Endolymphatic Drug Therapy with Laser Irradiation of the Uterine Cavity in Complex Treatment of Acute Endometritis

The research is dedicated to the development and comprehensive evaluation of the effectiveness of endolymphatic drug therapy in combination with laser irradiation of the uterine cavity in the treatment of acute endometritis. The relevance of the work is due to the insufficient effectiveness of traditional methods of therapy for acute endometritis, which is associated with the severity of the infectious process, a decrease in peripheral lipid peroxidation, arterial oxygenation of the spleen, and immune reactivity. The study provides anatomo-topographic substantiation of endolymphatic therapy methods, develops criteria for the combined use of endolymphatic drug administration with laser irradiation, and evaluates the impact of the proposed technique on immune status and lipid peroxidation processes in patients with acute endometritis.

Relevance of the study. The problem of purulent-inflammatory diseases is one of the most complex and far from resolved problems in obstetrics and gynecology (Gurtovoy B.L., 2006; Serov V.N., 2001; Krasnopolsky V.I., 2006; Peterson N.V. et al., 2001). Particular attention in the structure of purulent-inflammatory complications deserves endometritis after cesarean section, which, being the most common delivery operation, accounts for up to 80% of purulent-inflammatory complications from the total number of births (Kulinic S.I., 1999). In the structure of post-abortal diseases, endometritis account for 13.5-55% of all complications (Krasnopolsky V.I. et al., 1994; Katelnikov A.V. et al., 1999; Nomura R.M. et al., 2004).

The frequency of severe complications of endometritis, among which peritonitis, pelvic abscesses, and sepsis are included, constitutes less than 2% of the total number of endometritis (Manukhin I.B. et al., 2000; Ivanov P.A., 2001; Gurtovoy B.L., 2006; Repina M.A. et al., 2003; Kwast V.E., 1997), but it is precisely their share that accounts for a significant number of cases of maternal mortality.

Questions of etiology and pathogenesis of acute endometritis are sufficiently thoroughly covered in the literature. However, to date, the pathogenesis of endometritis has not been finally studied, and research in this direction continues (Krasnopolsky V.I. et al., 2006; Polk N., 2000). A characteristic feature of endometritis in modern conditions is its polyetiological nature. Microbial associations possessing more pronounced pathogenic properties, as a rule, cause the development of severe forms of the disease (Nikonov A.P., Ankirskaya A.S., 1991; Savicheva A.M. et al., 1996; Strizhakov A.N., Podzolkova N.M., 1996; Sidorova I.I. et al., 2006; Segal S., 2003).

Despite the great achievements of modern medicine, the problem of therapy of acute endometritis remains one of the most important tasks of gynecology (Strizhakov A.N., 1998; Pobedinsky N.M., 1999; Krasnopolsky V.I., 2001; Kasabulatov N.M. et al., 2006; Barbosa S., 1998; Macasaet M., 1999; Brockmann S., 2001; Nomura R.M. et al., 2004). In the treatment of endometritis, a large arsenal of medicinal means is used, the effectiveness of which turns out to be insufficient, which is due to the severity of the course of the infectious process, a decrease in POL, AOS, and immune reactivity. All this dictates the necessity of searching for new, effective methods of treatment of acute inflammatory diseases of the uterus (Gurtovoy B.L. et al., 2006; Lyakhovera O.V., 2003; Serov V.N., 1997; Marindole J.L., 2002).

In recent years, as part of complex anti-inflammatory therapy, in surgical practice for severe advanced purulent processes, endolymphatic drug therapy has been successfully applied. The method has been developed through numerous clinical-experimental studies and has wide practical application (Vyrenkov Yu.E., 1999; Yarema I.V. et al., 2007). In obstetric and gynecological practice, there are no examples of the application of endolymphatic therapy in combination with laser irradiation of the uterine cavity in the treatment of acute endometritis.

All of the above determines the necessity of conducting scientific research to study the effectiveness of the application of endolymphatic drug therapy in combination with laser irradiation of the uterine cavity in complex treatment of acute endometritis.

Goal of the study: To improve the results of treatment of patients with acute endometritis through endolymphatic administration of drugs in combination with laser irradiation of the uterine cavity.

Tasks of the study:

1. To substantiate the appropriateness and effectiveness of the application of endolymphatic drug therapy in combination with laser irradiation of the uterine cavity in the treatment of acute endometritis.

2. Based on clinical-laboratory and ultrasound studies of the small pelvis, to develop criteria for the combined application of endolymphatic administration of drugs with laser irradiation of the uterine cavity and to substantiate indications and contraindications for their use in clinical practice.

3. To assess the influence of endolymphatic drug therapy in combination with laser irradiation of the uterine cavity on the expression of immune status, free radical processes of POL, and their significance in the pathogenesis of acute endometritis.

4. To provide a comparative clinical analysis of the direct results obtained from the application of endolymphatic drug therapy in combination with laser irradiation of the uterine cavity in the treatment of acute endometritis.

Scientific novelty of the research:

Anatomo-topographic substantiation of the methods of endolymphatic drug therapy in combination with laser irradiation of the uterine cavity in the treatment of acute endometritis has been provided.

Based on clinical, laboratory, and instrumental studies, a comprehensive assessment of the effectiveness of the application of endolymphatic drug therapy in combination with laser irradiation of the uterine cavity in patients with acute endometritis has been conducted.

The influence of endolymphatic drug therapy in combination with laser irradiation of the uterine cavity on the dynamics of immunological indicators in patients with acute endometritis has been studied.

It has been established that in the overwhelming majority of cases, the septic complication of acute endometritis proceeds against the background of immunosuppression and is accompanied by an increase in the intensity of lipid peroxidation processes, which has prognostic significance.

Practical significance:

1. A methodology for complex treatment of patients with acute endometritis using endolymphatic drug therapy with laser irradiation of the uterine cavity has been developed.

2. The effectiveness of endolymphatic drug therapy with laser irradiation of the uterine cavity has been evaluated on a large clinical material compared with the traditional method of treatment.

3. The proposed method of endolymphatic drug therapy with laser irradiation of the uterine cavity has made it possible to identify advantages over the traditional method of administration of antibiotics, immunostimulants, and antioxidants.

4. The positive results obtained in the treatment of patients with acute endometritis allow the introduction of endolymphatic drug therapy in combination with laser irradiation of the uterine cavity into clinical practice as an effective and economical method of treatment of acute endometritis.

Main provisions for defense:

1. Endolymphatic administration of drugs with laser irradiation of the uterine cavity has a pronounced positive effect on the normalization of immune status, products of POL, AOS, and reduction of endogenous intoxication of the body in acute endometritis.

2. Criteria for the effectiveness of endolymphatic therapy with laser irradiation of the uterine cavity in the treatment of patients with acute endometritis have been determined (clinical-laboratory, ultrasound of pelvic organs).

3. The application of endolymphatic drug therapy in combination with laser irradiation of the uterus in complex treatment of patients with pronounced endogenous intoxication contributes to achieving a sustained clinical-laboratory effect, reducing the number of postoperative complications, and shortening the duration of hospital treatment.

4. The method of endolymphatic drug therapy with laser irradiation of the uterus has reliable advantages over traditional methods of treatment of severe forms of endometritis in achieving the overall clinical effect, the possibility of avoiding loss of the uterus as a primary focus of infection, and better distant results.

Validation of the work:

The main provisions of the dissertation have been reported and discussed at:

1. I Congress of Lymphologists of Russia (Moscow, 2003);

2. At the II Congress of Lymphologists of Russia (St. Petersburg, 2005);

3. At the VIII All-Russian Scientific Forum "Mother and Child" (Moscow, 2006);

4. At the XVI Congress of Surgeons of Dagestan, dedicated to the 50th anniversary of the Dagestan Society of Surgeons named after R.P. Askerkhanov (Makhachkala, 2006);

5. At the conference "New in Surgery of Dagestan" (Makhachkala, 2007);

6. At the All-Russian Scientific Forum "Mother and Child" (Moscow, 2007);

7. Interdepartmental scientific-practical conference of the departments of hospital surgery, operative surgery and topographic anatomy, anesthesiology and resuscitation, disaster medicine, pathological anatomy, laboratory of clinical and experimental surgery of the OKM NIMS Moscow State Medical and Dental University, laboratory of operative surgery and clinical lymphology of the Russian Academy of Postgraduate Education, October 19, 2007.

Publication:

15 scientific works have been published on the dissertation topic, including 2 in journals included in the "List of leading peer-reviewed scientific journals and publications in which the main scientific results of dissertations for the degree of Doctor and Candidate of Sciences should be published."

Methodological recommendations and a rationalization proposal are available.

Implementation of the results in practice:

The developed method is used in complex treatment of patients with acute endometritis at the Republican Interdistrict Multidisciplinary Hospital (settlement Shamil'kala), the Republican Center for Clinical Lymphology (city Makhachkala), and the Tlyaratinsky Central District Hospital (Republic of Dagestan). The main provisions of the dissertation are used in reading lectures and conducting practical classes at the Department of Operative Surgery and Topographic Anatomy of the Dagestan Medical Academy.

Volume and structure of the dissertation