Parametritis – it is purulent - an infiltrative inflammation a parametriya – the soyedinitelnotkanny cellulose surrounding a uterus in a neck and leaves of a wide sheaf. The parametritis demonstrates after the complicated abortions, childbirth, gynecologic operations, pyoinflammatory diseases of a uterus. The parametritis is shown by the febrilny temperature, an indisposition, oznoba, pains in the lower part of a stomach. In diagnosis of a parametritis collecting the anamnesis, given a gynecologic research, ultrasonography is important. Treatment of a parametritis demands performing the active antimicrobic, infusional, desensibilizing, immunocorrective therapy. When forming abscess a parametriya opening and drainage of an abscess is shown.
The macroscopic picture at a parametritis is characterized by expanded network of lymphatic and venous vessels, development of perivaskulyarny hypostasis and an ekssudation. In the beginning infiltrate is formed near entrance gate - in okolomatochny space, then in the limfogenny and venous way the inflammation diffuzno extends from top to bottom, kpered and kzad - to paarvaginalny, paravezikalny and pararectal cellulose. In case of purulent fusion of the fastion delimiting the called departments there is a diffusion inflammation of cellulose of all pelvic bottom – pelviotsellyulit. At the ascending infection pipes and ovaries, zabryushinny cellulose can be also involved in process (paratiflit, paranephrite). In rare situations the parametritis is complicated by phlegmons of a belly wall and external genitals.
In the majority (70-75%) of cases the inflammation at a parametritis does not go beyond cellulose of a small pelvis. At today's stage of development of gynecology, in connection with early recognition of a parametritis and application of antibiotics, the course of a disease which was more erased, easy, and infiltrate usually resolves, without reaching an abstsedirovaniye stage.
Microbic flora at a parametritis more often mixed, with prevalence of colibacillus, a klebsiyella, a protea, nesporoobrazuyushchy anaerobe bacterias, streptococci and stafilokokk. Infection a parametriya can happen via the tservikalny channel during the complicated or extra hospital abortions, a uterus neck operations; through the postnatal not recognizable and not sewn up side ruptures of a neck of a uterus.
Perhaps limfogenny spread of an infection from appendages (at adneksita) or uterus cavities at endometritises, metrothrombophlebitises, diagnostic vyskablivaniye, introduction of the Naval Forces complicated by damage of walls of a uterus. Sometimes the parametritis develops against the background of bacterial ekstragenitalny processes by a hematogenic drift of activators at osteomyelitis of bones of a basin, a paraproktita, cystitis, appendicitis, quinsy, tuberculosis, typhus etc.
Classification of a parametritis
On topography of an inflammation of okolomatochny cellulose allocate forward, back and a side parametritis. At a forward parametritis infiltrate is located kpered from a uterus, leading to smoothing of the forward arch of a vagina; quite often infiltration affects predpuzyrny cellulose, and also a forward belly wall. In case of a back parametritis the inflammation extends to cellulose uterine spaces; infiltration of pararectal cellulose can lead to narrowing of a gleam of a rectum. At a side parametritis the inflammation is limited above to a wide sheaf, below - cardinal sheaves; ahead - a wall of a small pelvis; infiltrate is formed sideways from a uterus, smoothing the side arches of a vagina
Taking into account pathogenesis allocate primary parametritis or secondary, acting as a complication of genital or ekstragenitalny inflammations. The clinical course of a parametritis can be chronic, subsharp or sharp.
The parametritis passes three stages in the development – infiltrative, ekssudativny, a stage of consolidation and a rassasyvaniye of exudate. The infiltration stage at a parametritis is characterized by expansion and a partial trombirovaniye of vessels, development of perivaskulyarny hypostasis. To stages of ekssudativny changes the vascular course in parametralny cellulose there are leukocytes and other elements of blood; diffusion, fanlike distribution of infiltrate to basin walls is observed. In a phase of consolidation the organization of infiltrate results from loss from fibrin exudate; formation of the granulyatsionny shaft delimiting infiltrate from healthy fabrics.
As favorable outcome of a parametritis serves the infiltrate rassasyvaniye. At suppuration of exudate abscess which can be opened in hollow bodies (a bladder, a rectum, a vagina) or outside through a forward belly wall is formed. At incomplete depletion of an abscess the purulent inflammation will recur with repeated breaks in the next bodies and formation of fistulas which support the course of a parametritis.
The clinic of a sharp parametritis usually appears in 7-10 days after the delivery, surgical termination of pregnancy, intrauterine interventions, gynecologic operations. Treat the first and early displays of a parametritis febrilitt (t ° bodies of 38-39 °C), constant, often pricking or cutting belly-aches irradiating in a sacrum and a waist. At suppuration the parametriya a condition of the patient worsens: even more temperature increases, accepting gektichesky character; tachycardia, oznoba, thirst, headaches is noted.
When involving in a ring of infiltrate of a bladder or a rectum the clinic of cystitis or a proktit from tenezma is observed. In case of spread of a parametritis on a lumbar podvzdoshnuyu a muscle its inflammation develops – psoit which is characterized by a typical sgibatelny contracture of a hip on the party of defeat. At a chronic parametritis of pain weaken and amplify only at the sexual intercourse; functional changes of cardiovascular and nervous systems can be noted; violations of menstrual function.
Diagnosis of a parametritis
The parametritis is diagnosed on a data set of the anamnesis, a gynecologic research (vaginal and rektovaginalny), ultrasonography. A vaginal research at a parametritis the parametriya, shortening of the arches of a vagina, uterus shift up or in the healthy party, cohesion in a uniform conglomerate with motionless dense infiltrate defines sharp morbidity. At a rektovaginalny research the provision of infiltrate (abscess) concerning a rectum and degree of mobility mucous over inflammatory consolidation is estimated.
In the general blood test at a parametritis increase in SOE up to 30-60 mm/h, , is noted. The Ekhoskopichesky picture of a parametritis allows to visualize infiltrates - the ekhopozitivny educations without accurate contours having irregular shape. At suppuration in structure of infiltrates the accurate capsule in which dense heterogeneous contents are located is defined.
At an infiltrate abstsedirovaniye a parametriya with break of an abscess in a bladder or a rectum urologists and proctologists are involved in diagnostics. Opening of parametralny abscess in a bladder is found by means of a tsistoskopiya, a research of the general analysis of urine, bacteriological crops of urine; the break of an abscess in a rectum is confirmed by a koprogramma research, macroscopic availability of pus in kalovy masses and given to a rektoskopiya. At the persistent course of a parametritis the actinomycosis exception is required. In the course of diagnostics the parametritis is differentiated with a pipe yaichnikovym abscess, tumors, pelvioperitonity.
Treatment of a parametritis
In an infiltrative stage of a parametritis treatment, as is carried out at a sharp salpingooforit: the bed rest, cold is appointed to a stomach; antibiotics taking into account type of the activator or microbic associations and their sensitivity to medicines; infusional therapy, the desensibilizing, immunomodulatory treatment.
In a stage of a rassasyvaniye of infiltrate enzymes apply NPVP, biostimulators, vitamins. LFK, gynecologic massage, electroprocedures widely practices in this phase of a parametritis (an electrophoresis with magnesium, copper, iodine, zinc; diadinamoterapiya, UVCh), phototherapy (Ural federal district, UFOK, VLOK), magnetotherapy, induktotermiya.
The long course of a parametritis which is followed by a syndrome of endogenous intoxication demands carrying out a plasma exchange. Rehabilitation of patients with a parametritis includes an active physiotherapeutic campaign: purpose of an oksigenobaroterapiya, microwave therapy, BONDS therapy, ultrafonoforeza, mud applications; performing resort treatment (hydrosulphuric bathtubs and vaginal irrigations, massage, mud tampons etc.).
When forming parametralny abscess its puncture through the vagina arch is shown. When receiving pus opening of an abscess and drainage a parametriya is required in the vaginal or bryushnostenochny way. After installation of a drainage in a purulent cavity the sanifying events are held: washing by dezrastvor, introduction of antibiotics.
Forecast and prevention of a parametritis
Formation of fistulas, adhesive and cicatricial process in a small basin, development of sepsis are among failures of a parametritis. When opening abscesses during a kolpotomiya there can be wound of mochetochnik, a bladder or uterine vessels. At a timely initiation of treatment of a parametritis there is a gradual return development of inflammatory changes.
Rational conducting childbirth, the prevention of abortions (especially criminal), strict observance of an asepsis when performing intrauterine manipulations, timely sanitation of the infectious centers belong to measures of prevention of a parametritis.