gnckКолопроктологияKoloproktologia2073-75562686-7303Russian Association of Coloproctology10.33878/2073-7556-2025-24-4-188-200gnck-2078Research ArticleОБЗОР ЛИТЕРАТУРЫREVIEWРектоцеле у женщин: нерешенные вопросы (обзор литературы)Rectocele in females: unresolved issues (review)https://orcid.org/0000-0002-5198-384XМетринскийЯ. Ю.MetrinskyY. Yu.

Метринский Ян Юрьевич — врач-акушер-гинеколог урологического отделения клиники высоких медицинских технологий имени Н.И. Пирогова

наб. реки Фонтанки, д. 154, г. Санкт-Петербург, 190020

Yan Yu. Metrinsky

Fontanka River embankment, 154, Saint Petersburg, 190020

https://orcid.org/0000-0002-2274-8170БелоусовА. М.BelousovA. M.

Белоусов Александр Михайлович — д.м.н., заместитель главного врача по медицинской части (хирургия и онкология) клиники высоких медицинских технологий имени Н.И. Пирогова

наб. реки Фонтанки, д. 154, г. Санкт-Петербург, 190020

Alexander M. Belousov

Fontanka River embankment, 154, Saint Petersburg, 190020

https://orcid.org/0000-0001-6455-0894СизоненкоН. А.SizonenkoNikolay A.

Сизоненко Николай Александрович — к.м.н., доцент кафедры военно-морской хирургии

ул. Академика Лебедева, д. 6ж, г. Санкт-Петербург, 194044

тел. 8 (911)7473075

Nikolay A. Sizonenko

Akademika Lebedeva st., 6G, Saint Petersburg, 194044

tel. 8 (911)7473075

n_sizonenko@mail.ruhttps://orcid.org/0000-0002-4579-2027КоржукМ. С.KorzhukM. S.

Коржук Михаил Сергеевич — д.м.н., профессор, старший преподаватель кафедры военно-морской хирургии 

ул. Академика Лебедева, д. 6ж, г. Санкт-Петербург, 194044

Mikhail S. Korzhuk

Akademika Lebedeva st., 6G, Saint Petersburg, 194044

https://orcid.org/0009-0004-6104-9905МулендеевС. В.MulendeevS. V.

Мулендеев Сергей Васильевич — начальник отделения неотложной хирургии клиники кафедры военно-морской хирургииул. Академика Лебедева, д. 6ж, г. Санкт-Петербург, 194044

Sergey V. Mulendeev

Akademika Lebedeva st., 6G, Saint Petersburg, 194044

Клиника высоких медицинских технологий имени Н.И. Пирогова ФГБОУ ВО «Санкт-Петербургский государственный университет»РоссияN.I. Pirogov High Medical Technology Clinic Saint Petersburg State UniversityRussian FederationФГБВОУ ВО «Военно-медицинская академия имени С.М. Кирова» МО РФРоссияS.M. Kirov Military Medical AcademyRussian Federation202519112025244188200Copyright © Метринский Я.Ю., Белоусов А.М., Сизоненко Н.А., Коржук М.С., Мулендеев С.В., 20252025Метринский Я.Ю., Белоусов А.М., Сизоненко Н.А., Коржук М.С., Мулендеев С.В.Metrinsky Y.Y., Belousov A.M., Sizonenko N.A., Korzhuk M.S., Mulendeev S.V.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/2078

Среди поражений промежности у женщин заметное место занимает пролапс тазовых органов. Одним из его вариантов является ректоцеле — выпячивание стенки прямой кишки вместе с задней стенкой влагалища (ЗСВ) в сторону влагалища (переднее ректоцеле) и/или по задней полуокружности кишки (заднее ректоцеле). Переднее ректоцеле (ПРЦ) сопровождается синдромом обструктивной дефекации (СОД) с такими симптомами, как боль, констипация и необходимость использования пальцевого пособия при дефекации. Распространенность пролапса тазовых органов (ПТО) среди женщин в отдельных странах достигает 50%. В России этот показатель превышает 30%. Женщины репродуктивного возраста (РВ) в контексте ПТО и ПРЦ представляют отдельный интерес. Заболевание в данной группе длительно протекает бессимптомно. Фактором риска ПТО у женщин РВ являются вагинальные роды без физической реабилитации, особенно крупным плодом. Анализ литературы свидетельствует, что операции на задней стенке влагалища, независимо от техники, с высокой частотой улучшают структуру задней стенки и с меньшей — снижают частоту симптоматических проявлений ПРЦ. Эффективность имплантации биологических или синтетических трансплантатов не выше, а число потенциальных осложнений, включая диспареунию и эрозии синтетического имплантата — выше. Степлерная трансанальная резекция прямой кишки ассоциирована с улучшением анатомии ЗСВ и разрешением СОД после вмешательства. На сегодняшний день имеется около 300 различных техник хирургического лечения ПРЦ. В 2020 году рабочая группа международной федерации акушеров-гинекологов (FIGO) при анализе имеющихся данных о лечении ПРЦ пришла к выводу, что тактика, предполагающая традиционную (с пликацией ректовагинальной фасции) заднюю кольпоррафию нативными тканями (ТЗКНТ) без использования синтетических имплантатов предпочтительнее. Однако данных для определения эталонной методики хирургического лечения ПРЦ недостаточно, и вопрос требует дополнительного изучения.

Among the lesions of the perineum in women, pelvic organ prolapse occupies a prominent place. One of its variants is rectocele — protrusion of the rectum wall together with the posterior vaginal wall (PVW) towards the vagina (anterior rectocele) and/or along the posterior semicircle of the intestine (posterior rectocele). Anterior rectocele (AR) is accompanied by obstructive bowel movement syndrome (OBMS) with symptoms such as pain, constipation and the need to use a finger aid during defecation. The prevalence of pelvic organ prolapse (POP) among women in some countries reaches 50%. In Russia, this figure exceeds 30%. Women of reproductive age (RA) in the context of POP and AR are of particular interest. The disease in this group is asymptomatic for a long time. A risk factor for POP in RA-women is vaginal delivery without physical rehabilitation, especially with a large fetus. An analysis of the literature indicates that operations on the posterior wall of the vagina, regardless of the technique, improve the structure of the posterior wall with a high frequency and reduce the frequency of symptomatic manifestations of AR with a lower frequency. The effectiveness of implantation of biological or synthetic grafts is not higher, and the number of potential complications, including dyspareunia and erosion of the synthetic implant, is higher. Stapler transanal resection of the rectum is associated with an improvement in the anatomy of the PVW and the resolution of OBMS after intervention. To date, there are about 300 different surgical techniques for the treatment of AR. In 2020, a working group of the International Federation of Obstetricians and Gynecologists (FIGO), analyzing the available data on the treatment of AR, concluded that a tactic involving traditional (with implication of the rectovaginal fascia) posterior colporraphy with native tissues without the use of synthetic implants is preferable. However, there is not enough data to determine the reference method of surgical treatment of AR, and the issue requires further study.

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