Terekhov V. Optimization of surgical treatment and prevention of postoperative complications for women with genital pathology using modern endoscopic technologies

Dissertation work is devoted to the increase of efficiency of operative treatment of high quality and inflammatory new formations of genitalia, and also decline of frequency of postoperative complications on the basis of improvement of tactic of the use of modern endoscopic technologies and treatment-and-prophylactic measures. The results of the conducted researches testify that in the structure of operative treatment of high quality new formations of uterus and additions minimally invasive operations (69.9%) prevail by comparison to traditional methods (30.1%). At an estimation the structures of minimally invasive operative interferences are set that in most cases (42.8%) organ-preserving operations were applied concerning new formations of uterus and additions, operation concerning prolapse genitalia (18.3%) and combined hysterectomy (15.2%). Among traditional operative interferences more frequent executed laparo¬tomical hysterectomy by comparison to a myomectomy (31.7%) and vaginal hysterectomy (27.7%). Thus, 81.8% operations are conducted in the planned order, and in urgent – 18.2% respectively. Among the different variants of hysterectomy laparotomical is 41.8%; combined laparoscopic and vaginal – 36.5% by comparison to exceptionally vaginal – 21.7%. In the structure of accesses at a myomectomy 48.0% occupies laparotomical; 27.9% – vaginal and 24.1% – combined laparoscopic and vaginal accesses. Frequency of depressions after different gynaecological operations is from 17.3 to 27.0% patients and related to the proof pain syndrome (coefficient of correlation of r=+0.45); by urination disorders – from 14.8 to 53.3% (criterion of 2=3.22) and by discomfort in the area of postoperative wound – from 11.4% to 40.0% (criterion of 2=2,3). In the structure of the complicated forms of inflammatory processes of organs of small pelvis, which need urgent operative interference, the pyosalpinxs of two- (38.3%) and one-sided prevail (26.1%); abscesses of small pelvis (16.2%); tubo-ovarian abscesses (12.8%); one-sided piovars (4.4%) and other forms (2.2%). Frequency of dynamic laparoscopy for women with the complicated inflammatory processes of organs of small pelvis makes (51.6%), and leading testimonies were: maintainance of pain syndrome; proof hyperthermia, symptoms of intoxication and desire of maintainance of genesial function. A level of single dynamic laparoscopy is 73.1%; twomultiple – 22.6% and three and anymore – 4,3% accordingly. At the estimation of volume of operative interference for women with the complicated forms of inflammatory processes of organs of small pelvis predominance of salpingostomy/ tubotomy is set on either side – 37.6%; salpingostomy from one side – 18.3%; lysis of joints with sanitation of small pelvis – 15.1%; to the dissection abscess from salpingo¬ovariolizis – 14.0%; tubotomy/adnexectomy from one side – 12.9%; adnexectomy from one side and salpingostomy from the second – 2.1% rrespectively. Women after operative treatment of the complicated forms of inflammatory processes of organs of small pelvis have changes of quality of life: decline of physical activity (92.6%); languor and somno¬lence (91.5%); lack of energy decline of vital tone (36.2%). The use of dynamic laparoscopy allows substantially to promote quality of life of these women. For women with the complicated forms of inflammatory processes of organs of small pelvis the expressed violations take place in plasma and vascular-platelet link to hemostasis: decline of fibrinolytic activity – 95.1%; diminishing of the activated time of recalcification – 85.0%; fibrinosis – 56.1%; decline of tolerance of blood to the heparin – 48.6%; positive ethanol test – 48.0%; diminishing of time of recalcification – 30.6%. Intersity of violations correlates hemostasis with weight of inflammatory process. Autoimmune the component of the complicated forms of inflammatory processes of organs of small pelvis is confirmed by the enhanceable concentration of autoantibodies to the phosphotides (54.1%), thus from 140 to 300% – in 41.0% and more than 300% – in 23.1% respectively. In the method of inseaming of abdominal region of the use of modern endoscopic technologies improved by us allows to promote efficiency of operative treatment of high quality and inflammatory pathology of organs of small pelvis. The use of the algorithm improved by us allows to promote quality of operative treatment and reduce frequency of violations of reproductive health in a postoperative period. After vaginal hysterectomy two blanket sutures imposed on the mucus shell of vagina, stump connection and pelvic peritoneum from vesicouterine fold and front wall of vagina to the peritoneum of retrouterine space and back wall of vagina.