gnckКолопроктологияKoloproktologia2073-75562686-7303Russian Association of Coloproctology10.33878//2073-7556-2021-20-4-56-69gnck-1659Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИORIGINAL ARTICLESЕсть ли преимущества 3D лапароскопических технологий при хирургическом лечении ректоцеле и выпадения прямой кишки?Are there any advantages of 3D laparoscopic technologies in surgery for rectocele and rectal prolapse?https://orcid.org/0000-0002-2108-2362ХитарьянА. Г.KhitaryanA. G.

Хитарьян Александр Георгиевич — доктор медицинских наук, профессор, заведующий кафедрой хирургических болезней № 3 ФГБОУ ВО «РостГМУ»; заведующий хирургическим отделением ЧУЗ «Клиническая больница «РЖД-Медицина»

пер. Нахичеванский, д. 29, г. Ростов-на-Дону, 344022,

ул. Варфоломеева, д. 92а, г. Ростов-на-Дону, 344011

Khitaryan Alexander G.

Nakhichevansky lane, 29, Rostov-on-Don, 344022,

 

https://orcid.org/0000-0001-5647-1192ГоловинаА. А.GolovinaA. A.

Головина Анастасия Андреевна — врач-хирург ЧУЗ «Клиническая больница «РЖД-Медицина»; аспирант кафедры хирургических болезней № 3 ФГБОУ ВО «РостГМУ»

пер. Нахичеванский, д. 29, г. Ростов-на-Дону, 344022,

ул. Варфоломеева, д. 92а, г. Ростов-на-Дону, 344011

Golovina Anastasia A. 

Department of Surgical Diseases №3 FSBEI HE «Rostov State Medical University»

Nakhichevansky lane, 29, Rostov-on-Don, 344022,

Varfolomeeva street, 92a, Rostov-on-Don, 344011

a_anastacia@icloud.comhttps://orcid.org/0000-0001-7697-3384КовалевС. А.KovalevS. A.

Ковалев Сергей Александрович — кандидат медицинских наук, доцент кафедры хирургических болезней № 3 ФГБОУ ВО «РостГМУ»; врач-хирург ЧУЗ «Клиническая больница «РЖДМедицина»

пер. Нахичеванский, д. 29, г. Ростов-на-Дону, 344022,

ул. Варфоломеева, д. 92а, г. Ростов-на-Дону, 344011

Kovalev Sergey A. 

Department of Surgical Diseases №3 FSBEI HE «Rostov State Medical University»

Nakhichevansky lane, 29, Rostov-on-Don, 344022,

Varfolomeeva street, 92a, Rostov-on-Don, 344011

koseal@mail.ruРомоданН. А.RomodanN. A.

Ромодан Наталья Александровна — врач-хирург

ул. Варфоломеева, д. 92а, г. Ростов-на-Дону, 344011

Romodan Natalia A.

Varfolomeeva street, 92a, Rostov-on-Don, 344011

sunny_anastacia@mail.ruhttps://orcid.org/0000-0003-4724-3774АлибековА. З.AlibekovA. Z.

Алибеков Альберт Заурбекович — кандидат медицинских наук, ассистент кафедры хирургических болезней № 3

пер. Нахичеванский, д. 29, г. Ростов-на-Дону, 344022,

ул. Варфоломеева, д. 92а, г. Ростов-на-Дону, 344011

Alibekov Albert Z. 

Department of Surgical Diseases №3 FSBEI HE «Rostov State Medical University»

Nakhichevansky lane, 29, Rostov-on-Don, 344022,

Varfolomeeva street, 92a, Rostov-on-Don, 344011

saul09@mail.ruhttps://orcid.org/0000-0001-5633-3224ЧепурнаяИ. А.ChepurnayaI. A.

Чепурная Инна Алексеевна — ординатор кафедры хирургических болезней № 3

пер. Нахичеванский, д. 29, г. Ростов-на-Дону, 344022

Chepurnaya Inna A. 

Department of Surgical Diseases №3 

Nakhichevansky lane, 29, Rostov-on-Don, 344022

i.tchepurnaya@yandex.ruhttps://orcid.org/0000-0001-9284-0127ШимченкоД. К.ShimchenkoD. K.

Шимченко Диана Константиновна — студент

пер. Нахичеванский, д. 29, г. Ростов-на-Дону, 344022

Shimchenko Diana K.

Department of Surgical Diseases №3 

Nakhichevansky lane, 29, Rostov-on-Don, 344022

dina.shimchenko@yandex.ruФГБОУ ВО «Ростовский государственный медицинский университет»; ЧУЗ «Клиническая больница «РЖД-Медицина»РоссияFSBEI HE «Rostov State Medical University», Department of Surgical Diseases №3; Private Healthcare Institution «Clinical Hospital «Russian Railways-Medicine»Russian FederationФГБОУ ВО «Ростовский государственный медицинский университет»; ЧУЗ «Клиническая больница «РЖД-Медицина»РоссияFSBEI HE «Rostov State Medical University»; Private Healthcare Institution «Clinical Hospital «Russian Railways-Medicine»Russian FederationЧУЗ «Клиническая больница «РЖД-Медицина»Russian FederationPrivate Healthcare Institution «Clinical Hospital «Russian Railways-Medicine»Russian FederationФГБОУ ВО «Ростовский государственный медицинский университет»Russian FederationFSBEI HE «Rostov State Medical University»Russian Federation2021211220212045669Copyright © Хитарьян А.Г., Головина А.А., Ковалев С.А., Ромодан Н.А., Алибеков А.З., Чепурная И.А., Шимченко Д.К., 20212021Хитарьян А.Г., Головина А.А., Ковалев С.А., Ромодан Н.А., Алибеков А.З., Чепурная И.А., Шимченко Д.К.Khitaryan A.G., Golovina A.A., Kovalev S.A., Romodan N.A., Alibekov A.Z., Chepurnaya I.A., Shimchenko D.K.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.ruproctology.com/jour/article/view/1659ЦЕЛЬ ИССЛЕДОВАНИЯ

ЦЕЛЬ ИССЛЕДОВАНИЯ: изучить непосредственные и отдаленные результаты применения 3D и традиционной 2D лапароскопической вентральной ректопексии в лечении пациентов с ректоцеле и выпадением прямой кишки.

ПАЦИЕНТЫ И МЕТОДЫ

ПАЦИЕНТЫ И МЕТОДЫ: проведено рандомизированное проспективное исследование (NCT 04817150), включившее пациентов в возрасте от 18 до 70 лет, которым выполнялась лапароскопическая вентральная ректопексия по поводу ректоцеле и/или выпадения прямой кишки. Проводилась оценка продолжительности вмешательства, объема интраоперационной кровопотери, частоты осложнений и степени их тяжести по шкале Clavien-Dindo, выраженности болевого синдрома, объема жидкостной полости в области импланта на 2–3 день после операции и через 2–3 недели. Также проводилась оценка комфорта и эргономичности работы хирурга при использовании 3D систем с помощью опросника POMS. Оценка отдаленных результатов включала частоту рецидивов, а также функциональные результаты вмешательства по шкалам CCCS score, Incontinence scale score, P-Qol и PGII.

РЕЗУЛЬТАТЫ

РЕЗУЛЬТАТЫ: в исследование были включены 29 пациентов основной и 32 пациента контрольной групп. Период наблюдения составил 21 ± 20,3 месяцев. Осложнение развилось в контрольной группе у 1 пациента (р = 1,0). Средняя длительность оперативного вмешательства в основной группе составила 74,1 ± 14 минут, в контрольной — 87,1 ± 24,3 мин. (р = 0,01). Интраоперационная кровопотеря в основной группе была 19,8 ± 9,6 мл (в контрольной — 55 ± 39,2 мл; р = 0,001). Выраженность болевого синдрома была достоверно ниже в основной группе (18,0 против 22,5 баллов, р = 0,03). На 2–3 сутки средний объем жидкостной полости в основной группе был 21,2 ± 9,7 см3 , в контрольной — 30,7 ± 25,6 см3 (р = 0,02). Средний балл по шкале POMS для хирурга в основной группе составил 56,4 ± 33,5 баллов, в контрольной — 87,3 ± 30,8 балла (р = 0,004). Спустя 12 месяцев после операции рецидивы в обеих группах выявлены не были (р = 1,0). Достоверных различий по функциональным результатам получено не было.

ВЫВОДЫ

ВЫВОДЫ: применение 3D лапароскопии при выполнении вентральной ректопексии сетчатым имплантом сопоставимо по отдаленным анатомическим и функциональным результатам с традиционными лапароскопическими операциями. Однако сопровождается уменьшением времени оперативного вмешательства, снижением выраженности послеоперационного болевого синдрома, снижением объема интраоперационной кровопотери, меньшим объемом экссудата в области импланта, большим удобством и эргономичностью работы для хирурга.

AIM

AIM: to assess results of 3D laparoscopic ventral mesh rectopexy versus traditional 2D laparoscopy for rectocele and rectal prolapse.

PATIENTS AND METHODS

PATIENTS AND METHODS: a prospective randomized study (NCT 04817150) included patients aged 18 to 70 years who underwent laparoscopic ventral mesh rectopexy for rectocele and/or rectal prolapse. The assessment included operation time, intraoperative blood loss, complications rate and their severity by Clavien-Dindo scale, the pain intensity by VAS, the volume of the fluid collection in the implant site 2–3 days and 2–3 weeks after the procedure. The surgeon’s comfort and ergonomics when using 3D systems was evaluated using POMS questionnaire. The late results were assessed by recurrence rate, functional results — by Cleveland Clinic Constipation scale score, Incontinence scale score, P-Qol, and PGII.

RESULTS

RESULTS: the study included 29 patients of the main and 32 patients of the control group. The follow-up was 21 ± 20.3 months. One complication developed in the control group (p = 1.0). The operation time in the main group was 74.1 ± 14 minutes (87.1 ± 24.3 minutes in controls, p = 0.01). The intraoperative blood loss was 19.8 ± 9.6 ml in the main group (55 ± 39.2 ml in controls, p = 0.001). The pain intensity was significantly lower in the main group (18.0 vs 22.5 points, p = 0.03). The volume of fluid collection 2–3 after surgery mesh site was 21.2 ± 9.7 cm3 in the main group (30.7 ± 25.6 cm3 in the control group, p = 0.02). The POMS scale assessment for a surgeon in the main group was 56.4 ± 33.5 points (87.3 ± 30.8 points in the control group). A follow-up examination 12 months postop revealed no recurrence in both groups (p = 1.0). The main and the control group showed no significant differences in functional outcomes.

CONCLUSIONS

CONCLUSIONS: the use of 3D laparoscopic ventral mesh rectopexy for rectocele and rectal prolapse is comparable in late results with traditional laparoscopic procedure. However, it takes less operation time, lower pain intensity, less intraoperative blood loss, smaller fluid collection at mesh site, better comfort and ergonomics for surgeon.

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The authors declare that there are no conflicts of interest present.