卷 54, 编号 5S (2005)

Over the past decade, the problem of congenital malformations has acquired great medical and social significance. The urgency of the problem and the priority of the development of this direction has increased in connection with the introduction into practice of methods of prenatal diagnostics, which created the basis for the active prevention of the birth of children with multiple developmental anomalies or their timely surgical correction. The significance and state of this problem is evidenced by statistics. According to the National American Center for Birth Defects, 10 to 20 million babies with congenital anomalies are born annually in the world.

Endometriosis is characterized by a variety of forms and variants of the clinical course, paradoxical aspects of etiopathogenesis. Many years of our own experience and analysis of the work of the Russian Association of Endometriosis indicate that this disease is a serious social problem due to the prevalence of such symptoms as debilitating chronic or cyclic pelvic pain, reproductive dysfunction and menstrual cycle in its clinical picture.

Introduction: Avoiding laparotomy by performing laparoscopic hysterectomy, of various types, has been shown to be beneficial in a number of ways. Shorter recovery times, shorter length of hospital stay and convalescence period, and earlier return to work than after abdominal hysterectomy are some of the positive factors cited. However, it is often considered that there is a size limitation of 14-16 weeks’ gestation to the feasibility of laparoscopic hysterectomy. Whilst a number of studies have shown that the laparoscopic-assisted vaginal hysterectomy (LAVH) successfully manages the large uterus, little has been published regarding a total laparoscopic approach.

Objective: the grounding and optimization of organ-saved surgery in treatment of uterine fibroid and benign ovarian cystadenomas.

Introduction. The mid-urethral sling procedures (MUS), like tension free vaginal tape (TVT) or transobturator tape (TOT) procedures are recent modalities for managing female urinary stress incontinence. They have been rapidly gaining popularity worldwide but little has been published to date on the nature and symptoms of associated complication

Relevance. A promising search stage in predicting treatment results using multivariate analysis on a computer is designated as the development of a fundamentally new direction in reproductive operative gynecology.
Purpose of the study. Study of the individual contribution of each of the necessary, sufficient risk criteria in the event of TBI with the formation of the combined most informationally significant signs that contribute to the implementation of the planned volume of laparoendoscopic operations.

The relevance of research. The problem of diagnostics and treatment of purulent inflammatory diseases of the uterine appendages (UHPD) remains relevant.
The purpose of this study: to study the quality of care for patients with HVHPM at the prehospital and hospital stages

Objective: the detrmination of indications and contraindications for reconstructive-plastic surgery of uterine tubes in patient with hydrosalpinx.

Materials and methods. We have operated 159 female patients with tubo-pertironeal sterility, which resulted from existence of hydrosalpinx. All patients were underwent salpingoneostomy with application of laparoscopic (n=122) or microsurgical (n=47) technique. In 26 cases the microbiopsy of ampullar part endosalpinx of uterine tube with subsequent investigation of its ultrastructure by method of light and electronic microscopy (microscope “Hitachi”, Japan) was performed.

Laparoscopy and hysteroscopy approaches are taking a leading position in the up-to-date diagnostic and treatment techniques in gynecology and in reproductive medicine, in particular.

Introduction. Uterine tubes occlusion at the proximal part is one of the causes of the tubal-peritoneal sterility at women. Frequency of proximal tubal occlusion according to various authors averages about 20%.

Authors have applied the method of transvaginal hydrolaparoscopy (THL) in 108 patients with previous history of tubal surgery and 4 patients with benign ovarian masses and severe postoperative adhesions of peritoneal cavity. THL allows to evaluate the effect of reconstructive reproductive surgery and determine the tactics of the further treatment of women infertility. Visual control and biopsy of inner surface of ovarian cyst is the informative tool of differential diagnosis of ovarian masses.

Introduction. In Russia the frequency of fruitless marriages exceeds the established WHO 15% critical level and reaches 17% from total of married couples.

Introduction. Acute inflammatory diseases of uterine appendages are today medical problem that significantly affect the health of women of child-bearing age. In recent years the number of diseases of this group has increased.

Objective: to study possibilities of dynamic laparoscopy in prevention and treatment of adhesions after surgical treatment of extrauterine pregnancy.

The relevance of the problem under study is due to an increase in gynecological morbidity rates, especially an increase in salpingo-oophoritis, characterized by a chronic course, frequent recurrence, severity of consequences and significant impairment of specific functions with persistent disability in young women of reproductive age.

Introduction. Hysterectomy is still the most often intervention in gynecology up to present day (Adamyan L.V. et al., 2000). The most often intervention all over the world after appendectomy is hysterectomy (Wattiez A., et al. 2003).

Introductions. In the structure of gynecological diseases combined uterine pathology requiring operative treatment comprises up to 20-30%. The advent of minor-invasive technologies in operative gynecology nowadays makes it possible to maximally adapt the administered operative treatment for a patient, to shorten the time of being at in-patient clinic, to improve the course of post-operative period.

Relevance. It is known that free radical metabolic reactions are involved in the development and progression of the development of various destructive and hyperplastic processes in tissues. In this regard, the aim of this study was to compare the severity of disorders of the pro- and antioxidant system in single and multiple benign tumors of the female reproductive system.

Purpose. To determine differential ethiopathogenetic approach of hysterectomy in females to prevent the occurrence of genital prolapse after hysterectomy.

Objective: to compare procedure time, blood loss, postoperative period of vaginal hysterectomy using sutures versus using an electrosurgical bipolar plasma kinetic generator GYRUS.

Introduction. Hysterectomy is the most common surgery performed by the gynecologist. There are many indications for hysterectomy and uterus can be removed using any of a variety techni ques and approaches including abdominal, laparoscopic, vaginal and laparoscopic assistance vaginal.

Subject: Optimization of the postoperative stage of treatment by analogs of gonadoliberin in the genital endometriosis patients (E).

Objective. To estimate the role of hormone-dependent changes of the microrelief of endometrial epitheliocytes in pathogenesis of infertility associated with peritoneal endometriosis.

Materials and methods. Endometriosis surgery was carried out in 401 patients.

In the hyperthermic variant, intraperitoneal chemotherapy (IVT) should be started immediately after the surgical stage. Perfusion is best accomplished by inserting 2 laparoscopic irrigation tips through the trocar ports connected to the perfusion system.

Introduction: Various components of immune system take part in pathogenesis of endometriosis. Their role might be paramount or minor during different periods of the disease.

Objective: to investigate the relationships between ovarian blood flow, folliculogenesis and sex-steroids production during normal menstrual cycle and in women with ovarian failure

The urgency of the problem. The problem of diagnosis and treatment of ovarian tumors is complex and relevant, especially when determining the possibility of carrying out organ-preserving surgery in young patients with impaired reproductive function.

Objective: to reveal especiallities of reproductive function disorders in patients with benign ovarian tumors.

Introduction. One of the serious problems of the surgical treatment of the lowering and falling of femal reproductive organs, is a reconstruction of rectovaginal septum at presence of rectocele.

Introduction. The inconsistency of pelvic muscles is one of actual gynecological problems today, resulting in significant amount of pathological processes and decreasing a quality of life. Now most effective method in treatment of pelvic prolaps is surgical treatment with use of prolen implants.

Conclusion. The optimal way for treatment of patients with pelvic prolapse complicated by cysto- and rectocele is combined operation which makes it possible to carry out correction of genital prolapse (including remodeling of pelvic floor) and to eliminate functional disorders of annexa.

The aim. Analsis of effectiveness in use of sling in incontinence treating in women.

Background: now the role of connective tissue displasia (CTD) in genesis of genital prolapse is known. Genital prolaps as nondifferentiated kind of CTD is a manifestation of generalized CTD on the level of reproductive system which developes in young unipara women after noncomplicated delivery without hormonal disorders and factors provided intraabdominal pressure increasing.

Background: genital prolaps which developes especially in young unipara women after noncomplicated delivery without hormonal disorders and factors provided intraabdominal pressure increasing is a common manifestation of generalized connective tissue defect (CTD) on the level of reproductive system.

An urogenital fistulas are serious complication after heavy multiple traumas, wounds, and radical operations. We offer a method of conservative treatment of the given pathology with the help of cultures of allogenic cells.

Introduction. Stress urine incontinence (SUI), gets the important medical and social meaning in view of its extremely high prevalence among the women of senior reproductive age, occurrence and increasing of complex of the factors promoting development of moral- psychological and social - industrial disadaptation of the women.

Introduction. For many years the problem of the lowering and fallouts of vagina and womb remains to be actual. The wide-spread way of the surgical treatment of the lowering and fallouts of the front wall of vagina and cystocele is an anterior colporrhaphia. Its using is limited by difficulties of the operative technics in case of thinness and atrophies of fascia vesicovaginalis, and the high frequency of prolaps relapse.

Problem: what is the effect of “sling” operations for patients with urinary incontonence.

The purpose of this message is to present the results of the use of a synthetic prosthesis for plastic surgery of the posterior vaginal wall during its descent with the formation of rectocele and to inform about a new modification of the plastic surgery of the posterior vaginal wall with the Gynemesh soft prolene mesh.

At present the different types of stress incontinence diagnostics and treatment are the main topics of urogy­necology. T1·aditional methods of clinical, urodynamic and endoscopic exams have been completed Ьу non­invasive 2D and 3D ultrasound.

Introduction and objectives. Paraurethral cysts which can be refered to nonmalignant cystic lesions of vagina are often found in urogynecologic practice. At the same time such rare pathology as diverticulum of urethra with the same symptoms can be diagnosed. The main symptoms of cysts are inflammation, pain, dyspareunia and obstructive voiding. It often requires surgical treatment. The world experience confirms that extirpation of paraurethral cysts is much more preferable than marsupialization because is more radical.

Hypothesis, aims of study. Mixed incontinence can be defined, as involuntary leakage of urine associated with both urgency and exertion, and effort, sneezing, and/or coughing. It can also be defined urodynamically, as combination of urodynamic stress incontinence and detrusor overactivity.

Objective. Comparison of the surgical treatment results in patients with SUI with the use of loop operations with prolen nets.

Aims & Objectives: sexual function can significantly affect human’s quality of life. It definitely decreases in female patients suffering from stress urinary incontinence. The aims of this study were to evaluate the female sexual function before and after surgical treatment of stress urinary incontinence (SUI), comparing long follow-up results of two different procedures.

Background: it’s known that antiestrogens and tamoxifen in the first instance display some level of estrogen activity.

The hysteroscopy diagnostic is considered as the method of definitive diagnostic of the endometrium cancer before the operation. The hysteroscopy is worth while in cases of difficulties with the diagnostic of the diseases. It is reasonable to introduce the hysteroscopy diagnostic in the algorithm of examination of the endometrium cancer diseases.

Urgency of research. Argon plasma coagulation (APC) as a method of monopolar high-frequency action upon a tissue, for last years is more and more widely used in endoscopy, open and laparoscopy surgery to stop bleedings and for devitalisation of superficial pathological processes. But the usage of this method in outpatient gynecology is poorly distributed.

Introduction. Now the cervical cancer wins first place in the world and the second main place in the Russian Federation among all malignant new growths of female genitals. Thus in our country, on the average only at 10% of patients fixed preinvasive stage of tumoral process, that is absolutely inadequate to opportunities of modem medicine and testifies to a low level of screening.

Aim: to evaluate possibility and effectiveness of laparoscopic surgery in patients with early stage ovarian malignancies after non-radical surgical treatment of ovarian malignancies.

Aim. The studying of laparoscopic lymphodissection results in cancer of different location.

Material and methods. In Ryazan Regional Clinical Hospital 86 laparoscopic operations have been performed during the period 1999/2005. 64 (74,4%) patients have had colorectal cancer, 10 (11,6%) patients have had renal carcinoma and 2 (2,3%) patients - cervical carcinoma. 20 (23,2%) operations have been combined ones.

Lymphodissection technique has been identical. But lymphodissection extent was different, depending upon the spread of cancer. At colorectal cancer aortoiliac and aortoiliopelvic lymphodenectomy has been performed, depending upon tumor location. Radical nephrectomy has been accompanied by monolateral wide removal of retroperitoneal fat in aortal and iliac zones (affected side). Extend of lymphodissection has corresponded to standard radical hysterectomy in 2 patients (Vertheim’s operation).

Actuality. Increase of traumatic effect during performance of simultaneous phases and additional accesses use are presented as a major reason of surgeons’ rejection to perform simultaneous correction of combined diseases with laparoscopic methods. This major reason may become disputable as laparoscopic methods are introduced in contemporary medicine.

Urgency of the problem. Extensive introduction of laparoscopy in surgery and operative gynecology, perfection of technique and low traumatic effect of endoscopic operations allow to expand indications for simultaneous laparoscopic interventions involving various abdominal organs.

Introduction. During the last years the method of simultaneous surgery, i.e. simultaneous operations using laparoscopic approach, has been elected in increasing frequency for combined surgical internal diseases.

Introductions. There has been huge progress in diagnosis and treatment of female sterility recently. Assisted reproductive technologies have become more available for couples who have no children. In Kirov region with population of about 1,5 mln people statistically 47,000 families suffer from sterility.

Introduction. Traditional treatment tactics in patients with endometrial hyperplasia provides the hormonal therapy during 3 months with following histological investigation of total mucoid scrape. Surgical operation is used if there are no clinical or/and morphological effects.

Materials and methods. 37 intestinal traumas were studied respectively. 11 cases occured after the first trocar was placed, 20 cases - in process of laparoscopy, 6 cases were complicated with ileus in postoperative period.

Urgency of the problem. Last years the problem of laparoscopic operations in patients with abdominal adhesions attracted experts’ attention.

Material and methods. The study was conducted using 51 specimen of normal female pelvis with ligaments from the Fundamental Museum of Department of Normal Anatomy of Military Medical Academy. To characterize the shape of pelvis the following standard pelviometric indexes had been used: pelvic ring index (PRI), pelvic height-width index (PHWI), pelvic width index (PWI), pelvic outlet expansion index (PEI).

Introduction. The study is aimed at the evaluation of the effects of cytomegaloviruses (CMV) on the development of ovarian resistance (OR) and at the development of a package of diagnostic and therapeutic measures in patients with such pathology.

Material and methods. To assess the psychological reaction to the stress connected to the laparoscopic intervention Spilberg - Hanyn scale have been used. Comparative analysis was used in two groups of patients with fallopian tube rupture (as a result of tubal gestation). In the Ist group there were 15 patients who had undergone laparoscopic surgery. In the IInd group there were 15 patients who had undergone laparotomy. In both groups average age of patients was 28 ± 3,1 and 30 ± 2,3 respectively. We estimated correlation between degree of anxiety and risk appraisal for surgical treatment of patients with ectopic pregnancy in both groups.

Conclusions. These parameters were directly connected to the stress caused by hospitalization with urgent surgical diagnosis. We have found that usage of laparoscopic surgery decreases level of anxiety of patients with ectopic pregnancy.