Habermas sees modernity as "unfinished project" . The central problem continues to be rationality . The utopian goal is to maximize rationalize the so-called "system" so "life world" Those. there is "System"- this is the state and the economy (they act strategically and rationally) And there is "Life World"- this is the private life of people and civil society (they are communicative and subject to morality).

Globalization has become a major problem for modern sociology. Giddens has a brief definition of globalization: "I define it as action at a distance". Or a more extended definition: "Globalization is the intensification of social relations on a worldwide scale, which connect remote localities in such a way that events occurring in one place are shaped by what happens many miles away, and vice versa." Globalization is interpreted by E. Giddens as a natural continuation of the original trends of modernity. Globalization according to Giddens hasfive components:

At the end of last year, a department of X-ray endovascular methods of diagnosis and treatment was opened in Reutov (a complex of intravascular interventions performed on blood vessels through percutaneous access under the control of radiation imaging methods). And now it has been made on the basis of the department - for the first time in the Moscow region! — a unique operation with a name that is difficult for non-medical people: endoprosthesis replacement of a saccular aneurysm of the aortic arch with a special stent graft. We talked about the new possibilities of Reutov healthcare with the head of the department of X-ray surgical methods of diagnosis and treatment of the Reutov Central Clinical Hospital, the chief specialist of the Ministry of Health of the Moscow Region for X-ray endovascular diagnosis and treatment Roman Goloshchapov-Aksenov.

- Roman Sergeevich, on December 27 last year, a department of X-ray endovascular diagnostics was opened at the Central Clinical Hospital. How do you, one of the leading experts in this field, evaluate the significance of the event?

“It is impossible to imagine today a modern multidisciplinary clinic without such a department. This is a fundamentally new, actively developing area of ​​medicine, expanding the possibilities of diagnostic methods to the active implementation of medical operations, which significantly improve the quality of life of patients. Such departments must be replicated, and X-ray surgical care should be as close as possible to the patient, so that the time interval from the onset of a life-threatening disease to the performance of the only possible effective operation is minimal.

What are the main advantages of this method?

– Minimal surgical intervention under local anesthesia, easy repeatability of procedures without a large additional risk for the patient, reduction in the time of stay of patients in the hospital, and hence reduction in the cost of treatment, improvement in the quality of life of patients and high economic efficiency of medical care. In addition, surgery may be offered to patients who are at high risk.

The main feature of X-ray endovascular surgery is that all operations, regardless of the disease, are performed inside the vascular bed, without incisions and under X-ray control, and surgical access is carried out using a special needle. The terms of hospitalization of patients when performing planned intravascular operations often do not exceed one day. Thus, the quality of life of patients is maintained at a high level. The methods of X-ray endovascular surgery are universal and have found application in almost all areas of medicine: cardiovascular surgery, cardiology, neurology, neurosurgery, urology, gynecology, oncology, liver and gastrointestinal tract surgery. X-ray endovascular surgeons restore the patency of the vessel, as in the treatment of acute myocardial infarction or ischemic stroke.

— Roman Sergeevich, on October 2, at the Reutov Central Clinical Hospital, an operation was performed to replace a saccular aneurysm of the aortic arch with a special stent-graft. What is the uniqueness?

- Firstly, until recently, the performance of such operations was impossible in any of the hospitals in the Moscow region, both at the municipal level and at the federal level. In the Moscow region there are well-equipped military hospitals, large federal centers, the regional institute named after. Vladimirsky - MONIKI, however, to perform a hybrid aortic surgery, not only modern equipment is needed, but also a team of highly qualified specialists - cardiovascular surgeons, specialists in X-ray endovascular diagnostics and treatment, as well as resuscitators.

- Please explain what a "hybrid" operation is?

“Hybrid surgery combines the capabilities of traditional surgery and X-ray endovascular surgery. It is performed by a cardiovascular surgeon and a specialist in endovascular diagnostics and treatment. This modern technology is used for stenting an aortic aneurysm, the largest arterial vessel in the human body, for implanting an artificial aortic valve without using cardiopulmonary bypass. The technology for installing endoprostheses is no different from traditional stenting of arteries, only for inserting a prosthesis into the vascular bed, not a point access to the artery is required, but a surgical minimal incision. To install a special stent in the aortic arch, from which the arteries that supply blood to the brain depart, it is necessary to first perform a bypass operation on these arteries. The danger of an aortic aneurysm lies in its rupture with a high risk of fatal outcome. The difference between a stent-graft and a conventional stent is that its cell is closed with a special vascular prosthesis, which, after implantation of the stent, covers the aneurysm and turns it off from the blood circulation. The peculiarity of localization of an aneurysm in the aortic arch is that the arteries supplying the head and upper limbs depart from this segment of the aorta, and blocking the lumen of the latter together with the aneurysm can lead to stroke and ischemia of the upper limbs.

- A little uncomfortable. Can you tell me if the operation was successful?

- Yes, the next day the 64-year-old patient could get up. Currently, the patient's condition is satisfactory, he is preparing for discharge. As for the operation itself, the first stage was bypassing the arteries of the aortic arch, it was performed by Doctor of Medical Sciences, Professor Roman Komarov, an employee of the clinic for aortic and cardiovascular surgery of the First Moscow State Medical University named after I.I. THEM. Sechenov. I performed the stenting of the aortic arch.

- Will similar operations be carried out in the Reutov Central Clinical Hospital in the future?

Hybrid technologies are expensive. To date, only about 50 transcatheter aortic valves have been implanted in Russia, stenting of the aortic arch is rare, and several more operations have been performed to stent an abdominal aortic aneurysm. In Europe and the United States, every patient with a diagnosed aortic aneurysm is considered a candidate for aortic stenting or a hybrid surgical option. In the EU countries, this technology is financially supported by the state, and in Germany and France there are also special federal programs. I hope that our clinic will also be included in such a program.

Some statistics
Myocardial infarction: in 98.5% of cases, it is possible to stop the pathological process of necrosis of the heart muscle with the timely application of X-ray surgery methods.
Ischemic stroke: mortality decreases from 40% to 27.2% with the timely administration of a thrombolytic drug into a thrombosed intracerebral artery.
Critical ischemia of the lower extremities: in 91% of cases, amputation can be avoided due to X-ray endovascular restoration of blood flow through the arteries of the leg.
Uterine fibroids: in 99% of cases, recovery can be achieved by blocking the blood flow through the uterine arteries and avoiding the removal of the uterus or fibroids.

An RTV video about the first aortic stenting operation in the history of the Moscow region, which was carried out in Reutov, can be.

On May 21–23, 2017, the Russian New University (RosNOU) took part in the 21st Annual Session of the National Scientific and Practical Center for Cardiovascular Surgery (NNPCSSKh) named after A. N. Bakulev of the Ministry of Health of the Russian Federation.

Within the framework of the session, a meeting “Sociology and jurisprudence in health care” and a scientific and practical seminar “Criminal legal risks of medical practice in cardiovascular surgery: prevention and prevention of negative legal consequences” were held, organized jointly by RosNOU, A. N. Bakulev NSPCSSH, Association "Law in Health Care" and the Chamber of Lawyers of the Moscow Region.

Alexey Tyrtyshny, Dean of the Faculty of Law of RosNOU, and Head of the Center for Medico-Legal Support for Medical Workers, Senior Researcher at the Department of Modern Sociology, Moscow State University named after M.V. M. V. Lomonosov Tatyana Semina.

Tatyana Vasilievna made a presentation "Trends in modern healthcare: burnout of a doctor - a cardiovascular surgeon", saying that one of the reasons for emotional burnout is the unsettled legal relationship in conflicts between doctors and patients.

The following speakers also made presentations at the meeting:

– Romanovsky Georgy Borisovich, Head of the Department of Criminal Law of the Penza State University, report “Legal foundations of telemedicine”;

– Kunts Elena Vladimirovna, Head of the Department of Criminal Law and Criminology, Chelyabinsk State University, report “The current state of defects in the provision of medical care”;

– Bokeria Leo Antonovich, Director of the A. N. Bakulev NSPTSSH, Vladimir Yuryevich Semyonov, Chief Physician of the IKiSH NTS A. N. Bakulev A. N. Bakulev, Igor Stupakov, Deputy Director of A. N. Bakulev NSPTSSH for General Issues, Ivan Yurlov , Surgeon NSPCSSH named after A. N. Bakulev, Vinokurov Alexander Vladimirovich Leading Researcher of the Department of Training and Continuing Education NSPTSSSh named after A. N. Bakulev with reports on the topic "The concept of professional development and the professional standard" doctor - cardiovascular surgeon " »;

– Osipova Nadezhda Gennadievna, Dean of the Faculty of Sociology, Moscow State University named after M.V. Lomonosov with the report "Sociology, jurisprudence and health care: the formation of an interdisciplinary categorical apparatus";

– Roman Sergeevich Goloshchapov-Aksenov, Head of the Department of X-ray Endosurgical Diagnostics and Treatment of the Central City Clinical Hospital of the city of Reutov, Lakunin Konstantin Yuryevich, Chief Physician of the Central City Clinical Hospital of the city of Reutov, Pigolkin Yury Ivanovich, Head of the Department of Forensic Medicine of I.M. Sechenov Moscow State Medical University with reports on the topic "Forensic medical criteria for assessing adverse outcomes of X-ray endovascular operations on the arteries of the lower extremities";

- Tyrtyshny Alexey Alexandrovich, Dean of the Faculty of Law of RosNOU, Pomazkova Svetlana Ivanovna, Head of the Department of Civil Law Disciplines of RosNOU with reports on the topic "Conciliation procedures for resolving disputes between doctors and patients."

In his report, Alexey Aleksandrovich focused on the need to introduce the institution of pre-trial dispute resolution into the practice of providing medical care, based on the experience of foreign countries, but reflecting the realities of modern Russian healthcare.

The Dean of the Faculty of Law of RosNOU spoke about the essence of the concept of conciliation (mediation) procedures and the experience of their application. According to him, in Russia, mediated dispute resolution procedures apply only to private law relations, while public law relations are prohibited by mediated dispute resolution.

Examples of judicial practice testify to the possible settlement of disputes in an administrative manner, which is a weighty argument in terms of introducing the institution of pre-trial dispute resolution. The nature of some cases makes it possible to allow in the future such an alternative method of dispute resolution as mediation. For example, in the issue of reimbursement of the cost of a technical means of rehabilitation, independently purchased by the patient at his own expense.

The report considered the legal risks of introducing the institution of conciliation procedures, analyzed the factors that can reduce the risks, as well as the directions for the implementation of the institution of the social ombudsman and mandatory pre-trial dispute resolution. According to the dean of the Faculty of Law of RosNOU, such areas include the resolution of medical disputes using online platforms, cooperation between insurance organizations, medical, patient and legal communities, professionalization of the reconciliation institute.

Alexey Alexandrovich Tyrtyshny paid special attention to the creation of the Council for the professional qualifications of non-medical personnel - lawyers, personnel officers, IT specialists, under the Association of Cardiovascular Surgeons and the League of Health of the Nation, for the direct implementation of the institution of pre-trial dispute resolution in the provision of medical care in cardiovascular surgery.

Svetlana Pomazkova, Head of the Department of Civil Law Disciplines of RosNOU, made a presentation “Reasonable risk and the limits of its legality. medical risk. According to Svetlana Ivanovna, one of the most important conditions for the legitimacy of a risk is the orientation of the actions of the risky person towards achieving a socially useful goal - improving the patient's health. The report noted that the patient has the right to receive information about the diagnosis, the methods of providing medical care and the associated risk. The head of the department of civil law disciplines of RosNOU also spoke about the assessment of the harm caused to the life and health of the patient, as well as about cases where the harm is not illegal.

In civil law, the so-called "principle of general tort" is enshrined, according to which any harm is unlawful. The exceptions are infliction of harm by lawful actions, infliction of harm with the consent of the victim and infliction of harm in a state of emergency.

Text - Daria Rozhkova

Goloshchapov-Aksenov Roman Sergeevich

Thesis for the degree of doctor of medical sciences

D 208.040.02
FGAOU HE First Moscow State Medical University named after I.M. Sechenov of the Ministry of Health of Russia (Sechenov University)
119991, Moscow, st. Trubetskaya, d. 8, building 2
tel. 248-04-37, 708-35-73
Estimated date of defense of the dissertation - April 21, 2020

Thesis - November 18, 2019

The decision of the dissertation council

Posted on the website - 12/20/2019

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posted on the website - 12/20/2019

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The owners of the patent RU 2289415:

The invention relates to medicine, in particular to gynecology, and for the treatment of uterine fibroids. To do this, after selective catheterization, 100 mg of actovegin in 2.5 ml are injected into both uterine arteries, and then the embolizate is immediately administered. EFFECT: method provides pain-free post-embolization period and reduction of post-embolization syndrome manifestations.

The invention relates to medicine, in particular to gynecology, and relates to the treatment of uterine fibroids, mainly nodular forms, using the technique of uterine artery embolization (UAE).

Uterine fibroids are among the most common benign tumors of the female genital organs, often detected in women of reproductive age. According to average statistics, its frequency after 30 years reaches 25-50%. Approximately 1/3 of all visits to gynecological clinics are diagnosed with this tumor (Kulakov V.I., Adamyan L.V., 2000). In 53.3-63.5%, uterine fibroids are diagnosed at the age of 40-50; more common among women engaged in mental work - 60.1%, in contrast to women engaged in manual labor - 9.4% (Gilyazutdinova Z.Sh., 2004). According to the literature, the incidence of uterine fibroids in young women is currently increasing. The problem of treating patients with uterine myoma is relevant in modern gynecology due to the high frequency of this pathology, as well as its negative impact on the reproductive system and the general health of women.

Currently, the treatment of uterine fibroids is carried out by conservative, surgical and combined methods. Conservative therapy consists in prescribing medications (neuroleptics, immunomodulators, general somatic and hormonal), physiotherapeutic, balneological methods of treatment. Modern hormone therapy has a large arsenal of drugs, the use of which inhibits growth and reduces the size of uterine fibroids, but after stopping treatment, as a rule, relapses of the disease are observed. Surgery remains the main treatment for uterine fibroids. The significance of the problem is emphasized by the fact that hysterectomy remains the most common gynecological operation worldwide (52-94% of patients). The volume of surgical intervention can be radical: hysterectomy, and conservative: myomectomy. However, the removal of the uterus leads to the development of posthysterectomy syndrome, and the removal of myomatous nodes in 30% of cases leads to relapse.

As mentioned earlier, in recent years there has been a "rejuvenation" of uterine fibroids, and therefore there is a need to preserve the generative function of women.

Modern diagnostics, the choice of an adequate method for the treatment of uterine fibroids, as well as the evaluation of the results are relevant at the present time.

In recent years, with the development of endovascular surgery, the method of uterine artery embolization (UAE) has found wide application in the treatment of uterine fibroids. UAE is a minimally invasive non-surgical organ-preserving procedure that is a sufficient alternative to surgical treatment.

UAE has been used since 1979 to stop severe postpartum and post-traumatic uterine bleeding. In 1990, Jacques Ravina, using uterine artery embolization for preoperative preparation of women with uterine fibroids in the presence of hypervascular tumors, noted that in some patients, as a result of the manipulation, the main symptoms were stopped and surgical treatment was not required. In September 1995, Jacques Ravina published the first article in The Lancet on the treatment of uterine fibroids using UAE. Currently, the EMA method is widely used in medical institutions in the USA, Europe, Asia and the Middle East. In 1996, UAE received FDA approval in the United States, and in 1998, by order of the Russian Ministry of Health, it was included in the list of approved endovascular interventions. More than 300,000 UAE procedures have been performed in Europe and the USA. Currently, more than 100,000 embolizations are performed annually around the world, including leading clinics in our country.

In the pathogenesis of uterine fibroids, as is known, an important role is played by neoangiogenesis, which is activated during tumor growth. As the hypertrophy of the myometrium and the growth of the mass of the tumor in the capillary network of the myometrium adjacent to the myomatous nodes, the architectonics of the capillary network characteristic of normal myometrium completely disappears - its loopy-cellular pattern, the capillary network becomes shapeless, chaotic, uneven filling of the vessels with blood appears, they appear stasis, capillaries often acquire a tortuous course. The angioarchitectonics of the capillary network of the "intact" myometrium in some cases retains its normal appearance (Savitsky G.A., Savitsky A.G., 2003).

The vessels of the perifibroid plexus, a chaotic vascular network that surrounds the myoma along the periphery, are represented by arcuate and radial arteries that go around the node and give a weakly expressed capillary network into the tumor. Myoma vessels have a diameter of up to 0.5 mm, which is several times greater than the diameter of the arteries of normal myometrium. During UAE, injected particles of polyvinyl alcohol (PVA) of a certain size (300-700 microns) migrate with the blood stream only to the peripheral branches of the uterine arteries of the corresponding diameter and accumulate in them, causing segmental occlusion of the vessels. At the same time, the distal parts of the vascular bed of the unchanged myometrium remain passable and, after a short period of time, begin to be supplied with blood through the collateral vessels, which contributes to the gradual elimination of ischemia of the organ tissue. Of great importance in this mechanism are the anastomoses between the ovarian branches of the uterine artery and the ovarian arteries proper, extending from the aorta. The capillary ramifications of the myomatous nodes themselves do not have anastomoses at the end sections, therefore, PVA particles entering them lead to persistent blockage of the supply vessels, which determines the selective effect of endovascular intervention and its effect only on the myoma itself (Dobrokhotova Yu.E., Kapranov S.A. ., Bobrov B.Yu., Alieva A.A., Grishin I.I.). After the introduction of embolization particles, the myoma loses its blood supply and it is replaced by connective tissue - fibrosis, which leads to a significant reduction and / or disappearance of the fibroids and its manifestations.

The closest analogue of the proposed method is a method for the treatment of uterine fibroids by selective embolization of the uterine arteries proposed by Jacques Ravina (Ravina J.H., Arterial embolization to treat uterine myomata. Lanset 1995; 346: 671-672). Under local anesthesia of the skin in the upper third of the thigh with transfemoral access under the control of X-ray television, sequential catheterization of the uterine arteries is performed, after which an angiogram is performed, followed by the introduction of embolizing particles of polyvinyl alcohol (PVA) into the vessels of the myoma, which leads to complete occlusion of the vascular bed and the main artery.

Catheterization of the uterine arteries is always carried out from two sides, since the blood supply of even one node can be carried out from different vessels, utero-ovarian anastomoses of various types (B.Yu. Bobrov, S.A. Kapranov, Yu.E. Dobrokhotova, I.A. Krasnova, N. A. Shevchenko, D. D. Aliyeva, V. B. Aksenova Endovascular surgery of the heart and blood vessels, p.

UAE causes myoma ischemia, resulting in acute hypoxia and necrotic changes in tissues. This leads to the appearance of pain of varying intensity, blood discharge from the vagina, fever, weakness, malaise, dysfunction of the bladder and intestines, changes in blood counts, that is, to the development of "post-embolization syndrome" (Yu.E. Dobrokhotova, S. A. Kapranov, B. Yu. Bobrov, A. A. Aliyeva, I. I. Grishin, Russian Bulletin of the Obstetrician-Gynecologist, 2, 2005, 44-49). Depending on the severity of its symptoms, analgesic, infusion, anti-inflammatory, antibacterial therapy is carried out.

The purpose of the invention: to reduce these complications by a preliminary increase in the parenchymal blood flow of the myomatous uterus before UAE, which contributes to better embolization due to the penetration of PVA particles into previously spasmodic myoma capillaries and, accordingly, a decrease in ischemic areas in it and an improvement in blood supply to healthy tissues of the myometrium, which prevents the development of gross morphological changes in the uterus, leading to post-embolization complications. To achieve the effect of increasing parenchymal blood flow, we used Actovegin in an injection solution of 200 mg / 5 ml, which was divided into equal parts and injected 100 mg / 2.5 ml into each uterine artery, while counting on an improvement in blood circulation, which Actovegin provides , as well as its metabolic effect in the myometrium, namely the activation of aerobic oxidation processes, increased oxygen utilization by tissues, activation of enzymes of the antioxidant defense system, and increased tissue tolerance to hypoxia.

Modified EMA technique.

The method is carried out as follows:

Under local anesthesia in the upper third of the right thigh, a puncture of the femoral artery is performed;

A pig-tail catheter is advanced to just below the renal arteries and a pelvic angiogram is performed to clarify the anatomy of the uterine arteries;

A Roberts (COOK) or cobra catheter is placed in the contralateral uterine artery and selective catheterization of the uterine artery is performed under the control of radio television;

A contrast agent is injected and subsequent angiography to visualize the vessels of the uterus;

100 mg (2.5 ml) of actovegin is injected into the uterine artery;

An embolizate is introduced, for example, such as polyvinyl alcohol (PVA 500 from COOK: 500-710 microns) mixed with a contrast agent in an amount necessary to completely stop antegrade blood flow through the artery;

The Roberts catheter is placed in the ipsilateral artery and the above manipulation is performed on the opposite side.

This technique: the introduction of actovegin 2.5 ml/100 mg on each side was effective regardless of the size and location of the fibroids.

Since 2004, we have been performing uterine artery embolization to treat uterine fibroids, since 2005, UAE has been performed in our modification using Actovegin.

Treatment by the UAE method in our modified technique using Actovegin was carried out in 11 patients, 20 patients made up the control group, who underwent standard UAE. UAE was performed in patients with the following types of uterine fibroids:

A general increase from 6 to 15 weeks of the pregnant uterus;

The presence of a single node and with multiple nodes;

In combination with adenomyosis;

Intermuscular arrangement of nodes and nodes with centripetal and subserous growth;

The presence of a node with a power failure in it.

The course of the post-embolization period after the standard UAE was characterized by a variety of post-embolization symptoms: abdominal pain, hyperthermia up to 38°C and above; disruption of the gastrointestinal tract; symptoms of an acute abdomen; menorrhagia; leukocytosis.

When conducting UAE according to a modified method with Actovegin, a favorable course of the post-embolization period was achieved: pain was insignificant or absent; an increase in body temperature not higher than 37.0-37.5 ° C; no dysfunction of the gastrointestinal tract was noted; discharge from the genital tract is scarce and was observed only in 2 patients; the number of leukocytes was up to 8.0 to 11.5 * 10^9/l, the stay of patients in the hospital after UAE was 1-2 days.

Patients, both experimental and control groups, were under dynamic observation: an examination was carried out, ultrasound of the pelvic organs after 1, 3, 6, 9 months. The reduction in the size of uterine fibroids was the same in both groups.

Thus, when using a new modified UAE technique using Actovegin, a practically painless course of the post-embolization period was noted. The use of the above technique provided a significant reduction in the manifestations of post-embolization syndrome while maintaining the effectiveness of this manipulation in terms of reducing the size of fibroids and its manifestations.

Clinical examples.

Patient 3., 47 years old. Case history No. 919. DS: Uterine fibroids, enlargement up to 8 weeks of the pregnant uterus with centripetal nodule growth (node ​​size up to 5.0 cm in d).

02/01/05: UAE was performed in the following way: selective catheterization of the uterine arteries was performed by transfemoral access, followed by the introduction of 2.5 ml/100 mg of Actovegin under fluoroscopic control and immediately the introduction of PVA-500 (COOK). In the p / o period, there was no pain symptom, body temperature remained at normal levels, in the blood test L - 5.3 * 10^9 / l, fibrinogen was normal. Ultrasound control on the day of discharge on day 3 - a decrease in the size of the node from 5.0 cm to 3.2 * 3.0 cm. Observation for 9 months: the size of the node is 2.5 * 2.2 cm, normalization of the menstrual cycle, improvement in general well-being.

Patient U., 26 years old. Case history no. 11099. DS: Multiple uterine fibroids enlargement up to 15 weeks pregnant uterus. Chronic anemia II stage. Ultrasound examination and gynecological examination revealed many nodes located in all layers and on all surfaces of the uterus. 20.10.05: UAE according to our modified method with actovegin: selective catheterization of the uterine arteries was performed by transfemoral access, followed by the introduction of 2.5 ml/100 mg of actovegin under fluoroscopic control and immediately the introduction of PVA-500 (COOK). P / o period with a slight pain syndrome (stopping by a single injection of tramadol and no-shpa), t up to 37.3 ° C, on the first day - weakness, dizziness against the background of normal blood pressure, in the blood test L - 11.5 * 10 ^ 9/l, fibrinogen - 2.68. Ultrasound after 3 days: reduction in the size of the uterus up to 13 weeks.

Patient 77., 37 years old. Case history No. 11427. DS: Uterine fibroids 8 weeks, node malnutrition. Received 25.10.05, with complaints of pulling pain in the lower abdomen. According to the ultrasound and examination, the patient revealed a malnutrition of the myomatous node (interstitial node 4.3 * 3.5 cm along the left uterine rib). On day 1, the patient was intravenously injected with 200 mg of actovegin in 200.0 physical. solution; 2.0 2% papaverine; 400.0 5% glucose solution; 100.0 metrogil; 0.1 doxycycline in 200.0 physical. solution. A day later, on October 27, 2005, against the background of the disappearance of pain, UAE was performed according to a modified method with actovegin: selective catheterization of the uterine arteries was performed by transfemoral access, followed by administration of 2.5 ml/100 mg of actovegin under fluoroscopic control and immediately administration of PVA-500 (COOK). In the p / o period, ongoing therapy was continued. The pain syndrome was insignificant, rectal suppositories "diclofenac" were used once a day, body temperature was at normal levels, in the blood test L was 7.1*10^9/l, fibrinogen was 3.26. Ultrasound 29.10.05: node 3.5*2.8 cm, clear contours. Extract 29.10.05 - 2 days after UAE.

Conclusion.

For the first time, an original modification of uterine artery embolization in the treatment of uterine fibroids was proposed, developed and used in clinical practice. The method of embolization of the uterine arteries with the preliminary administration of Actovegin makes it possible to achieve a more favorable course of the post-embolization period: a painless course or with slight pain sensations; reduction of postoperative bed-day; reducing the amount of medications used without compromising the effectiveness of the manipulation and its immediate and long-term results of treatment.

A method for the treatment of uterine fibroids by embolization of the uterine arteries, characterized in that after selective catheterization, 100 mg of actovegin in 2.5 ml are injected into both uterine arteries, and then the embolizate is immediately administered.

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