Ректоцеле у женщин: нерешенные вопросы (обзор литературы)

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.

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