Modern technology in the treatment of patients with purulent inflammatory diseases of uterine appendages

Introduction:

Inflammatory diseases of the uterus continues to occupy first place in the structure of gynecological pathology. In Russia, they are detected in 60–65% of outpatients and 30% of hospitalized patients, while 4–15% of women are diagnosed with purulent inflammation of the uterine appendages (PIDUA). Violations of the reproductive system appear almost in every second patient, and the frequency of ectopic pregnancy increased by 10 times.

The task of the study:

To evaluate the effectiveness of the combined use of laparoscopy and intra-arterial perfusion of long-term (IAPLT) of drugs in the treatment of complicated forms PIDUA in women of reproductive age.

Materials and methods:

The study included 52 women with PIDUA interested in reproductive function. The average age was 25.7±1.4 years. After a complete clinical and laboratory examination of all the women were held sparing surgery laparoscopic access. Further, all patients were randomized into two groups: the core group included 23 women who are in rehabilitation after laparoscopic treatment was the method of IAPLT. An intraarterial catheter was inserted in surgery in rentgenoperation theatre according to Seldinger method. After the catheter is inserted at the level of the internal iliac artery the perfuzomat was connected. The composition of the perfusate consisted of drugs that improve blood rheology, microcirculation, and antibiotics. Comparison group consisted of 29 patients with conventional postoperative care.

Results:

In the course of treatment in women primary group of intra-and postoperative complications were noted. The dynamic of laparoscopy or laparotomy was not required. During the second-third day there was normalization of body temperature, reduction of pain and reduction of intoxication syndrome. In contrast, two women in the comparison group had continuing hyperthermia, persistent pain and the presence of positive peritoneal signs emerged. Therefore there was a need for a dynamic remediation laparoscopy.

Laboratory findings in patients compared groups showed a significantly more rapid dynamics of reducing the number of leukocytes, C-reactive protein and medium-molecular peptides, as well as normalization of leukocyte counts in the main group of women compared with those of patients with traditional postoperative care (p<0.001).

Conclusion:

The results indicate a high clinical effectiveness of combined treatment (laparoscopy + IAPLT) of the patients of reproductive age with PIDUA. However a final assessment of their reproductive function requires further observation.

Keywords:

Purulent inflammation of the uterine appendages, laparoscopy, intraarterial infusion of antibiotics.