In recent years, the prevalence of adhesivedisease in the field of gynecology has increased significantly. The most frequent causes of the disease are inflammatory processes. Adhesive disease in the small pelvis can occur due to inflammation of the uterus, pelvic peritoneum and appendages. A negative factor, in addition to infectious diseases, can be prolonged wearing of a spiral, abortion, sexual infections that cause an adhesion process in the small pelvis. Symptoms of the disease depend on the degree of spread of adhesions.
There are three clinical forms - acute,intermittent and chronic. In the acute course of the disease, the pain syndrome gradually builds up, patients are disturbed by nausea, sometimes vomiting. The temperature rises, the heart rate increases. Pressing on the stomach responds with a sharp pain. As a result, adhesive disease causes an extremely serious condition - protein and water-salt metabolism is violated, blood pressure drops sharply, and the amount of daily urine released decreases. With intermittent form, pain sensations are periodic, sometimes diarrhea or constipation occurs. In chronic form, from time to time there are aching, pulling pains in the lower third of the abdomen. Adhesive peritoneum has similar symptoms. The danger of the disease is the occurrence of obstruction of the fallopian tubes, which leads to persistent infertility.
A reliable diagnosis can be made only aftera number of studies and analyzes, such as a smear on the vaginal flora, PCR, pelvic MRI, ultrasound of the pelvic organs, diagnostic laparoscopy. The latter method is an operational intervention, but at the same time, the most reliable method of diagnosis.
Adhesive disease in combination with obstructionof the fallopian tubes is determined by hysterosalpingography when a substance of contrasting color is injected into the uterus and then an X-ray examination is performed. Successful treatment largely depends on the stage of spreading the process of formation of adhesions. Patients can be observed for years for a gynecologist with an unexplained diagnosis, and only laparoscopy makes it possible not only to reliably diagnose, but also to treat the disease at the same time.
Adhesive disease is treated surgically andconservative way. With the intermittent and acute form of the disease, the most effective treatment is laparoscopy. Concurrently, conservative therapy is used to enhance the therapeutic effect. The chronic form can be cured with only conservative treatment.
For the successful fight against the disease, first of all,it is necessary to find out the reasons for its occurrence. In the case where the cause is urogenital infection, therapy should be directed to the treatment of the underlying disease. For this, anti-inflammatory drugs (corticosteroids, NSAIDs) and antibiotics are used. If the disease is caused by endometriosis, treatment with hormonal and anti-inflammatory drugs is prescribed, as well as symptomatic and desensitizing therapy.
Enzymology is widely used whenfibrinolytic agents are used. Their action is based on the dissolution of fibrin (chymotrypsin, trypsin, longidase). These drugs are effective for resorption of adhesions of small sizes. In the absence of acute inflammation, physiotherapy is used, which consists of internal laser and external magnetic-laser therapy. Conservative treatment is effective only in the early stages of adhesions. In other cases, a medical-diagnostic laparoscopy is recommended.