Method for primary treatment of invasive cancer of uterine cervix
FIELD: medicine, oncogynecology.
SUBSTANCE: it is necessary to carry out expanded uterine extirpation and intrasurgical radiation therapy (ISRT). In women of reproductive age at squamous cell forms of uterine cervix cancer before the stage of expanded uterine extirpation one should fulfill ovarian transposition by fixing them in the upper departments of lateral canals of abdominal cavity to provide their functional safety and integrity of vascular peduncle. On finishing the stage of expanded uterine extirpation it is important to form the field of irradiation that includes vaginal stump and perivaginal fiber by restricting the organs of small pelvis and abdominal cavity against irradiation region. Irradiation should be carried out due to distance technique by providing the dosage of 15 Gy in the preset area. On finishing the ISRT seance it is necessary to conduct peritonization of small pelvis. The innovation enables to decrease the frequency of postsurgical complications that take place while ISRT procedure.
EFFECT: higher efficiency of therapy.
1 cl, 2 ex
The invention relates to medicine and can be used to treat patients with invasive cervical cancer (cervical cancer). The optimal volume of surgeries performed about invasive forms of malignant neoplasms of the cervix, is extended hysterectomy with appendages (Wertheim operation) or transiciel ovarian Bohman AV, Manual of gynecology, St. Petersburg.: Folio, 2002, str-259). As a rule, patients with invasive forms of cervical cancer is a combination treatment, including surgical component and different ways of radiotherapy. For example, there is a method of postoperative radiation therapy which can be considered as the closest prior art (Vishnevskaya E.E. Modern principles of combined treatment of patients with cervical cancer. // The. Oncology, t, No. 3, 1985, p.9-17). The objectives of postoperative irradiation is the eradication of microscopic elements of the tumor remaining after surgery. The effectiveness of irradiation in the postoperative period, in terms of violations of the architectonics of the pelvic organs and bound in hypoxic tissues of the tissues is somewhat lower. The duration of combined treatment significant and currently averages 1.5 months. The frequency of complications in different variants to binyavanga treatment varies 20-82% (Bagirov H.F. Combined treatment of cervical cancer stage Ib using two variants of preoperative gamma therapy. // abstract. Diss. on saisc. academic step. CMN Moscow 1983.; Gerdin E, Cnattingius S, Johnson P. Complications after radiotherapy and radical hysterectomy in early-stage cervical carcinoma. // Acta Obstet Gynecol Scand. 1995 Aug; 74(7): 554-61).
In this regard, tasked with the development of a method for the treatment of said pathology devoid of these disadvantages. The technique of intraoperative radiation therapy (IORT) is conducting radiation exposure once the high-dose beam of electrons of various energies, the use of the latter allows to concentrate the dose in a given volume at a given depth. The method of deciding on ionizing radiation can reduce the absorbed dose to critical organs of small pelvis (bladder, ureter, rectum), as well as reduce the overall treatment time due to the reduction or complete waiver of course additional fractionated radiation therapy. While holding IORT until peritoneal pelvic floor eliminates radiation exposure of critical organs of small pelvis and reduces the number of radiation complications. This is the technical result of the invention.
The method is as follows. In the first stage of surgical intervention in patients of reproductive age with squamous forms of cervical cancer and the ri the absence of confounding factors forecast is the transposition of the ovaries. As a result of transposition of the ovaries are moved to the top floor of the abdominal cavity. When this is achieved, their withdrawal from the zone of the radial load and the exception radiation castration. An important aspect when performing a transposition is retroperitoneal holding neurovascular bundle (Voronko-pelvic ligament), and the appendages are located in the abdominal cavity, which creates favorable conditions for their normal functioning. The transposition is performed on the original developed technique, which consists of several stages:
- is selected along the vascular pedicles of the ovary and fallopian tube length of at least 12 cm;
- upper and lower poles of the ovaries marked tantalum clips, allowing them to easily visualize on survey radiographs of the abdomen;
- is the formation of the right and left retroperitoneal channels with upper and lower apertures;
- using the clip appendages are conducted through the retroperitoneal lateral channels and displayed in the abdominal cavity through the upper aperture.
- fixation appendages separate silk ligatures to the lateral divisions of the abdominal wall in the region of podrebarac.
Next is the main stage - extended hysterectomy that includes removal of the uterus with the upper third of the vagina and parallel the Noah fiber, as well as bilateral ilio-obturatorious the lad. This sequence of surgical operations guarantees the preservation of the ovaries and their vascular legs. After removal of the drug in the operating wound clearly visible main anatomical structures: the neurovascular bundles (common, external and internal iliac artery and vein, ureter, locking nerves, the stump of the vagina, bladder and rectum. The loops of the small intestine is fixed in the top floor of the abdominal cavity. Women pre - and postmenopausal age stage of transposition of the ovaries is not made, but is extended hysterectomy with appendages.
Once you have defined the target exposure and the anatomical relationship of critical organs, the selected size of the field and made adjustments to the data pre-planning, radiation therapist forms a bolus and marks on the surface of a field boundary. In the case of an application system beam shaping is selected suitable for the diameter of the tube, the latter is set in the operative wound and is fixed by means of special fastening system. One of the difficulties IORT on the area of the vaginal stump is that in the immediate vicinity of the zone of interest are the rectum, maketoc the ISR and the bladder which is highly sensitive to ionizing radiation hollow bodies, radiation damage which may result in a serious, life-threatening complications. To provide an adequate margin forming and to reduce the radial load IORT should be to peritoneal pelvis, directly after removal of the drug. This allows to clearly visualize the location of large vessels, ureters, bladder, rectum at the stage of forming fields. Is the delimitation of hollow bodies from the vaginal stump using gauze swabs soaked in saline solution. Holding IORT to peritoneal avoids fixation of the bladder, rectum, ureters to the cult of the vagina, this circumstance provides the output of hollow organs outside the field of irradiation with IORT. Empirically determined the optimal focal dose of IORT, the components of 15-20 Gy. After the session IORT is peritonial pelvic peritoneum: the cult of the vagina filed abdominal integuments of the bladder, rectum, sewn together separated sheets parietal peritoneum.
Example 1. Patient, 57 years of age.
In April 2002 revealed cervical cancer TIBINoMostage. 21.05.2002 - extended hysterectomy with appendages, IORT to the vaginal stump in SD 15 Gr. IORT was performed to peritoneal pelvic floor. When a plan is the first histological study low differentiated squamous cell carcinoma with invasive growth in thickness of the cervix at a depth of 7 mm In regional lymph node metastases not identified. The postoperative period was without complications. Subsequent follow-up without evidence of disease progression, late complications were recorded.
Example 2. Patient D. 32 years.
In March 2002 revealed cervical cancer TIbINIM0. 08.04.2002 - extended hysterectomy with ovarian transposition, IORT to the vaginal stump in SD 20 Gr. IORT was performed to peritoneal pelvic floor. Histological examination - squamous cell carcinoma moderately differentiated carcinoma with infiltration 2/3 of the cervix, in one of the regional lymph nodes metastasis of cancer. The patient uncomplicated postoperative period. In connection with metastatic lymph nodes postoperative held remote radiation therapy to the area of regional lymphatic drainage. During follow-up without evidence of disease recurrence, late complications were recorded.
By now, we have 58 extended the removing of the uterus with appendages or transposition of the ovaries, accompanied IORT 14 operations with IORT conducted to peritonial the pelvic floor, the complication rate was 21.4%.
Thus, the run method allows to reduce the frequency of postoperative complications, developing when conducting IORT.
1. The primary treatment of invasive cervical cancer, including extended hysterectomy and radiation therapy, wherein the radiation therapy is carried out intraoperatively, after the completion of the advanced stage of removing the uterus form an irradiation field, including the vaginal stump and okoloolgiline fiber, ogranichivaya the pelvic and abdominal cavity from the zone of irradiation, irradiation is carried out remotely, providing in a given zone dose of 15 Gy, after the end of the session intraoperative radiation therapy are peritoneal pelvis.
2. The method according to claim 1, characterized in that in women of reproductive age with squamous cell cancers of the cervix until the advanced stage of removing the uterus perform the transposition of the ovaries, locking them in the upper sections of the lateral channels of the abdominal cavity, providing them with functional safety and the integrity of the vascular pedicles.
FIELD: medicine, oncology, radiology.
SUBSTANCE: the suggested thermochemoradiation treatment should be fulfilled in three stages at intervals between each of them being 10-14 d: during the 1st stage it is necessary to carry out distance gamma-therapy daily at fractionating the dosage during 1-3 d per 4 Gy, then during 4-22 d per 2 Gy up to TFD being 50 isoGy, radiosensitization with 5-fluorouracil daily at the dosage of 125 mg intravenously at flow-type technique 30 min before the séance of radiation treatment and local thermotherapy with transrectal sensor once/2 d, every other day, just before gamma-therapy; during the 2nd stage it is necessary to conduct radiosensitization and local thermotherapy similarly, as it was during the first stage, as for irradiation it should be carried out as intracavitary gamma-therapy daily per 3 Gy up to TFD being 18-24 Gy; during the 3d stage one should fulfill radiosensitization with fluorouracil as during the first and second stages and carry out distance gamma-therapy daily per 2 Gy so that TFD from all three stages should achieve 74 isoGy.
EFFECT: higher efficiency of therapy.
FIELD: medicine, oncology.
SUBSTANCE: the present innovation deals with complex therapy of mammary gland cancer at T1-2NO-1MO. The method includes chemo- and radiation therapy and operation procedure. Moreover, in post-surgical period, before the onset of radiation therapy course it is necessary to sample 200 ml patient's blood and due to centrifuging technique isolate autoplasma. One should place 20 ml autoplasma and chemopreparations into the first vial, into the second vial - remained blood cells and autoplasma. Vials should be separately incubated for 40 min at 37° C, then during the first day of radiation therapy before the onset of the seance one should introduce the half of autoplasma volume incubated with chemopreparations from the first vial into the ducts of operated mammary gland, as for the remained part of autoplasma incubated with chemopreparations, from the first vial it should be introduced into the site of surgical withdrawal of drainage tube. Blood incubated with chemopreparations from the second vial should be reinfused intravenously by drops. The innovation is of low toxicity and enables to carry out complex organ-saving therapy in short terms, decrease the frequency of local relapses and remote metastases, the number of radiation reactions and complications.
EFFECT: higher efficiency.
FIELD: methods and devices for treatment of oncology patients using sources of ionizing radiation, namely, technology of pre-irradiation preparation and irradiation during intracavitary and interstitial radiotherapy.
SUBSTANCE: method for pre-irradiation preparation and irradiation includes positioning the patient on treatment-diagnostics table, inserting into cavity to be irradiated of hollow applicators with imitators of ionizing radiation sources, controlling position thereof relatively to target being irradiated with usage of x-ray television device, building of dosimetric plane and irradiation, while applicators inserted into cavity being irradiated are connected to treatment-diagnostics table, x-ray radiography is performed with output of image onto monitor of viewing station of x-ray television device, image via the interface is transported into planning system, dosimetric plane of irradiation is computed, which is then exported into system for controlling device and irradiation procedure is performed. Treatment-diagnostics table has frame, two supporting posts with overhung table top mounted on them, consisting of a pelvic-dorsal and two extending leg sections, connected to pelvic-dorsal section by means of twin joints. For connection of applicator table is provided with mounting pillar.
EFFECT: possible irradiation directly near apparatus without moving the patient during x-ray control of position of applicators and, therefore, increased quality of radiotherapy and therapeutic efficiency, decreased duration of pre-irradiation preparation.
2 cl, 3 dwg
FIELD: medicine, in particular, radiotherapy.
SUBSTANCE: during irradiation of oncology patients on cobalt distance apparatuses dose field is formed by injecting topographic-anatomic information of patient into dose planning system and generating with its consideration of main dose field on basis of results of calculations of main dose field, dose deficiency area is located within limits of target and iso-centers of additional dose fields are positioned therein, while width of radiation beams, generating additional dose fields, is less than width of beam of main dose fields 1,5-2,5 times, while value of dose of main field is 0,7-0,85 of resulting dose within limits of target.
EFFECT: possible generation of dose field with minimal possible dose change on target while simultaneously decreasing radiation loads on normal tissues and skin.
2 dwg, 1 ex
FIELD: medicine, in particular, oncology.
SUBSTANCE: in accordance to method, thermo-radio-therapy of malignant tumors is performed in form of split course in mode of enlarged dynamic fractioning of dose in 6 fractions of 4 Gy and 8 fractions of 2 Gy in first course, and 6 fractions of 4 Gy and 3 fractions of 2 Gy in second course in conjunction with hyper-thermal effect in the same day when radio-therapy is performed.
EFFECT: increased apparent counter-tumor local effect.
FIELD: medicine, namely, medicinal use of radiation, possible use for determining dose really received by pathologic focus having absorbed open radioactive nuclide.
SUBSTANCE: method for verification of dose during medicinal usage of open radioactive nuclides includes measuring intensiveness of radiation, with consideration of changes in radiation source activity in time, during that, by means of tissue-equivalent phantom, original intensiveness of radiation of open radionuclide is measured immediately prior to injecting it into organism of patient as well as average intensiveness of radiation from focuses having absorbed radionuclide, and after that individual relative dose of open radionuclide injected into pathologic focuses is computed using formula
where Dn/o - value of relative dose in %, Io - original intensiveness of radiation at the moment of injection of radionuclide, In - average intensiveness of radiation from focuses at day or hour of measurement of n, B0 and Bn - background values of radiation intensiveness at the moment of injection of radionuclide and at the day of measurement, respectively, k - coefficient of daily or hourly decomposition of radionuclide, n - number of days or hours having passed since the moment of injection of radionuclide.
EFFECT: invention allows verification of relative dose in most precise and individual manner.
FIELD: medical facilities.
SUBSTANCE: device can be used as a tool for malignant tumors surgery. Device for radionuclide surgery has gamma radiation detector, collimator and handle. Wire of detector is connected with measuring unit. Gamma radiation detector is fixed in metal tip with sharpened side edge, which passes in plane being perpendicular to optical axis of gamma radiation detector. Detector is made in form of semiconductor crystal; two collimators adjoin opposite surfaces of crystal. Collimators have cells which pass in parallel to optical axis of gamma detector. Measuring unit has electronic circuit with sonic signal source.
EFFECT: ability of reaching area of lesion for removing it.
4 cl, 2 dwg
SUBSTANCE: device belongs to wide spectrum of influence devices, which is able to make prophylactic and medicinal influence onto human body; in particular, it can be used for destroying benign and malignant tumors and other concentrated formations. Device for making physiotherapeutic effect has control unit and influence localization unit connected with influence localization area. It also has hard base and unit for movement along x, y and z coordinates. Physiotherapeutic device is made in form of frame mounted onto hard base for shift in linear coordinates x, y and z, and n physiotherapeutic influence sources. The sources are disposed along perimeter of frame, which frame is connected mechanically with corresponding outputs of shift unit along coordinates x, y and z. Inputs o shift unit are connected with corresponding outputs along coordinates x, y and z of control unit. Corresponding inputs of control unit are connected with additional outputs of shift unit along coordinates x, y and z. Control input of control unit is connected with output of influence localization unit.
EFFECT: improved efficiency of physiotherapeutic effect; reduced negative reactions of organs and tissues surrounding the area.
13 cl, 5 dwg
SUBSTANCE: method involves administering Wobenzyme combined with brachytherapy with radiomodification and transpupillary thermotherapy or combined with isolated transpupillary thermotherapy. When combined with brachytherapy with radiomodification, Wobenzyme is given 2 days before brachytherapy at a dose of 3 pills 3 times a day with the exception of 8 h before fixation and removal of β-applicator. Next to it, Wobenzyme is given at a dose of 4-6 pills 3 times a day during 3 months. Then, the dose is reduced by 2 pills every month at the fourth, fifth and sixth months. Adjuvant transpupillary thermotherapy is carried out 6 months later after brachytherapy. Wobenzyme is given at a dose of 2-3 pills 3 times a day 2 days before transpupillary thermotherapy. Then, the dose is 4-6 pills 3 times a day during 2 months with following dose reduction by 3 pills every month to prophylactic dose of 1 pill a day. When carrying out isolated transpupillary thermotherapy, Wobenzyme is given in the same mode that it was the case when carrying out adjuvant transpupillary thermotherapy after brachytherapy. To prevent metastasis occurrence, Wobenzyme administration is continued at a dose of 1 pill 7 days every month during the first year and at a dose of 1 pill 3 days every month during the second observation year.
EFFECT: accelerated resorption processes; reduced risk of radiation treatment complications.
FIELD: medicine, oncology.
SUBSTANCE: one should carry out radiation therapy with quick neutrons 6.3 Mev twice weekly in two stages: at the first stage it is necessary to prescribe 3-4 seances of neutron therapy at interval of 48-72 h directly onto area of tumoral relapse and onto surrounding normal tissues at the distance of about 3-5 cm against tumoral foci, single focal dosage being 1.6-2.0 Gy, relative biological efficiency corresponds to 2.91-2.79, onto the skin - 2.0-2.2 Gy, up to total focal dosage being 6.6±1.5 Gy, onto the skin - 8.3±1.3 Gy, at the second stage it is necessary to carry out gamma- or electronic therapy at single focal dosage being 2.0-3.0 Gy, 5 fractions weekly, moreover, total course dosage of neutron-photon irradiation per a focus corresponds to 60 Gy by isoeffect at duration of irradiation course of about 20-25 d.
EFFECT: higher efficiency of therapy.
2 dwg, 3 ex
FIELD: medicine, colon proctology.
SUBSTANCE: one should mobilize posterior vaginal wall from anterior wall of the rectum and anterior levators. Moreover, mobilization should be carried out due to introducing Sol.Novocaini 0.25% into rectovaginal septum at the dosage of 40-80 ml. Then one should apply sutures: for this purpose left vaginal wall should be punctured from the bottom upwards with a round piercing needle under left forefinger's control through the rectum to suture the levator along the perimeter up to the opposite one, as for the puncture-out it should be performed at the site of the needle's puncture-in. The innovation enables to improve functional results of therapy and prevent the relapses.
EFFECT: higher efficiency.
2 dwg, 1 ex
FIELD: medical engineering.
SUBSTANCE: device has bushing having internal surface engageable with guide member and flexible disk-shaped sealing members. The flexible disk-shaped sealing members are placed in grooves on outer bushing surface. Maximum flexible disk-shaped sealing members dimensions grow when moving towards idle bushing end. The bushing has at least one additional flexible disk-shaped sealing member. Additional flexible disk-shaped sealing member dimensions are equal to maximum flexible disk-shaped sealing member dimensions. Flexible disk-shaped sealing member having minimum dimensions and flexible disk-shaped sealing member placed near the former one have common surfaces rounded near the working bushing end. Flexible disk-shaped sealing member having maximum dimensions and at least one additional flexible disk-shaped sealing member have guide members with symmetrically rounded edges. The rounded guide members are conjugated with bevels. The bevels are produced on flexible disk-shaped sealing members on the working bushing end side and are equal in length to at least 1/4 times difference between external bushing diameter and maximum size of additional flexible disk-shaped sealing member. Locking member is available on the idle bushing end side.
EFFECT: improved surface engagement conditions of obturator and vagina; facilitated surgeon working conditions.
3 cl, 3 dwg
FIELD: medicine, plastic surgery.
SUBSTANCE: it is necessary to apply a blanket suture onto female genital organs at up to 4-5 mm distance between the stitches at capturing the tissue along the surface for the depth of about 1-2 mm and inside by applying any absorbable material. The innovation enables to avoid inflammatory and cicatricial tissue deformations and, also, increase cosmetic effect.
EFFECT: higher efficiency.
4 dwg, 2 ex
SUBSTANCE: method involves introducing gynecological instrument into uterine cavity without dilation. Material to be removed is treated, including its separation from uterine walls and from its cavity with endometrium state instrument position in the uterus cavity concurrently instrumentally controlled by means of transabdominal echo scanning. After having removed material to be removed from easily accessible uterus areas, a hard-to-reach uterus area of its surface is moved to zone accessible for treating with gynecological instrument causing directed uterus wall sites contraction. To do it, uterine probe is introduced into engagement with uterine wall at place being most close to hard-to-reach area and retained in this position until the instrument is compressed with uterine walls. Then probe is substituted for an instrument usable for separating and removing content from uterine cavity. The work is carried out in the newly formed operation canal under transabdominal echo scanning in removing material to be removed from this uterine cavity site.
EFFECT: enhanced effectiveness in removing the whole hyperplastic endometrium or fetal ovum remnants from uterine cavity under anomalous uterus structure.
FIELD: urology and gynecology, in particular, treatment of pelvic fundus prolapse.
SUBSTANCE: common feature with each of versions of implantation tape is that tape is adapted for creating loop around urethra, is made perforated for growing of fibroblasts therethrough, and comprises distal ends and central part adapted for embracing of urethra between the latter and wall of the vagina. Central part is widening toward one side, said widening portion being made in the form of perforated patch enabling growing of fibroblasts through perforations and adapted for positioning between wall of the vagina and urinary bladder fundus region. According to first version, patch is made triangular and may be connected with central part by apex part of triangle. Such shape allows patch to be deformed so as to impart any desirable anatomic form thereto without formation of undesired creases. Total length of tape, according to first version, is 350-650 mm, thickness is 0.5-1.5 mm, width of distal ends of tape is 4-12 mm. Length of patch from central part of tape perpendicular thereto is 15-45 mm. Width of the widest part of pitch is 15-45 mm. According to second version, patch is made rectangular or trapezium-shaped, and is connected with central part of tape along one side of rectangle or trapezium. Triangular recess is formed at the side of rectangle opposed to side along which it is connected with central part. Apex of recess is directed inward of patch for reducing the probability of forming undesired creases. Depth of recess is 0.2-1.0 the height of rectangle or trapezium, which is measured in direction perpendicular to longitudinal axis of tape central part.
EFFECT: increased efficiency in treatment of urogynecological diseases owing to employment of optimal tape shape and ratio of sizes.
15 cl, 4 dwg, 3 ex
FIELD: medicine, obstetrics, gynecology.
SUBSTANCE: due to instrumental technique one should pre-detect the volume of uterine cavity and its longest length against the cervix. Moreover, it is necessary to fix a woman's body in position at which the upper edge of uterine cavity bottom is below against the lower edge of uterine cervical opening till the moment of complete filling in uterine cavity with blood. With the help of a catheter one should introduce medicinal preparation heated up to +42- +45° C into uterine cavity through an opening in uterine cervix into area of cavitary bottom at the volume exceeding the half of cavitary volume. Moreover, as the above-mentioned medicinal preparation it is necessary to apply dehydrated silicone gel impregnated with equal volume of 3%-hydrogen peroxide solution. The innovation enables to interrupt postpartum hypotonic uterine hemorrhage efficiently and safely.
EFFECT: higher efficiency.
FIELD: medicine, gynecology.
SUBSTANCE: before photocoagulation it is necessary to remove mucous layer in intramural department uterine tube up to the level of fibrinous fibers of submucous membrane, close the passability of isthmus and intramural department of uterine tube due to photocoagulation with scattered laser radiation. A light guide should be replaced from isthmus' lumen through intramural department towards uterine cavity at stops for irradiation purpose by developing dead-end septa along forming closed sections. At photocoagulation one should apply a biological protein hematofibrinous intratissue solder of removed mucous layer. The innovation provides tight tissue welding, decreases traumatism of sterilization due to applying a biological solder, moreover, by keeping viability of epithelial parts in intramural department of uterine tube.
EFFECT: higher efficiency.
SUBSTANCE: method involves cutting of the uterus body and its blood vessels in single stage in 20 min using electrical thread loop from stainless steel string of variable size. The loop is put on over the uterus with both arteries, in loosening it. The loop is fixed pressing it into the uterus body in appropriate position by reducing loop size. Current is supplied to the loop in coagulation mode. The uterus is excised in cutting or mixed mode. Excised uterine stump and blood vessel surface is coagulated with thread slack being pulled with tension mechanism of the instrument. Device has electrically insulated casing having tube enclosing string electrode manufactured from stainless steel and ending in loop connected to electric plug. The electrode string is placed on drum mounted on casing axle. It is engageable to movable handle with its lateral surface by means of serrated joint along circle perimeter allowing engagement over the other lateral drum surface by means of serrated joint along circle perimeter having locking member mounted on the casing. The casing axle has supporting pin engageable with inclined surface of movable handle saddle for pressing the movable handle to the drum to rotate it when moving the handle and for disengaging the movable handle and the drum in carrying out return handle movement and releasing locking member connection to the drum.
EFFECT: accelerated operation process; minimized blood losses.
3 cl, 2 dwg
FIELD: medical equipment.
SUBSTANCE: device for sterilizing women has shutter of Fallopian tubes which has elongated cylindrical shape and which is made of bio-inertial material. As the material, porous-penetrable titanium nickelide is chosen which has maximal lateral size of porous being equal to 50-100 mm.
EFFECT: improved efficiency of shutter.
3 cl, 4 dwg
SUBSTANCE: method involves excising posterior vaginal wall. Oval flap is cut out from allogenous dura mater transplant. Transversally corrugating sutures are applied to anterior rectal wall. Levators are mobilized. The flap is fixed with separate sutures to the rectum. U-shaped sutures are placed through levator with transplant being fixed with 2-3 sutures on the right and on the left side. The right and left levators are joined by suturing. Threads are tied in double-triple knot. Next, U-shaped sutures are tied with double-triple knot. Thread ends are cut off at the level of knot. Posterior wall wound is sutured separate loose sutures.
EFFECT: enhanced effectiveness of treatment; reliable rectovaginal septum fixation.
FIELD: medicine, gynecology.
SUBSTANCE: the method includes laparoscopic access. One should perform dissection of closed functioning uterine horn in its bottom area. Under laparoscopic control due to retrograde hysteroresectoscopy one should carry out resection of endometrium of closed functioning uterine horn. Uterine wall should be restored.
EFFECT: decreased traumaticity of operative interference.