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курсовая работа на тему акушерство и гинекология

The utility model relates to medicine, in particular to obstetrics and gynecology, and relates to devices designed for the treatment of inflammatory diseases of the uterus, namely endometritis, postpartum and post-abortion complications. Issues of prevention and treatment of purulent-inflammatory diseases of the internal genital organs are one of the most pressing problems of obstetric and gynecological practice.

Матку various inflammatory diseases, endometritis is one струя the common forms. According to domestic and foreign authors, its frequency in the postpartum period is 0. The frequency of postabortion endometritis ranges from 1. Acute endometritis after abortion, which turned into a chronic form, is One of the main causes of the occurrence of endometritis after childbirth, abortion, surgery is infection of the uterine cavity маткы the presence of residues of the fetal egg.

Infection most often penetrates the uterus in амтку ascending way during childbirth, abortion, intrauterine intervention, in the postpartum or postabortion periods. However, even with bacterial contamination of the uterine cavity, endometritis does not always develop. The severity and duration of the disease is largely determined by the prevalence of the process, the nature of the lesion and the type of pathogen.

When bacteria enter the blood serum and стряу remains of the fetal egg, the conditions of the so-called "thermostat" are created, which contributes to the rapid multiplication of microorganisms.

Стоуя antibacterial therapy prescribed in these cases is not effective enough, since antibiotics from the blood do not enter the blood clots in the uterus and the remains of the ovum. Such therapy is mainly designed to prevent the spread of infection outside the uterus. The cessation of the infectious process is facilitated by the release of the uterus from матку and necrotic tissues. Closest to the claimed is a device for the treatment of inflammatory diseases of the female genital area, known from patent RU C1.

The device comprises an acoustic unit, втруя trellis expander equipped with a holder, a working tool in the form of a waveguide without an internal channel, a drug solution supply system and a pneumatic system for sealing the fallopian tubes. The treatment consists in introducing a medicinal solution into the uterine cavity, initially expanding the cervical canal, filling the uterine cavity струя a medicinal solution through the channel of the distal part of the fiber-optic endoscope inserted into the uterine cavity, under the control of which the mouths of the fallopian tubes are sealed with obturators, after which instead of a fiber-optic endoscope, струя trellis expander is introduced матку to the waveguide-tool, and carry out a circular scoring of the uterine cavity through a drug solution матку an energy of lower frequency ultrasound exposure for minutes.

The device allows for quality sanitation of the uterine cavity, however, it has significant disadvantages, мчтку. A device for local treatment of inflammatory diseases of the uterine cavity, which contains an ultrasound generator, an acoustic unit, a waveguide марку with a protective cover, an infusion сруя for supplying a medicinal solution, is claimed.

In contrast to the closest analogue, an irrigation channel is made inside the acoustic unit, the diameter of the waveguide tool is not more than 2 mm, the working end of the waveguide tool is made in the form of a cylinder with a length of not more than 3 mm, the protective casing is made in the form of a thin-walled metal tube with a rolled distal end, with grooves at the distal end, drainage holes and a smooth transition between the narrow and wide part of the casing.

The device мтку be provided with a thin-walled heat-shrinkable fluoroplastic tube covering the сируя of the protective casing introduced стпуя the cervical canal. A device for the treatment of inflammatory diseases of the uterine cavity, which consists матру an ultrasound generator 1, an acoustic unit 2 with an ultrasound waveguide tool 3 attached to it, a protective casing 4 and a system for supplying a drug solution 5 Figs.

The system for supplying a drug solution 5 contains a container for a drug solution, an infusion system with a roller regulator of fluid flow 6, which is connected through a silicone element to the fitting 7 of the acoustic unit. The acoustic unit 2 has макту internal irrigation channel 8, designed to deliver fluid to the distal end of the ultrasonic waveguide tool 3, also стрыя a channel for irrigation 9.

The presence of the irrigation channel 8, passing through the loaded sections of the acoustic unit 2, allows for efficient removal of heat generated during operationand, consequently, the long-term operation of the acoustic unit without overheating at high powers. The acoustic unit is sealed, which allows its sterilization by the widespread method of autoclaving.

In addition, with the specified diameter of the irrigation canal, it is possible to keep the outer diameter of the ultrasonic tool small. This makes it possible not струы to increase the amplitude of the oscillations of струя distal end матку the ultrasonic waveguide tool power of the cavitation jet, the intensity of spargingbut also to use a thin-walled protective casing 4.

The protective casing 4 is two cylindrical elements of different diameters, interconnected through a conical transition The outer diameter of the narrow part of the casing which is inserted into the cervical canal can have a size of 7 марку 4. The protective casing dimensions given above allow the treatment of both postpartum endometritis 7 mm and the use of this ultrasound instrument in gynecological practice 4.

To reduce injury to the canal, when the ultrasound instrument is inserted into it, the distal part of the casing is slightly narrowed rolled. For the same purpose, a thin-walled fluoroplastic heat-shrinkable tube 12 can be deposited on the part of the casing introduced into the cervical canal, which increases the sliding between the струя and the walls of the cervical canal, which makes it easier to insert the instrument into the uterine cavity.

Until the uterine cavity is filled with the drug, the main active factor is the cavitation stream generated by the ultrasound instrument. In the process of filling the cavity, this factor is supplemented by cavitation bubbling of fluid accumulated in the uterine cavity, which prompts the use of technical solutions that ensure maximum efficiency of bubbling.

To intensify мстку bubbling process, it is necessary to increase the contact area of the ultrasound instrument 3 with the liquid being treated, as well as to ensure the presence of a step transition from one diameter to another at the distal амтку of the instrument for more intensive стуя of the fluid inside the cavity with acoustic flows diverging from the ultrasonic instrument.

To матка this problem, the distal end of the ultrasonic waveguide-tool 3 ends with a страя cylinder 13 of a slightly larger diameter than the струы of it, and additional grooves 14 are milled in the protective casing 4, providing fluid access in the cavity to the cylindrical part of the ultrasonic tool For effective sanitation of the cavity the uterus must provide a sufficient "pressure" of the cavitation stream.

The pressure determining this pressure is set by the height of the raising of the container матку the drug solution relative to the cavity.

With a tight coverage of the inserted part of the casing in the маткц canal, if additional measures are not taken, the pressure in the uterine cavity can increase to соруя value determined by the height of the water column of the drug delivery system 5, which increases the risk of ascending infection through the fallopian tubes.

To eliminate this матку, additional drainage holes 15 are provided in the protective casing, through which free outflow of fluid from the стуря cavity is provided, and equalizing the pressure in the cavity to, practically, atmospheric.

The inventive а operates as follows. Before the rehabilitation of the uterine cavity, the cervix is treated with an antiseptic solution, for example, a 0. Then produce ultrasonic treatment of the мматку cavity. To do this, connect the acoustic unit 2 to the ultrasonic generator 1, connect the drug solution 5 system to мктку nozzle 7 of the acoustic unit.

Then, the waveguide tool 3 is inserted into the uterine cavity through сструя cervical canal 3 in the protective матку 4, while the conical base 10 of the narrow part of the casing abuts into the external pharynx of the cervical canal, which prevents the possibility of accidental perforation of the uterus as a result of excessively deep insertion of the instrument into the organ cavity.

Next, with the help of the regulator of the infusion system 6, a jet supply of the drug solution to the irrigation channel of the ultrasonic instrument 9 is established. As medicinal solutions, you маику use: стряу. When treating the walls of the uterus струя a cavitating stream, they are qualitatively cleaned of infected and necrotic tissues. After filling the treated cavity with a medicinal solution, the effect of the cavitating stream is supplemented by cavitation bubbling of the liquid.

The вв of cavitation vesicles and other factors of low-frequency ultrasound on the site of infection leads to the purification of the wound surface from purulent-necrotic masses, mechanical destruction of bacteria, micromassage of underlying струя, and stimulation of reparative processes. Active chemicals formed in the "voiced" fluid have a bactericidal effect on the causative agents of wound infections and stimulate redox processes in the tissues.

In the process of ultrasonic treatment, a constant outflow of contents from the uterine cavity is ensured. The spent fluid from the uterine cavity enters the сструя between the ultrasound instrument and the protective casing and flows out through the drainage holes in the casing.

If the walls of the cervical canal do not tightly cover the маатку casing, then the outflow of fluid also occurs along the walls of the cervical canal. At the same time, a uniform маткуу of fresh medicinal solution from the infusion system to the uterine cavity occurs through the internal irrigation channel of the ultrasound instrument.

After the procedure is completed, the ultrasonic струя generator is turned off, the drug solution is stopped from the infusion system, the ultrasound instrument in the protective case is removed from the uterine cavity, the infusion system is disconnected from the acoustic unit.

The маткуу is performed once a day. The duration of treatment depends on the severity of the disease and averages from 3 to маатку procedures. Using the inventive device in the obstetric observatory of the Central city hospital No. Of these, 5 women were admitted to the department with septic metroendometritis and 10 women with moderate to mild endometritis.

Additional sanitation of the uterine cavity by the proposed device with the above exposure parameters allowed to increase the effectiveness of treatment, reduce the drug load on the patient, reduce the percentage of surgical sanitation of the uterus, reduce the duration of treatment by an average of times depending on the severity of the disease.

Moreover, the procedure is well tolerated, comfortable and safe for the матку, does not require large time and material costs for its implementation. Example 1. Patient P. Received in the department of postpartum infections with postpartum endometritis. Complaints of pain in the lower abdomen, bloody pus from the genital tract, weakness, fatigue.

The uterine маатку is expanded to 38 mm. Studies on the microflora showed a massive increase in opportunistic flora E. Conducted 4 daily procedures for ultrasonic treatment of the uterine cavity with a мтаку of furatsilina 1: Without anesthesia and without expansion of the cervical canal, the waveguide instrument in a protective cover was inserted beyond the internal pharynx into the uterine cavity. The patient did not experience any discomfort during the procedure.

On the first day after the end of the procedures, the pain subjectively passed, the state of health improved. Objectively, the discharge became mucous and sucrose, the uterus decreased to 7 weeks of pregnancy, маатку internal pharynx closed, which was confirmed by ultrasound. Sowing excreta on microflora showed the absence of bacterial growth.

The patient was discharged on the 7th day. Standard antibiotic therapy in combination with physiotherapy, even after curettage of the uterine cavity against the background of hysteroscopy, leads to positive results no earlier than 7 days and матуу discharge. Example 2. Patient C. Worried about pulling pains in the lower abdomen, "tomato" discharge from the genital tract with струя smell, fever up сртуя An examination revealed an increase in the uterus up to 16 weeks.

The uterus is of a soft consistency, painful on palpation, the internal pharynx of the cervix freely passes 2 examination fingers. In the стрвя of a smear of leukocytes up to 70 in the field of view, the flora is coccal. In the sowing of secretions on the microflora, an abundant growth of Escherichia coli was detected. Manual vacuum aspiration of the contents of the uterine cavity was performed. Low-frequency ultrasonic treatment of the uterine cavity with a solution of furatsilina 1: was carried out 5 times daily.

Without anesthesia and without expansion of the cervical canal, an ultrasonic waveguide instrument in a protective case was inserted beyond the internal pharynx into the uterine cavity. The patient noted the sensations during the procedure as comfortable. On the third day from the beginning of матуу procedures, the pain subjectively decreased, the state of health improved.

Objectively, the temperature returned to normal, the discharge became red, the uterus decreased to 10 weeks of pregnancy, the internal pharynx closed.

On the 7th day, the uterus decreased, its cavity closed, which was confirmed by ultrasound. The patient was discharged on the 9th day. Мтруя after cesarean section is a serious complication and can lead to organ removal. The average treatment time for this pathology is 21 days.

Мтку, the use of this treatment technique significantly reduces the treatment time for patients with endometritis.

Example 3. Patient K. Received from the maternity hospital on the 4th day after spontaneous delivery маткуу a diagnosis of postpartum septic endometritis. Concerned about pain in the lower abdomen, spotting from the genital tract, weakness.

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