Ryzhenko Y. Optimization of the methods of treatment and rehabilitation of pa-tients with infertility due to inflammatory diseases of the uterine appendages.

In the dissertation the scientific data in the experimental study on the influence of the radio waves of different power and the antiadhesion barrier of the derivative of carbomethylcellulose on the formation of the adhesion process after simulation in the ex-perimental animals of the adhesion process in comparison with the conventional methods of electrosurgical action and postoperative rehabilitation have been extended. The scientific data on the effectiveness of the use of radiowave energy in conjunction with the intraoperative administration of the antiadhesion barrier of the derivative of carbomethylcellulose with the use of conventional methods of treatment and prevention of postoperative adhesion formation in women with tubal peritoneal infertility due to in-flammatory diseases of the appendages of the uterus have been refined. Additional scientific data on the effectiveness of the treatment of patients with tubal-peritoneal infertility, caused by inflammatory diseases of the uterus appendages using radiowave energy, with the prevention of postoperative adhesion, by the use of an in-traoperative antiadhesion barrier of the derivative of carbomethylcellulose and the developed phased complex of physiotherapeutic procedures from the early postoperative period are supplemented. The efficiency of the developed scheme of complex rehabilitation of patients with tubal-peritoneal infertility, caused by inflammatory diseases of the append-ages of the uterus for more effective rehabilitation and restoration of the generative func-tion, was determined. Clinical material for the study was the data of examination, treatment and data on the catamnesis of 96 patients with tubal-peritoneal infertility caused by inflammatory diseases of the uterine appendages and 30 gynecological and somatically healthy non-pregnant women of reproductive age taken for control. Histological, immunohistochemical features of the influence of radiowave energy on uterine horn tissue in female Wistar rats and com-parison with the effect of diathermic energy and methods of preventing the development of adhesive process after modeling of adhesions developing during surgery were studied. Clinical - anamnestic, clinico - laboratory mechanisms of adhesions in women who un-derwent inflammatory diseases of the uterine appendages were studied. Determined experimentally that the influence of radiowave energy to the tissue of the fallopian tubes away from the impact zone leading to minor injuries only 0.1 cm, even at maximum power of 40 watts. Supplemented with scientific evidence that the use electro-surgical method 40 W fallopian tube tissue away from the impact zone of 0.1 cm observed phenomenon of carbonization and necrosis entire thickness of muscle layers of the pipe wall. At a distance of 0.2 - 0.3 cm from the zone of influence in all cases there is loss of functionally active ciliary epithelium, which allows you to use radiowave energy with minimal tissue damage fallopian tubes. Determined experimentally that when used as a buffer environment antiadhesion gel derived carbomethylcellulose both the macro and mi-croscopic adhesions less pronounced (immature fibroblasts in 1,5 times, mature fibroblasts - 3 times, almost 2 fibrotsyty times below). Supplemented with scientific evidence that the use of 0.9% sodium chloride adhesive process - much more pronounced (increased amounts of collagen, which is due to benefit populations functionally active fibroblasts that produce it). Determined frequency (at preoperative examination) increase in serum of patients with infertility caused by inflammation of applications uterus indicators TGF, IL-1, IL-6 and fibronectin depending on the stages and duration of inflammatory diseases of applications cancer over 5 years, which makes it possible to use these figures (together) as markers predicting the severity of adhesions and defined in 1,4 times more accurate diagnostic in-formative method hromosalpinhohrafic compared with histerosalpinhographic A new method of treatment of infertility due to inflammatory diseases of the uterine application using radiowaves, the antiadhesion gel of derivative carbomethylcellulose and a complex of rehabilitation therapy has been proposed, which allowed to increase the inci-dence of uterine pregnancy from 16 to 40% and reduce the risk of an ectopic pregnancy from 13 % to 7.9 % .