COMPARATIVE CHARACTERISTICS OF THE STATE OF MICROCIRCULATION WHEN USING ELECTROCOAGULATION AND MEDICAL LASER IN THE SURGICAL TREATMENT OF ACUTE CONDYLOMAS OF THE ANOGENITAL REGION UNDER THE CONDITIONS OF USING NITROGEN DONORS

Abstract

The aim of the work: comparative characteristics of the effect of surgical treatment methods for acute condylomas of the anogenital region (ACAR) on microcirculation in complex therapy using nitrogen donors.

Materials and Methods. 146 patients with ACAR were examined and treated, divided into 3 groups. Group 1 (n=70): patients with multiple ACAR – 47 (67.14 %); isolated – 21 (30.0 %); Buschke – Levenstein condylomas – 2 (2.86 %); Group 2 (n=35): multiple – 19 (54.29 %); single – 15 (42.86 %); Buschke – Levenstein condylomas – 1 (2.86 %); Group 3 (n=41): multiple – 21 (51.22 %); solitary – 20 (48.78 %). Microcirculation was studied during the initial examination, after preoperative preparation, and in the postoperative period on days 3 and 10 using laser Doppler flowmetry: M – arithmetic mean value of microcirculation index (MCI); σ (“flax”) – standard deviation (SD) of blood flow amplitude fluctuations from the mean value M; Kv – coefficient of variation – the ratio between the perfusion index and its variability: Kv = σ/M×100%. The nature of microcirculation and its changes depending on the surgical method and the use of arginine aspartate were determined. Patients in groups 1 and 3 underwent Arginine aspartate therapy before surgery and in the postoperative period. Surgical treatment in groups 1 and 2 was performed using electrocoagulation, while in group 3, it was performed by using surgical laser.

Results. In all groups, the initial MCI data were representative, with mean values in patients with multiple ACAR`s: M – (12.29±0.32) pf. units (p<0.05), flax – (0.66±0.03) pf. units (p<0.05), Kv – (5.52±0.22) % (p<0.05) (hyperemic type); in isolated cases: M – (4.60±0.06) pf. units (p<0.05), flax – (0.56±0.03) pf. units (p<0.05) and Kv – (12.23±0.58) % (p>0.05) (spastic type); for giant condylomas of Buschke – Levenshtein: M – (18.92±0.55) pf. units (p<0.05), flax – (0.55±0.21) pf. units (p<0.05), Kv – (2.95±1.17) % (p<0.05) (hyperemic, congestive-stasis). After preoperative preparation, patients with multiple ACAR in groups 1 and 3 undergoing arginine aspartate therapy showed a change in microcirculation toward normalization, indicating the elimination of the venous component in the form of slowed blood outflow. In group 2, these changes were less pronounced, which can be explained by the absence of the effect of the NO donor on the vascular endothelium. In the postoperative period, patients in groups 1 and 2 showed persistence of the inflammatory phase of the wound healing process, which was offset in group 1 by arginine aspartate therapy. In the group of patients treated with a surgical laser, microcirculation parameters did not change significantly and did not differ from the control group by day 10. In groups 1 and 3 of patients with isolated ACAR, after preoperative preparation, there were significant shifts toward the normotonic variant of microcirculation. In group 2, the positive dynamics were insignificant in the form of a tendency toward normalization. On the third day of the postoperative period after electrodestruction, a slowdown in microcirculation was observed as a reaction to trauma, more significant in group 2, with gradual normalization in group 1 on the tenth day. In group 3, the indicators did not differ significantly from those in healthy individuals. The condition of the MCI in patients with Buschke-Levenstein condylomas in group 1 tended to improve in one case but did not change significantly, depending on the nature of the spread and complications.

Conclusions. The use of a surgical laser promotes earlier restoration of microcirculation than the use of electrocoagulation, due to early normalization of microcirculation and reduction of the inflammatory phase.

When using the electrocoagulation method, the use of arginine aspartate promotes the optimization of microcirculation and neutralizes the effects of post-traumatic tissue reactions.