PERTUBATION (Latin per through + tuba a pipe; synonym aerotubation) — a method of a research of passability and a functional condition of uterine tubes by administration of gas in a cavity of the uterus and uterine tubes. The item can promote elimination of pipe and peritubarny commissures.
Indication to P. is infertility (see), connected with commissural process in uterine tubes or with peritubarny commissures (peritoneal infertility).
Item. it is contraindicated at diseases of cardiovascular system with the phenomena of a decompensation, the disseminated tuberculosis, inf. diseases, acute and subacute diseases of generative organs, sactosalpinx.
For P.'s carrying out the device designed by the principle offered by S. A. Yagunov is used (see. Hydrotubation ).
Items carry out in out-patient conditions or in a hospital in the absence of contraindications, normal to body temperature, a wedge, blood test, urine and the first or second degree of purity of vulval flora (see. Vagina ). The item should be carried out to the first or second phase of a menstrual cycle taking into account an oestrogenic saturation on tests of functional diagnosis of function of ovaries.
In day of carrying out a pertubation empty intestines, and before the procedure — a bladder. Before a pertubation it is necessary to conduct vaginal examonation.
The neck of uterus is bared vaginal speculums and processed alcohol. By means of a uterine tip into the canal of a neck of uterus enter carbon dioxide gas with constant speed of 25 cm 3 in a minute which then comes to uterine tubes and an abdominal cavity. Reductions of uterine tubes cause change of pressure in system and change of a signal of the sensor that is fixed on a tape of the recorder (kimogramm).
During P. the doctor watches the general condition of the patient. In case of pains administration of gas is stopped.
About passability and a functional condition of uterine tubes judge by maximal pressure, at Krom passability of uterine tubes, to character kimo-grams, to amount of the entered gas in a cavity of the uterus, uterine tubes and an abdominal cavity, to listening of noise of the gas coming to an abdominal cavity, to definition (on time) emergence of pains in an anticardium and under clavicles, to availability of the gas in an abdominal cavity found at percussion of a stomach or rentgenol, a research, to emergence of characteristic pains in the bottom of a stomach is established. After P. overseeing by the general condition of the patient continues within 1 — 2 hour.
Allocate the following options of a functional condition of uterine tubes: passable uterine tubes, short-term or hron.spazm uterine tubes, impassable uterine tubes.
At passable uterine tubes the maximal pressure of the entered gas makes 30 — 40 mm of mercury. «Blare» (gurgle or rustling) is well listened, in 10 — 15 min. appears frenikus-symptom (see). The amount of the entered gas makes 100 — 160 cm 3 . In an abdominal cavity free gas comes to light by percussion and roentgenoscopy. At good sokratitelny activity of uterine tubes on a kimogramma oscillations appear. At insufficient sokratitelny activity of uterine tubes of oscillation are absent.
Short-term or hron, the spasm of uterine tubes is characterized by the short-term high initial pressure of the entered gas (150 — 180 mm of mercury.), a cut falls at introduction of antispasmodics. At the same time «blare» which timbre depends on extent of narrowing of a uterine tube is listened. In 5 — 10 min. appears frenikus - simp - volume, is more often in vertical position of the patient; the amount of the entered gas is equal to 100 — 180 cm 3 . At percussion and rentgenol, a research free gas in an abdominal cavity is defined. In the presence of peritubarny commissures a frenikus-symptom (see) appears in 1 hour and more after P., and in a free abdominal cavity gas is defined.
At impassable uterine tubes with suspicion on a sactosalpinx the maximal pressure of the entered gas is equal to 140 — 180 mm of mercury., minimum 40 — 10 mm of mercury. Owing to transition of gas from narrower part of a pipe in its widest part, there can be «blare», the frenikus-symptom is absent. Stretching of uterine tubes can cause pain in the bottom of a stomach; free gas in an abdominal cavity is not defined. At vaginal examonation increase in appendages of a uterus at the expense of stretching of a uterine tube is noted. At impassable uterine tubes without suspicion on a sactosalpinx the maximal pressure of the entered gas makes 120 — 140 mm of mercury., minimum 10 — 5 mm of mercury., the amount of gas 10 — 20 smv, «blare» is not listened, the frenikus-symptom does not appear, in an abdominal cavity there is no free gas.
Complications happen seldom. Isolated cases of an air embolism are described and at increase in pressure of the entered gas of St. 180 mm of mercury. — rupture of uterine tubes and uterus.
Bibliography: Degtyarev S. S. Comparative assessment of data of a pertubation and a gisterosalpingografiya during the definition of an anatomic and functional condition of a uterus and pipes, Akush, and ginek., No. 1, page 8, M., 1963; Diagnosis and treatment of female infertility, under the editorship of N. M. Pobedineky and T. V. Chervakova, M., 1979; Mandelstam A. E. Evolution of definition of passability of uterine tubes, Akush, and гинек^ No. 3, page 45, 1965.
L. P. Bakuleva.