

Based on the formula: - the density of the obtained liquid was determined.

The density of the contents of cyst No. 1 was 1035 g/l. A similar method was used to determine the density of the contents of cyst No. 2 - 1038 g/l, the volume of the aspirate obtained from cyst No. 2 was 5 ml.

Taking into account the obtained data, using Table No. 1, the concentration of the ozone-oxygen mixture was calculated based on the following criteria: the wall thickness of cystic cavity No. 1 is more than 0.5 cm, the diameter in the maximum cross-section is more than 2.5 cm, the density of the contents is 1035 g/l - the concentration of the injected mixture is 80 mg/ml, the volume of gas injected into cyst No. 1 is 3 ml (⅓ of the volume of the obtained aspirate), based on the same criteria for cyst No. 2, using Table 1, a similar concentration was selected and 1.5 ml of the ozone-oxygen mixture was injected (Fig. 4).

After the manipulation, the palpable formation disappeared. Conservative drug therapy was prescribed, including drugs based on micronized progesterone (Progestogel), indole-3-carbinol (Indole-Forte) and Vitex sacred (Cyclodinone) for 3 months.

In the remote period after 3 months, premenstrual mastalgia clinically disappeared, the mammary gland is soft upon palpation, no formations are palpable. During ultrasound examination, duct ectasia is bilateral, no formations are detected.

Example 2 - wall thickness less than 0.5 mm, cyst size 1.6-2.5 cm, density of contents 1012 - 1024 g/l, concentration of injected ozone-oxygen mixture was 60 mg/ml.

Patient L.K., born in 1988, came to the clinical diagnostic department of the State Institution of the Russian Academy of Medical Sciences with complaints of a palpable mass in the lower outer quadrant of the left mammary gland and premenstrual mastalgia. The mass was discovered about a month before the present examination. She had not been treated before.

The ultrasound characteristics of the cystic cavity were assessed: size 2.2 cm in maximum cross-section, wall thickness - 0.2 cm. Under ultrasound navigation, fine-needle puncture aspiration of the cystic cavity contents was performed with a 21 G needle without removing the needle from the cystic cavity (Fig. 4), the density of the aspirate was determined. From the resulting fluid (6 ml), 1 ml of aspirate was collected with a laboratory dispenser, the weight of the latter was measured on high-precision laboratory scales DA-4202C (4200 g x 0.01 g, BEL Engineering) (Fig. 1). Then, the density of the aspirated fluid was calculated using the standard formula - the ratio of mass to volume. The density was 1019 g / l. Using Table No. 1, the optimal concentration of the administered ozone-oxygen mixture was calculated.

2 ml of ozone-oxygen mixture at a concentration of 60 mg/ml was introduced into the residual cavity of the cyst (Fig. 4).

In the follow-up period of 6 months, no relapses were observed.

Example 3 - wall thickness greater than 0.5 mm, cyst size 1.6-2.5 cm, density of contents 1025 - 1034 g/l, concentration of injected ozone-oxygen mixture equaled 70 mg/ml.

Patient A.A., born in 1989, came to the clinical diagnostic department of the State Institution “Russian State Medical University of Orthopedics” with complaints about the presence of a painless formation in the upper outer quadrant of the left mammary gland.

The ultrasound characteristics of the cystic cavity were assessed: the size in the largest cross-section was 2.1 cm and the wall thickness was 0.6 cm. Fine-needle puncture aspiration of the cystic cavity contents was performed under ultrasound control, with a 21 G needle. 5 ml of straw-yellow fluid was obtained. Without removing the needle, the density of the aspirate was determined by the standard method - by measuring the weight of 1 ml of the obtained fluid on high-precision laboratory scales DA-4202C (4200 g x 0.01 g, BEL Engineering). The density of the aspirate was calculated using the density determination formula (mass to volume ratio). The density was 1031 g/l. Using Table No. 1, the optimal concentration of the ozone-oxygen mixture was calculated, which was 70 mg/ml.

An ozone-oxygen mixture at a concentration of 70 mg/ml was introduced into the residual cavity of the cyst in a volume of 1/3 of the amount of the obtained aspirate.

In the separated period after 6 months - no relapses were observed at the site of the cystic cavity. In the contralateral mammary gland, new cysts were formed that did not require puncture treatment (up to 1 cm in diameter). Conservative drug therapy was prescribed.

Example 4 - wall thickness less than 0.5 mm, cyst size less than 1.5 cm, density of contents 1012-1024 g/l, concentration of injected ozone-oxygen mixture equaled 60 mg/ml.

Patient Sh.T., born in 2001, came to the clinical diagnostic department of the State Institution of the Russian Academy of Medical Sciences with complaints of premenstrual mastalgia in the outer quadrants of both mammary glands, more pronounced on the right in the upper outer quadrant.

The patient was examined, an ultrasound examination of the mammary glands was performed, which revealed that in the upper outer quadrant of the right mammary gland, a round, anechoic formation is located, with smooth, clear contours, with distal pseudo-enhancement of the echo signal, without blood flow during Doppler mapping, the size of the cystic cavity is 1.2 cm x 1 cm, the wall thickness is 0.2 cm. Bilateral duct ectasia with cystic expansion of the milk sinuses is also noted bilaterally.

Considering the severe pain syndrome associated with the presence of a cyst in the upper outer quadrant of the right mammary gland, it was decided to perform fine-needle aspiration of the contents of the cystic cavity and sclerotherapy with an ozone-oxygen mixture.

Under ultrasound guidance, a puncture and aspiration of the contents of the cystic cavity was performed. 4 ml of a straw-yellow liquid was obtained. Without removing the needle, the assistant determined the density of the contents by measuring the mass of 1 ml of aspirate on a laboratory scale using the density determination formula - The density of the aspirated fluid was 1012 g/l.

Using Table No. 1, we calculated the optimal concentration of the ozone-oxygen mixture applicable in this case. The mixture was introduced into the residual cyst cavity at a concentration of 60 mg/ml in a volume of 1/3 of the amount of the obtained aspirate.

In the separated period after 3 months, no relapses were observed; against the background of concomitant drug therapy, premenstrual mastalgia was relieved; after 6 months, there was no relapse of the cyst.

Example 5 - wall thickness is greater than 0.5 mm, cyst size is less than 1.5 cm, density of contents is 1035-1042 g/l, concentration of injected ozone-oxygen mixture is 80 mg/ml.

Patient B.A., born in 1983, came to the clinical diagnostic department of the State Institution of the Russian Academy of Medical Sciences with complaints of a painful lump on the border of the outer quadrants on the left, and an increase in body temperature to 38 degrees. It is known from the anamnesis that the above complaints appeared and began to increase about 3 days before the visit. She had not been seen by a mammologist before.

An ultrasound examination of the area of interest was performed - an oval, anechoic formation with a heterogeneous echostructure, with clear smooth contours, with a distal pseudo-enhancement of the echo signal, 1.3 cm x 0.8 cm in size, wall thickness 0.7 mm, perifocal zone of reduced echogenicity, single blood flow loci are located with color Doppler mapping. The diagnosis was: acute non-lactational mastitis, suppurating cyst of the lower-outer quadrant of the left mammary gland. Under ultrasound guidance, fine-needle aspiration of the contents of the cystic cavity was performed, 4 ml of turbid yellow fluid was obtained. The assistant determined the density of the aspirate by measuring the weight of 1 ml of liquid on high-precision laboratory scales DA-4202C (4200 g x 0.01 g, BEL Engineering) using the density calculation formula - the ratio of mass to volume. The density of the aspirate was 1040 g/l.

Taking into account the obtained data, using table No. 1, the concentration of the ozone-oxygen mixture was calculated to be 80 mg/ml.

An ozone-oxygen mixture was introduced into the residual cavity at a selected concentration of 80 mg/ml in a volume of 1/3 of the amount of the obtained aspirate. Drug therapy was prescribed: Cefepime 1000 mg intramuscularly 2 times a day, Bactroban cream 3 times a day on the infiltrate zone and Ibuprofen 200 mg 2 times a day. On the second day after the start of therapy, the body temperature returned to normal, and a week later, the manifestations of inflammation on the skin disappeared. Dynamic ultrasound examination after 7 days showed that an anechoic formation remained - dimensions 0.7 cm x 0.4 cm. A month later, no formations were located in the area of the suppurating cyst.

Example 6 - wall thickness less than 0.5 mm, cyst size greater than 2.5 cm, density of contents 1012-1024 g/l, concentration of injected ozone-oxygen mixture - 70 mg/ml.

Patient T.L., born in 1979, came to the Clinical Diagnostic Department of the State Institution "RGIVOV" for a routine ultrasound examination. At the time of examination, she complained of a round, displaceable, painful formation in the lower-outer quadrant of the right mammary gland. It is known from the anamnesis that she has been suffering from benign dysplasia of the mammary gland for a long time, a cystic form with multiple small (up to 1 cm) and single large cysts bilaterally. Previously, she received drug therapy with Dostinex, Progestogel, Mastodinone. Fine-needle aspiration of the contents of large cysts of both mammary glands was performed without the use of sclerosants. The treatment had a temporary positive effect - mastalgia decreased, but no significant decrease in the size of the cysts or their number was observed.

Ultrasound examination revealed: multiple small cysts and cystically dilated ducts of the upper outer and lower outer quadrants of the left mammary gland, cysts of the upper outer quadrant of the right mammary gland, a large cyst (size 2.9 cm x 2.4 cm, wall not located, thickness ≈ 0.1 cm) of the lower outer quadrant of the right mammary gland. It was decided to perform fine-needle aspiration of the cyst contents of the lower outer quadrant of the right mammary gland with the introduction of an ozone-oxygen mixture into the residual cavity. Consent for the manipulation was obtained.

Under ultrasound control, a 21G needle was inserted into the cyst cavity, the contents were aspirated, and 11 ml of a straw-yellow liquid was obtained. The assistant determined the density of the obtained aspirate. From the entire volume of liquid, 1 ml of aspirate was collected using a laboratory dispenser, and the mass of the latter was determined using high-precision laboratory scales DA-4202C (4200 g x 0.01 g, BEL Engineering). Using the density determination formula ( calculated the density of the obtained aspirate. The density was 1017 g/l. Using the table we developed, we calculated the optimal concentration of the ozone-oxygen mixture required for sclerotherapy - 70 mg/ml.

An ozone-oxygen mixture at a concentration of 70 mg/ml in a volume of 3.5 ml was introduced into the residual cavity of the cyst.

In the separated period after 3 months, there are no cystic formations in the area of the manipulation, multiple small cysts of both mammary glands remain.

The proposed method allows to increase the efficiency of using ozone-oxygen mixture in the treatment of breast cysts, namely:

- reduce the frequency of recurrence of mammary gland cysts using puncture sclerotherapy with an ozone-oxygen mixture;

- reduce the number of repeated therapeutic punctures in case of relapses or incomplete elimination of the cystic cavity;

- prevent possible complications (bleeding, suppuration) that arise during repeated punctures.

Claims (21)

A method for selecting the concentration of an ozone-oxygen mixture in sclerotherapy of breast cysts, including ultrasound examination of the breast, aspiration of the contents of the cystic cavity and the introduction of an ozone-oxygen mixture under ultrasound navigation, characterized in that the concentration of the ozone-oxygen mixture is determined by the following criteria: the thickness of the wall of the cystic cavity is determined, the size of the cystic cavity in the largest cross-section is determined, 1 ml of the cyst contents is weighed and the density of the aspirate is determined by the formula: ρ = m/V, Where: ρ – density of the substance, m – mass, V - volume, and if: - the wall thickness is more than 0.5 mm, the cyst size is less than 1.5 cm, the density of the contents is 1012-1024 g/l, then the concentration of the injected ozone-oxygen mixture is 60 mg/ml; - the wall thickness is more than 0.5 mm, the cyst size is 1.6-2.5 cm, the density of the contents is 1012-1024 g/l, then the concentration of the injected ozone-oxygen mixture is 60 mg/ml; - the wall thickness is more than 0.5 mm, the cyst size is more than 2.5 cm, the density of the contents is 1012-1024 g/l, then the concentration of the injected ozone-oxygen mixture is 80 mg/ml; - the wall thickness is less than 0.5 mm, the cyst size is less than 1.5 cm, the density of the contents is 1012-1024 g/l, then the concentration of the injected ozone-oxygen mixture is 60 mg/ml; - the wall thickness is less than 0.5 mm, the cyst size is 1.6-2.5 cm, the density of the contents is 1012-1024 g/l, then the concentration of the injected ozone-oxygen mixture is 60 mg/ml; - the wall thickness is less than 0.5 mm, the cyst size is more than 2.5 cm, the density of the contents is 1012-1024 g/l, then the concentration of the injected ozone-oxygen mixture is 70 mg/ml; - the wall thickness is more than 0.5 mm, the cyst size is less than 1.5 cm, the density of the contents is 1025-1034 g/l, then the concentration of the injected ozone-oxygen mixture is 70 mg/ml; - the wall thickness is more than 0.5 mm, the cyst size is 1.6-2.5 cm, the density of the contents is 1025-1034 g/l, then the concentration of the injected ozone-oxygen mixture is 70 mg/ml; - the wall thickness is more than 0.5 mm, the cyst size is more than 2.5 cm, the density of the contents is 1025-1034 g/l, then the concentration of the injected ozone-oxygen mixture is 80 mg/ml; - the wall thickness is less than 0.5 mm, the cyst size is less than 1.5 cm, the density of the contents is 1025-1034 g/l, then the concentration of the injected ozone-oxygen mixture is 60 mg/ml; - the wall thickness is less than 0.5 mm, the cyst size is 1.6-2.5 cm, the density of the contents is 1025-1034 g/l, then the concentration of the injected ozone-oxygen mixture is 60 mg/ml; - the wall thickness is less than 0.5 mm, the cyst size is more than 2.5 cm, the density of the contents is 1025-1034 g/l, then the concentration of the injected ozone-oxygen mixture is 80 mg/ml; - if the density of the contents of the cystic cavity is 1035-1042 g/l, then regardless of the thickness of the wall and the size of the cyst, the concentration of the ozone-oxygen mixture is 80 mg/ml; In this case, the volume of injected gas is 1/3 of the volume of the obtained aspirate.