RU2196518C2 - Method for surgical treatment of rectocele - Google Patents
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- RU2196518C2 RU2196518C2 RU2001100638A RU2001100638A RU2196518C2 RU 2196518 C2 RU2196518 C2 RU 2196518C2 RU 2001100638 A RU2001100638 A RU 2001100638A RU 2001100638 A RU2001100638 A RU 2001100638A RU 2196518 C2 RU2196518 C2 RU 2196518C2
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Изобретение относится к медицине, а именно к хирургии и проктологии, и может быть использовано для хирургического лечения ректоцеле. The invention relates to medicine, namely to surgery and proctology, and can be used for surgical treatment of rectocele.
Одной из важных задач колопрооктологии является хирургическое лечение ректоцеле. Наиболее часто для лечения этого заболевания применяется способ, разработанный сотрудниками НИИ проктологии (В. Д. Федоров, В.Д. Дульцев. Проктология, -М. : Медицина, 1984, - c.29, 140), который заключается в следующем. Операцию выполняют под общим обезболиванием. Положение больной на операционном столе с разведенными в стороны и согнутыми в коленных и тазобедренных суставах нижними конечностями. Выкраивается треугольный лоскут задней стенки влагалища, который отсепаровывается. Переднюю стенку прямой кишки гофрируют в продольном направлении отдельными кетгутовыми швами без прокалывания слизистой оболочки кишки. Вторым рядом швов ушивают мышцы, поднимающие задний проход, предварительно острым путем, выделив их из окружающих тканей. Недостатком данной операции является высокая частота рецидивов и инфекционных осложнений от 5,3 до 16%. One of the important tasks of coloproctology is the surgical treatment of rectocele. Most often, the method developed by the staff of the Research Institute of Proctology (V.D. Fedorov, V.D. Dultsev. Proctology, -M.: Medicine, 1984, p.29, 140) is used to treat this disease, which is as follows. The operation is performed under general anesthesia. The patient’s position on the operating table with the lower extremities bent to the sides and bent at the knee and hip joints. A triangular flap of the posterior wall of the vagina is cut out, which is detached. The front wall of the rectum is corrugated in the longitudinal direction by individual catgut sutures without piercing the intestinal mucosa. The second row of sutures is used to suture the muscles that raise the anus, previously in the acute way, isolating them from the surrounding tissues. The disadvantage of this operation is the high frequency of relapses and infectious complications from 5.3 to 16%.
Техническим результатом является повышение эффективности лечения и профилактика рецидивов. The technical result is to increase the effectiveness of treatment and prevention of relapse.
Способ осуществляется следующим образом. За 5-7 дней до операции для коррекции микробиоценоза влагалища применяют препарат "Бактиспорин" (Бактиспорин сухой представляет собой лиофилизиорованные живые бактерии Bacillus subtilis штамма 3Н), обладающий бактерицидным и фунгицидным действием (тампоны во влагалище на 2 ч, ежедневно). Кроме того, "Бактиспорин" назначают перорально по 1 дозе 2-3 раза в день для коррекции дисбактериоза кишечника. The method is as follows. 5-7 days before surgery, the drug "Baktisporin" is used to correct vaginal microbiocenosis (Dry bactisporin is a lyophilized living bacteria Bacillus subtilis strain 3H), which has bactericidal and fungicidal effects (tampons in the vagina for 2 hours, daily). In addition, "Baktisporin" is administered orally at a dose of 2-3 times a day to correct intestinal dysbiosis.
Операцию выполняют под общим обезболиванием. Положение больной на операционном столе с разведенными в стороны и согнутыми в коленных и тазобедренных суставах нижними конечностями. Первым этапом выкраивают аутодермальный лоскут с медиальной поверхности бедра. Обработку лоскута осуществляют по Янову В.Н. Далее расщепляют ректовагинальную перегородку, выделяют мышцы леваторов. Переднюю стенку прямой кишки гофрируют в поперечном направлении отдельными кетгутовыми швами без прокалывания слизистой оболочки кишки. Вторым рядом, викриловыми швами ушивают мышцы, поднимающие задний проход, предварительно острым путем выделив их из окружающих тканей. Выкраивают аутодермальный лоскут нужного размера и концы его фиксируют поверх викриловых швов. Поверх трансплантанта укладывают мышцы - леваторы. The operation is performed under general anesthesia. The patient’s position on the operating table with the lower extremities bent to the sides and bent at the knee and hip joints. The first step is to cut out an autodermal flap from the medial surface of the thigh. Processing the flap is carried out according to Yanov V.N. Next, the rectovaginal septum is split, the muscles of the levators are secreted. The front wall of the rectum is corrugated in the transverse direction with separate catgut sutures without piercing the intestinal mucosa. The second row, with acrylic sutures, sutures the muscles that raise the anus, having previously sharply selected them from the surrounding tissues. An autodermal flap is cut out to the desired size and its ends are fixed on top of the vicryl joints. Muscles - levators are laid on top of the transplant.
Данный способ обладает рядом существенных преимуществ в сравнении с известными. Нашими морфологическими исследованиями установлено, что аутодермальный лоскут обладает иммуномодулирующими свойствами, кроме того, он выполняет каркасную функцию. Немаловажное значение имеет воздействие "Бактиспорин" на состояние местного макрофагального звена иммунитета, вследствие этого косвенно оказывается влияние на обсемененностъ слизистой оболочки толстой кишки, в биоптатах у пациентов, которым проводилось лечение по разработанному способу. This method has several significant advantages in comparison with the known. Our morphological studies have established that the autodermal flap has immunomodulating properties, in addition, it performs a skeleton function. Of no small importance is the effect of "Baktisporin" on the state of the local macrophage immunity, as a result of which indirectly affects the colonization of the colon mucosa, in biopsy specimens in patients who were treated according to the developed method.
Данный способ применен у 28 больных, у которых, благодаря использованию предлагаемого способа, удалось сократить сроки лечения с 13-20 суток до 12-14, по сравнению с пациентами контрольной группы (22 человека) (таблица). This method was applied in 28 patients, who, thanks to the proposed method, managed to reduce the treatment time from 13-20 days to 12-14, compared with patients in the control group (22 people) (table).
При применении данного способа у больных основной группы осложнений не наблюдалось, у всех больных получен хороший и отличный результат. Рецидивов заболевания не отмечалось на протяжении 3 лет. When using this method in patients of the main group of complications was not observed, all patients received a good and excellent result. Relapse of the disease was not observed for 3 years.
Клинический пример. Больная Т., 42 лет история болезни N 13678, поступила в клинику в плановом порядке с диагнозом ректоцеле 3 ст. Диагноз верифицирован ректороманоскопией, ирргографией, сфинктерометрией. За 5 дней до операции применяли препарат "Бактиспорин" (тампоны во влагалище на 2 ч, ежедневно). Кроме того, "Бактиспорин" назначили перорально по 1 дозе 2-3 раза в день для коррекции дисбактериоза кишечника. Clinical example. Patient T., 42 years old, case history N 13678, was admitted to the clinic in a planned manner with a diagnosis of rectocele 3 tbsp. The diagnosis was verified by sigmoidoscopy, irrography, sphincterometry. 5 days before the operation, the drug “Baktisporin” was used (tampons in the vagina for 2 hours, daily). In addition, "Baktisporin" was administered orally at a dose of 2-3 times a day to correct intestinal dysbiosis.
Операцию выполняли под общим обезболиванием. Первым этапом выкраивали аутодермальный лоскут с медиальной поверхности бедра. Обработку лоскута производили по Янову В. Н. Далее расщепили ректовагинальную перегородку, выделили мышцы леваторов. Переднюю стенку прямой кишки гофрировали в поперечном направлении отдельными кетгутовыми швами без прокалывания слизистой оболочки кишки. Вторым рядом, викриловыми швами ушили мышцы, поднимающие задний проход, предварительно острым путем, выделив их из окружающих тканей. Выкроили аутодермальный лоскут нужного размера и концы его фиксировали поверх викриловых швов. Поверх трансплантанта уложили мышцы - леваторы. The operation was performed under general anesthesia. The first stage was an autodermal flap cut from the medial thigh. The flap was processed according to V. N. Yanov. Next, the rectovaginal septum was split, the levator muscles were isolated. The front wall of the rectum was corrugated in the transverse direction by separate catgut sutures without piercing the intestinal mucosa. The second row, with acrylic sutures, the muscles that lifted the anus were sutured previously by the sharp path, separating them from the surrounding tissues. An autodermal flap of the required size was cut out and its ends were fixed on top of the vicryl joints. Levator muscles were placed on top of the transplant.
Осмотрена через 1,3 года, рецидива заболевания не было. Examined after 1.3 years, there was no relapse of the disease.
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АМИНЕВ А.М. Учебное пособие по проктологии. 1977, с.118-128. * |
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