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Diagnostics and treatment of patients with endometriosis

The difficulty of diagnosis and treatment of patients with endometriosis does not cause doubts. Not less important is the subsequent management of patients, determination of indications for fixing and anti-relapse therapy and its organization, the treatment of neuropsychiatric effects of endometriosis, a dysbacteriosis of intestines, and also frequently observed in these patients genital candidiasis and other bodies. The number of features it has and treatment of concomitant somatic pathology, which is under the influence of complex therapy for endometriosis may be exacerbated. Mentioned that in anticipation of or in the course of long-term hormone therapy in some situations it is necessary to raise the issue of cholecystectomy at a bile stone disease, the removal of varicose veins of the lower extremities, vagotomy with piloroplasty with ulcers duodenal ulcers, etc.
Essential rational use of physiotherapeutic procedures and resort factors. Will have to rethink a number of outdated provisions and to overcome the inertia of some of the commissions for selection of patients to sanatorium-resort treatment. Existed for many years the idea that endometriosis is a contraindication for sanatorium treatment and, in particular, the use of radon water and preformed physical factors, convincingly refuted next fundamental research of Russian authors [meadow L. P., B. N. Baskakov and others, 1979; strugatskiy Century Meters, 1981; the Summary A. N., 1985, and others]. Moreover, the necessity of their inclusion in complex therapy of patients with endometriosis at various stages (without surgery, in preparation for the operation after the operation and in the following months and years).
Various physiotherapy we begin soon after surgery. So, when expressed cicatricial inflammatory changes and neurological manifestations due to pelvic - plexitis, lumbosacral neuralgia, coccygodynia and so on, with 5-6-th day after the operation patients are appointed phonophoresis with biocontrol or Trilon-B, diadynamic currents; from 10 - 12-days - electrophoresis of sodium thiosulfate, etc.
Under study is the question of the timing of treatment radon in the form of General baths, vaginal lavage and intestinal mikroklizm. Before that we started in 5-6 months after surgery. Currently, there is every reason to believe it expedient shortening of the term of up 3-2 months. As for revitalising Spa treatment, including for the concomitant somatic pathology (hospital disease stomach or duodenal ulcer, chronic cholecystopancreatitis, toxico-allergic arthritis, neurological syndromes and other), you have to start even earlier (1-2 months after operations). Otherwise it's kind of a paradox: on the job patients can write and send an aftercare in the sanatorium .
In our country until organized specialized centers, whose main task would be to study various aspects of endometriosis, and only a few clinics dealing with this problem. And patients are such a lot. Fundamentally incorrect position, when all the help is only in surgery, sometimes not always sufficiently qualified. The overwhelming majority of patients who had been operated on for endometrioid ovarian cysts and turned in our clinical hospital, there are pockets of POSADSKOGO endometriosis or on the back of the TIR wide uterine ligaments with cicatricial inflammatory changes in the parametric, pararectal cellular and paravaginal tissue with evidence of involvement of the colon and / or ureter. Even the basic examination of the intestine (sigmoidoscopy, barium enema, not to mention, fibreboard colonoscopy) and excretory urography was not done. Maintenance therapy was not carried out or it was only in the late appointment of some hormonal preparations (when signs of relapse of the disease) In the best case patients with recommended "search the medical institution or experts who deal with endometriosis, or non-traditional methods of treatment".
Therefore, it is expedient to concentrate the work on diagnosis and treatment of endometriosis in the departments and clinics of obstetrics and gynecology of the medical schools with qualified personnel and modern methods of diagnosis (endocrine, endoscopic, radiological, including pneumopericardium, even better - computer tomography, immunological, urological, ultrasonic and other). But even in the absence of some of these diagnostic possibilities of obstetricians-gynecologists should not shy away from these patients, the more that they can count on the help of departments and clinics of the Institute. It is important to interest related professionals, to show them the clinical value of endometriosis and to introduce the essence and peculiarities of the disease. A similar relationship can be established gynecologists with other departments and specialists of General hospitals and a well-equipped health units.