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<article article-type="research-article" dtd-version="1.3" xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xml:lang="ru"><front><journal-meta><journal-id journal-id-type="publisher-id">gnck</journal-id><journal-title-group><journal-title xml:lang="ru">Колопроктология</journal-title><trans-title-group xml:lang="en"><trans-title>Koloproktologia</trans-title></trans-title-group></journal-title-group><issn pub-type="ppub">2073-7556</issn><issn pub-type="epub">2686-7303</issn><publisher><publisher-name>Russian Association of Coloproctology</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="doi">10.33878/2073-7556-2025-24-1-115-122</article-id><article-id custom-type="elpub" pub-id-type="custom">gnck-1979</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research Article</subject></subj-group><subj-group subj-group-type="section-heading" xml:lang="ru"><subject>ОБЗОР ЛИТЕРАТУРЫ</subject></subj-group><subj-group subj-group-type="section-heading" xml:lang="en"><subject>REVIEW</subject></subj-group></article-categories><title-group><article-title>Хирургическая тактика лечения пациентов с боевыми ранениями промежности (обзор литературы)</article-title><trans-title-group xml:lang="en"><trans-title>Surgery of military injuries of the perineum (review)</trans-title></trans-title-group></title-group><contrib-group><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0001-7166-0290</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Переходов</surname><given-names>С. Н.</given-names></name><name name-style="western" xml:lang="en"><surname>Perekhodov</surname><given-names>S. N.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Переходов Сергей Николаевич — член-корр. РАН, д.м.н., профессор, заведующий кафедрой госпитальной и военно-полевой хирургии</p><p>ул. Долгоруковская, д. 4, г. Москва, 127006, вн. тер. г. Муниципальный Округ Тверской </p></bio><bio xml:lang="en"><p>Sergey N. Perekhodov  </p><p>Dolgorukovskaya st., 4, Moscow, 127006 </p></bio><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0009-0000-9040-4022</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Кузьминов</surname><given-names>А. Д.</given-names></name><name name-style="western" xml:lang="en"><surname>Kuzminov</surname><given-names>A. D.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Кузьминов Алексей Дмитриевич — аспирант кафедры госпитальной и военно-полевой хирургии</p><p>ул. Долгоруковская, д. 4, г. Москва, 127006, вн. тер. г. Муниципальный Округ Тверской, Россия, 8-903-568-89-55 </p></bio><bio xml:lang="en"><p>Aleksey D. Kuzminov  </p><p>Dolgorukovskaya st., 4, Moscow, 127006 </p></bio><email xlink:type="simple">kuzminov3003@yandex.ru</email><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-3858-2371</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Онницев</surname><given-names>И. Е.</given-names></name><name name-style="western" xml:lang="en"><surname>Onnitsev</surname><given-names>I. E.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Онницев Игорь Евгеньевич — д.м.н., главный хирург госпиталя </p><p>Госпитальная пл., д. 3, г. Москва, 105094 </p></bio><bio xml:lang="en"><p>Igor E. Onnitsev  </p><p>Hospitalnaya sq., 3, Moscow, 105094 </p></bio><xref ref-type="aff" rid="aff-2"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-0873-1380</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Козлов</surname><given-names>Н. С.</given-names></name><name name-style="western" xml:lang="en"><surname>Kozlov</surname><given-names>N. S.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Козлов Николай Сергеевич — к.м.н., доцент кафедры госпитальной и военно-полевой хирургии</p><p>ул. Долгоруковская, д. 4, г. Москва, 127006, вн. тер. г. Муниципальный Округ Тверской </p></bio><bio xml:lang="en"><p>Nikolay S. Kozlov </p><p>Dolgorukovskaya st., 4, Moscow, 127006 </p></bio><xref ref-type="aff" rid="aff-1"/></contrib></contrib-group><aff-alternatives id="aff-1"><aff xml:lang="ru"><institution>ФГБОУ ВО «Российский университет медицины» Минздрава России</institution><country>Россия</country></aff><aff xml:lang="en"><institution>Russian University of Medicine</institution><country>Russian Federation</country></aff></aff-alternatives><aff-alternatives id="aff-2"><aff xml:lang="ru"><institution>ФГБУ «Главный военный клинический госпиталь имени академика Н.Н. Бурденко» Министерства обороны Российской Федерации</institution><country>Россия</country></aff><aff xml:lang="en"><institution>N.N. Burdenko Main Military Clinical Hospital</institution><country>Russian Federation</country></aff></aff-alternatives><pub-date pub-type="collection"><year>2025</year></pub-date><pub-date pub-type="epub"><day>21</day><month>03</month><year>2025</year></pub-date><volume>24</volume><issue>1</issue><fpage>115</fpage><lpage>122</lpage><permissions><copyright-statement>Copyright &amp;#x00A9; Переходов С.Н., Кузьминов А.Д., Онницев И.Е., Козлов Н.С., 2025</copyright-statement><copyright-year>2025</copyright-year><copyright-holder xml:lang="ru">Переходов С.Н., Кузьминов А.Д., Онницев И.Е., Козлов Н.С.</copyright-holder><copyright-holder xml:lang="en">Perekhodov S.N., Kuzminov A.D., Onnitsev I.E., Kozlov N.S.</copyright-holder><license xml:lang="ru" license-type="creative-commons-attribution" xlink:href="https://creativecommons.org/licenses/by/4.0/" xlink:type="simple"><license-p>Данная работа распространяется под лицензией Creative Commons Attribution 4.0.</license-p></license><license xml:lang="en" license-type="creative-commons-attribution" xlink:href="https://creativecommons.org/licenses/by/4.0/" xlink:type="simple"><license-p>This work is licensed under a Creative Commons Attribution 4.0 License.</license-p></license></permissions><self-uri xlink:href="https://www.ruproctology.com/jour/article/view/1979">https://www.ruproctology.com/jour/article/view/1979</self-uri><abstract><p>ЦЕЛЬ: провести обзор литературы, посвящённой лечению боевой травмы промежности.МАТЕРИАЛЫ И МЕТОДЫ: для анализа литературы в ходе написания данной статьи был осуществлен поиск литературных источников с помощью Научной электронной библиотеки eLIBRARY.RU и информационной базы PubMed.gov по ключевым словам: «ранения промежности», «ранения прямой кишки», «травма промежности», «perineum injury», «rectal injuries», «perineum trauma». Превалирует поиск данных за последние 10 лет.РЕЗУЛЬТАТЫ: в настоящее время основным методом лечения боевых ранений промежности с повреждением внебрюшинной части прямой кишки является метод 4D: формирование проксимальной стомы, устранение дефекта прямой кишки, пресакральное дренирование и дистальное промывание прямой кишки, а также первичная хирургическая обработка раны с последующими санациями. При подобных травмах, полученных в мирное время, авторы склоняются к более дифференцированному подходу к лечению, которое обычно в той или иной степени отличается от концепции 4D. Стоит отметить, что методы и результаты лечения ран промежности, полученных в мирное время, нельзя однозначно проецировать на тактику лечения боевых повреждений промежности. Это обусловлено морфологическими особенностями ран промежности, полученных в боевых условиях.ЗАКЛЮЧЕНИЕ: ранения промежности встречаются примерно в 5,4% случаев от общей боевой травмы. Наиболее актуальной проблемой является сочетанная травма внебрюшинной части прямой кишки. Общепринятая тактика хирургического лечения боевых ранений промежности с повреждением внебрюшинной части прямой кишки сложилась ещё во времена войны во Вьетнаме. С тех пор тактика кардинально не изменилась, а большая часть исследований, посвящённых боевым ранениям промежности, носят, как правило, описательный характер и не дают чётких рекомендаций к лечению.</p></abstract><trans-abstract xml:lang="en"><p>AIM: to analyze literature on perineal military injuries.PATIENTS AND METHODS: a search of sources was carried out using eLIBRARY.RU and the PubMed.gov using the keywords: “perineal wounds”, “rectal wounds”, “perineal trauma”, “perineum injury”, “rectal injuries”, “perineum trauma” for the last 10 years.RESULTS: recently, the main method for military injuries of the perineum with damage to the extraperitoneal part of the rectum is the 4D method: diverting stoma, elimination of the rectal defect, presacral drainage and distal lavage of the rectum, as well as primary surgical treatment of the wound with subsequent sanitation. For such injuries received in peacetime, the authors are inclined to a more differentiated approach, which usually differs from the 4D concept. It is worth noting that the methods and results of treating perineal wounds received in peacetime cannot be unambiguously projected onto the treating of military injuries. This is due to the morphological features of perineal wounds received in military actions.CONCLUSION: perineal injuries occur in approximately 5.4% of cases of total military actions. The most pressing problem is combined trauma of the extraperitoneal part of the rectum. The generally accepted conception was developed during the Vietnam War. Since then, the approach has not changed crucially, and most studies are, as a rule, descriptive in nature and do not provide clear recommendations for treatment.</p></trans-abstract><kwd-group xml:lang="ru"><kwd>ранение промежности</kwd><kwd>VAC-система</kwd><kwd>внебрюшинная часть прямой кишки</kwd><kwd>проксимальная стома</kwd><kwd>пресакральное дренирование</kwd><kwd>дистальное промывание</kwd></kwd-group><kwd-group xml:lang="en"><kwd>perineal injury</kwd><kwd>VAC system</kwd><kwd>extraperitoneal rectum</kwd><kwd>proximal stoma</kwd><kwd>presacral drainage</kwd><kwd>distal washout</kwd></kwd-group></article-meta></front><back><ref-list><title>References</title><ref id="cit1"><label>1</label><citation-alternatives><mixed-citation xml:lang="ru">Brogden TG, JP Garner. Anorectal injury in pelvic blast. Journal of the royal army medical corps. 2013; 159 Suppl 1: p 26-31.</mixed-citation><mixed-citation xml:lang="en">Brogden TG, JP Garner. Anorectal injury in pelvic blast. 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