| 摘要 |
FIELD: medicine. ^ SUBSTANCE: method involves carrying out combined spinal and intravenous anesthesia. Greater sexual lips are sutured to perineal skin on both sides. Diamond-shaped incision is done on posterior vaginal wall, the incision grows wide from top to bottom, and the incision bottom edge corresponds to the posterior vaginal wall bottom edge, and the incision top edge corresponds to the posterior vaginal wall bulging top edge. Rectovaginal partition is exposed upwards to posterior vaginal vault top, anterior muscle portions of rectum-lifting muscles are mobilized, and anterior fascia portions of the rectum-lifting muscles are cut along muscular fibers. Mirror is introduced into wound and vagina is lifted as high as possible towards entrance into small pelvis and then exposed posterior leaflets of the right and left anterior fascia portions of the rectum-lifting muscles are sutured to each other with absorbable synthetic sutures. Implant, surgical wavy trapezoid Prolene gauze is placed in wound with wider trapeze base being individually selected with distance between anterior portions of the rectum-lifting muscles in their attachment places adjacent to bottom branches of patient pubic bones, taken into account. The gauze has perpendicular arrangement of its fibers. The wider trapeze base is placed in proximal position and stretched from the posterior vaginal vault top to the operational access bottom edge. Its lateral edges are proximally fixed to periosteum of internal surface of the right and left pubic bone bottom branches at the places the rectum-lifting muscles are attached to them and also fixed with 2-5 interrupted sutures to the posterior vaginal vault and to the anterior rectum wall with nonabsorbable suture. Distal redundant narrow portion of stretched implant is dissected in the middle at the level of 1 cm above the lower edge of vaginal wound giving the implant trousers shape. Tunnels are bluntly created through the available separate 10-15 mm long incisions in internal sciatic tubercles edges projection area from skin to the lower lateral edges of rectovaginal partition wound and then each leg of trousers-shaped implant is brought out through the created tunnels to pireneal skin with some excess left. The implant is pulled catching each of the implant legs, straightened and stretched in operation wound on posterior fascia leaflets sutured to each other of the anterior portions of the rectum-lifting muscles with two longitudinal central absorbable suture rows 10-15 cm far from each other. Then anterior levatoroplasy is carried out above the implant with 3-4 interrupted absorbable sutures and implant legs are fixed through incisions in sciatic tubercles projection with interrupted nonabsorbable sutures to sciatic tubercles periosteum. Unused implant rest is cut off. Skin wounds are sutured. Redundant posterior vaginal wall residue restricted by incision is excised and the vaginal wound is repaired with isolated interrupted sutures. ^ EFFECT: provided sufficient blood supply to the implant-surrounding tissues; reliable engraftment conditions; reduced risk of rectocele and metroptosis relapses. ^ 2 cl |
