Prevention and treatment of adhesions in women with exacerbation of chronic inflammatory diseases of the pelvic organs
Authors:   Russian University of Medicine, Umakhanova M.M. ,   Moscow, Russian Federation, Arakelov S.E. ,   Russian University of Medicine; Moscow, Russian Federation, Smirnova L.E. ,   Russian University of Medicine; Moscow, Russian Federation, Torchinov A.M. ,   Russian University of Medicine; Moscow, Russian Federation, Gabaraeva M.R. ,   Russian University of Medicine; Moscow, Russian Federation
Published: January 2025

Abstract
Relevance. Inflammatory diseases of the pelvic organs (PID) consistently occupy one of the first places in the structure of gynecological morbidity.
With each subsequent exacerbation of PID, the risks of developing an adhesive process increase, which can lead to infertility, miscarriage, chronic pelvic pain, ectopic pregnancy, which significantly worsens the quality of life of women. In this regard, it is important to search for effective methods for preventing adhesions against the background of PID, which can become an important part of the therapy of such patients, capable of preventing the development of significant complications.
Aim. To evaluate the effectiveness of complex therapy for exacerbation of chronic PID in combination with adhesions in the pelvis using bovhyaluronidase azoximer (Longidaza®) suppositories for rectal use.
Design. Randomized placebo-controlled study.
Materials and methods. A study approved by the Ministry of Health of the Russian Federation was conducted, in which 50 women aged 18 to 42 years with exacerbation of PID in combination with adhesions in the pelvis, receiving basic therapy with antimicrobial drugs, were selected. Patients were divided into two groups using simple randomization using the random numbers method. The main group (30 patients) additionally received Longidaza 3000 IU suppositories rectally according to the scheme of 1 suppository once every 3 days for 10 days, then 1 suppository once every 5 days 5 administrations, the control group (20 patients) received placebo suppositories according to a similar scheme. The course of treatment was 55 days, further observation was carried out for 140 days from the beginning of therapy. In both groups, the clinical course of the disease was assessed, laboratory and instrumental research data were studied, the frequency of pregnancy after treatment was analyzed.
Results. In the main group, a more rapid, by 5–7 days compared to the control group, improvement of clinical symptoms was noted, which was manifested by an improvement in general well-being, the disappearance or decrease in the intensity of pain, dysuria, dyspareunia, regression of pathological discharge from the genital tract. According to the assessment of the dynamics of laboratory parameters, in the main group, the disappearance of leukocytosis in the peripheral blood, the band shift of the leukocyte formula, and the normalization of ESR were noted in all 30 (100%) patients by the 6th-7th day of treatment, while in the patients of the control group, such dynamics were noted in only 9 (45%) patients during the same period (p < 0.001).
When analyzing the results of microbiological studies, it was established that during the control examination after the completion of treatment (by the 55th day), the proportion of patients with lactobacillary degree IIB-III in the main group decreased from 80 to 10%, while in the control group the proportion of such patients decreased from 75 to 60%. In all patients of the main group (100%), elimination of Candida spp. was revealed during control microscopy and "key" cells, while in control patients their detection rate was 40% and 60%, respectively (p < 0.01). A control study using the polymerase chain reaction method showed that in most cases, the patients of the main group achieved elimination of specific pathogens, which was significantly lower in the control group.
During control ultrasound of the pelvic organs, performed on days 5–7 from the start of treatment, positive changes in the ultrasound picture were noted (absence of free fluid in the retro-uterine space and normalization of sound conductivity of ovarian tissue) in 80% of patients in the main group, while in 80% of patients of the control group, similar dynamics were noted only on days 10–14 from the start of treatment. According to the results of control hysterosalpingography, performed 6 months after the end of antimicrobial therapy, the detection of occlusion of both fallopian tubes in patients of the main group decreased from 6 (20%) to 1 (3.3%), while in the control group this indicator remained unchanged and amounted to 5 (25%) both before and after treatment (p < 0.01).
The positive dynamics of clinical manifestations in the main group led to a reduction in the length of stay of patients in the hospital by 5.9 ± 0.6 days compared to the control group, averaging 6.6 ± 0.4 and 12.5 ± 0.7 days, respectively (p < 0.001).
Three months after completion of treatment, the main group experienced 6 pregnancies (20%), all pregnancies were observed until successful delivery, while in the control group no pregnancies were observed (p < 0.05).
Conclusion. The obtained data suggest that the inclusion of Longidaza in the complex therapy of exacerbation of chronic PID allows to increase the effectiveness of etiotropic therapy by increasing the bioavailability of antibacterial agents, to reduce the incidence of tubal occlusion, to increase the frequency of pregnancy, to optimize treatment costs by reducing the length of hospital stay.
Keywords: bovhyaluronidase azoximer, PID, Longidaza, tubal occlusion, inflammatory diseases of the pelvic organs, bioavailability of antibiotics, adhesions, tubal-peritoneal infertility.