Solderings: whether it is possible to avoid infertility?
of Soldering are some kind of “strings“ from connecting fabric which are formed as a result of an inflammation or surgeries and reach from body for body. If solderings are located in a cavity of a small pelvis or in an abdominal cavity, they can interfere with conception therefore it is very important to find and eliminate them in time.
What is solderings?
Abdominal organs and a small pelvis (a uterus, uterine tubes, ovaries, a bladder, a rectum) are outside covered with a thin brilliant cover - a peritoneum. Smoothness of a peritoneum in combination with a small amount of liquid in an abdominal cavity provides a good smeshchayemost of loops of intestines, uterus, uterine tubes. Therefore normal work of intestines does not prevent capture of an ovum a uterine tube 1 , and growth of a uterus during pregnancy does not interfere with normal work of intestines and bladder.
a peritoneum Inflammation - peritonitis - very dangerous disease. And it is more dangerous by that, than the bigger space in an abdominal cavity or in a small basin takes. But in an organism there is a mechanism limiting distribution of peritonitis - formation of solderings.
At development of inflammatory process in a small basin of fabric in the center of an inflammation become edematous, and the surface of a peritoneum becomes covered by the sticky raid containing fibrin (the protein making a basis of a blood clot). The fibrin film on a peritoneum surface in the center of an inflammation sticks together the next surfaces with each other therefore there is a mechanical obstacle for distribution of inflammatory process. After the end of sharp inflammatory process in places of pasting of internals unions in a look can be formed it is transparent - whitish films. These unions are also called solderings. Function of solderings - protection of an organism against distribution it is purulent - inflammatory process on an abdominal cavity.Inflammatory process in an abdominal cavity not always leads
to formation of solderings. If treatment is begun in time and carried out correctly, the probability of formation of solderings decreases. Solderings are formed when sharp process passes in chronic and process of healing drags on on time.can prevent
of Soldering normal work of internals. Violation of mobility of loops of intestines can result in intestinal impassability. The solderings affecting uterine tubes, a uterus, ovaries break hit of an ovum in a uterine tube, movement of spermatozoa on a uterine tube, a meeting of spermatozoa and an ovum, advance of a germ after conception to the place of an attachment in a uterus cavity. In gynecology of soldering can be the cause of infertility and pelvic pains.
of the Reason of formation of solderings
are the Main reasons of formation of solderings in bodies of a small pelvis:
- inflammatory diseases;
- endometriosis - a disease at which the internal cover of a uterus expands in places uncharacteristic for this purpose;
- blood in an abdominal cavity.
of Soldering, formed as a result of an inflammationUterine tubes, a uterus and ovaries can be involved by
in the adhesive process arising at an inflammation of the next bodies (appendicitis - an inflammation of a worm-shaped shoot), and also at damages of a small and large intestine. In this case genitals suffer a little: adhesive process almost does not break their internal structure. If the inflammation arises in genitals, there is not only a formation of solderings, but also injury of genitals.
of the Most unprotected in this regard is the uterine tube - one of the most gentle and thinly arranged gladkomyshechny bodies. It plays a key role in ensuring conception and support of pregnancy in its beginning.the Spermatozoa getting into a vagina are filtered by
through uterus neck slime, pass through a cavity of a uterus and get into a uterine tube. The vermicular movement - the movements of a uterine tube - helps spermatozoa to get to an external third (ampoule) of a uterine tube where there is a conception process. During an ovulation - an ovum exit from an ovary - the uterine tube “sucks in“ a mature ovum. If at the time of hit of an ovum in a uterine tube there are spermatozoa, there is a fertilization, and the formed germ within several days moves to a uterus cavity where there will be its immersion in a mucous membrane of a uterus (implantation). Delivery of a germ in a cavity of a uterus is provided with the movements of a uterine tube and active work of microeyelashes of a uterine tube.
Thus, the uterine tube not only provides transportation of gametes and a germ, but also creates an environment for fertilization and development of an embryo during the first 5 - 6 days of pre-natal development. Change of composition of liquid which is produced in a uterine tube can ruin a germ. Local immunity in a uterine tube is minimum, that is there are few mechanisms providing rejection of alien substances, the germ is half alien, the uterine tube does not tear away it, and excess activity of immune system is adverse for pregnancy development. That is why uterine tubes so easily fall a victim of the so-called ascending infection (getting from a vagina and a cavity of a uterus). Surgical and diagnostic interventions in uterus cavities (abortions, diagnostic a scraping, hysteroscopy 2 , a gisterosalpingografiya 3 ) facilitate hit of an infection in uterine tubes.
2 Hysteroscopy - introduction to a uterus of the special optical device which allows to examine a uterus from within.
3 Gisterosalpingografiya - introduction to a uterus a X-ray - contrast substance with carrying out a series of x-ray pictures.
Having got into uterine tubes, the infection at first affects mucous a uterine tube (endosalpinks), then - the muscular layer (miosalpinks), and only at the last stage is involved in inflammatory process the most external layer of a uterine tube (perisalpinks) and there are conditions for formation of solderings. If treatment was late or is insufficiently effective, after recovery there are not only solderings, but also irreversible injuries of a mucous membrane of a pipe and its muscular layer. Eyelashes disappear, and on the place of gladkomyshechny fibers cicatricial fabric is formed. The uterine tube can turn in soyedinitelno - a woven bag (saktosalpinks), i.e. it loses ability to advance the impregnated ovum. At such violations elimination of solderings cannot restore function of a uterine tube, and existence of the center of inflammatory process leads to decrease in probability of approach of pregnancy even in a pipe from the opposite side or by means of fertilization in a test tube. In such cases for increase in chances of approach of pregnancy by means of EKO which can be carried out after recovery it is necessary to delete all pipe entirely. Pasting and union of walls of a uterine tube can result from an inflammation that results in impassability of a pipe for an ovum and also is the indication for division of solderings or removal of a pipe.If treatment does not help
Unfortunately, the laparoscopy cannot solve all problems connected with adhesive process. It is possible to exempt internal genitals from solderings, but it is impossible to restore structure and function of uterine tubes. Therefore in case of not approach of pregnancy within several months after the carried-out laparoscopy it is necessary to think of transition to more radical methods of treatment of infertility. Various kinds of fertilization in a test tube, including extracorporal fertilization (EKO) concern to them.
For increase of efficiency of EKO take the following into account:
- Existence of saktosalpinks (the delimited liquid congestion in a uterine tube) sharply reduces efficiency of the EKO method. Saktosalpinksa delete by means of a laparoscopy. Before the EKO procedure the special immunological inspection allowing to increase chances of a prizhivleniye of germs is desirable to take place
At surgical interventions of soldering are formed by
- of a hypoxia or ischemia of fabrics - insufficient supply of fabrics with blood and oxygen;
- of drying of fabrics during operation;
- of rough manipulations with fabric;
- of presence of foreign matters;
- of presence of blood;
- of division of the solderings which were earlier.
talc particles from gloves of the doctor, small cotton fibers from a gauze or tampons, sutural material often belong To the foreign matters causing formation of solderings. Solderings are formed also at endometriosis. During periods a small amount of the menstrual blood containing living cells of a mucous membrane of a uterus (endometriya) can get to an abdominal cavity through uterine tubes. Normal these cages are removed by means of own immune system, but in the presence of any malfunctions they get accustomed and form the functioning islands an endometriya which menstruate in an abdominal cavity. Around these centers solderings are also formed.
can Suspect existence of solderings in an abdominal cavity at the patients, in the past who had inflammatory diseases of a small pelvis, surgeries on bodies of a small pelvis and an abdominal cavity and at the women having endometriosis. However with existence more than two risk factors of development of adhesive process in the anamnesis of soldering are found only in a half of patients during a laparoscopy (operation in time to which in a forward belly wall do small openings through which enter the optical device allowing to examine a cavity, and special surgical tools).
Gynecologic survey allows to assume existence of adhesive process in an abdominal cavity with probability of 75%. Impassability of uterine tubes according to a gisterosalpingografiya (enter contrast substance into a uterus, make radiological pictures) and ultrasonic research with big degree of reliability indicates existence of adhesive process, however passability of uterine tubes does not allow to exclude existence of the solderings which are seriously interfering pregnancy approach. Usual ultrasonic research does not allow to find existence of solderings of a small pelvis authentically. In diagnostics of adhesive process the method of a nuclear magnetic resonance (a nuclear magnetic resonance, or a magnetic resonance tomography, MRT) is represented very perspective today. By means of this method receive the pictures reflecting “state of affairs“ in different levels.
by the Main method of diagnostics of adhesive process is the laparoscopy method. He allows not only to find existence of solderings and to estimate weight of adhesive process, but also to carry out treatment.
are Distinguished by three stages of adhesive process according to a laparoscopy:
I stage: solderings settle down around a uterine tube, an ovary or in other area, but do not prevent capture of an ovum;
II stage: solderings settle down between a uterine tube and an ovary or between these bodies and other structures and can prevent capture of an ovum;
III stage: occurs or pereknut a uterine tube, either its obstruction by solderings, or a total block of capture of an ovum.
Treatment of solderings
by the Main method of treatment of adhesive process is a laparoscopy . By means of special micromanipulators it is made by adgeziolizis - a section and removal of solderings. Methods of division of solderings include laser therapy (a section of solderings by means of the laser), an akvadissektion (a section of solderings by means of the water pumped under pressure) and electrosurgery (a section of solderings by means of an electroknife).by
For prevention of formation of new postoperative solderings during a laparoscopy the following methods can be used:
- introduction to spaces between anatomical structures of various barrier liquids (a dextran, a povidin, mineral oils and so forth) ;
- an enveloping of uterine tubes and ovaries the special polymeric resolving films.
Besides, after carrying out a laparoscopy the control diagnostic laparoscopy in several months after the first laparoscopy gained ground in recent years.Prevention of solderings
Cellular and molecular mechanisms of formation of solderings are quite well studied by
now. Therefore process of a spaykoobrazovaniye after surgeries including after a laparoscopy, it is possible to slow down sharply by means of carrying out so-called adjyuvantny (auxiliary) therapy. This therapy has to begin as soon as possible after the performed operation (in the first days and hours) and to proceed several weeks. Treatments are directed to suppression of inflammatory reaction, suppression of adjournment of fibrin in an abdominal cavity, fibrin dissolution activation.
of Adjyuvantnaya therapy includes application of the following preparations:
- of Fibrinolitichesky agents - the substances dissolving fibrin around which solderings are formed: Fibrinolizin, Streptokinase, Urokinaza, Gialuronidaz, Hemotripsin, Trypsin, fabric activators of a plazminogen.
- Anticoagulants - the preparations interfering fibrillation: heparin preparations, oxalates, citrates.
- Antibiotics : tetratsiklina, tsefalosporina, sulfanylamides.
- Resolvents : corticosteroids, antihistaminic preparations, nonsteroid anti-inflammatory preparations, progesterone, blockers of calcic channels.
the Choice of preparations and schemes of treatment depends on each case and can be made only the attending physician.