Гинекологические проблемы, опосредованно связанные с патологией перианальной области и колопроктологией

Хрянин А.А., Маркарьян Д.Р., Агапов М.А., Бочарова В.К. Гинекологические проблемы, опосредованно связанные с патологией перианальной области и колопроктологией. Гинекология. 2021;23(6):472–479.
DOI: 10.26442/20795696.2021.6.201150

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Khryanin AA, Markaryan DR, Agapov MA, Bocharova VK. Gynecological conditions related to the perianal area and coloproctology. Gynecology. 2021;23(6):472–479. DOI: 10.26442/20795696.2021.6.201150

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Аннотация

Данная статья предназначена для специалистов, которые проводят лечение и коррекцию заболеваний перианальной области и тазового дна. Тазовое дно представляет собой пространство, в котором органы различных систем имеют общее происхождение и расположены в тесном контакте друг с другом. Ввиду перечисленных особенностей необходимо помнить о частом сочетании с нарушениями со стороны соседних органов и систем. Авторы обсуждают наиболее актуальные и часто встречающиеся проктологические и урологические проблемы беременных и родильниц, включая повреждение промежности при вагинальных родах с развитием анального недержания и недержания мочи, ректоцеле, пролапс и выпадение тазовых органов. Представлены детальное описание всех анатомических структур, задействованных в патологическом процессе, а также основные этапы эмбрионального развития. Подробно с точки зрения современных анатомо-физиологических данных разобраны нарушения, лежащие в основе дисфункций тазовых органов. Представлены диагностические протоколы и тактические подходы к выбору лечения. Особое внимание уделено точкам взаимодействия смежных специалистов (урологов и проктологов) и необходимости их совместного участия в лечебно-диагностическом процессе. Колоректальные хирурги должны быть осведомлены о часто ассоциированных гинекологических патологиях, описанных в данной статье. Сотрудничество смежных специалистов, специализирующихся на лечении различных систем тазового дна, необходимо для обмена опытом и улучшения качества оказания помощи данной категории пациентов. Статья иллюстрирована оригинальными рисунками и клиническими примерами «до и после».

Ключевые слова: дисфункция тазовых органов, пролапс тазовых органов, ректоцеле, выпадение прямой кишки, цистоцеле, OASIS, родовая травма промежности, анальная инконтиненция, недержание мочи, эндометриоз

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This review is addressed to the specialists who treat and correct pathologies of the perianal area and pelvic floor. The pelvic floor area is a space in which the organs of different systems have a common origin and a common framework, therefore they are located in close contact with each other. In view of these features, all specialists working with pelvic floor dysfunction should be aware of the possible combination with disorders from neighboring organs and systems. The article discusses the most urgent and common proctological and urological problems of pregnant women and maternity women, including perineal damage during vaginal childbirth with the development of anal incontinence and urinary incontinence, rectocele, prolapse and prolapse of pelvic organs. The paper presents a detailed description of all anatomical structures involved in the pathological process, as well as their gradual embryonic development. The article presented in details the disorders, which are lying in the base of pelvic organ dysfunctions, from the point of view of modern anatomical data, and discussed different diagnostic protocols and tactical approaches to the choice of treatment. Special attention is paid to the points of interaction of related specialists (urologists and proctologists) and the need for their joint participation in the medical and diagnostic process. Colorectal surgeons should be aware of the frequently associated gynecological pathologies described in this article. The cooperation of related specialists in the field of working with pelvic floor pathology is necessary to exchange experience and improve the quality of care for this category of patients. The article is illustrated with original drawings and clinical examples “before and after”.

Keywords: pelvic organ disorders, pelvic organ prolapse, rectocele, rectal prolapse, cystocele, OASIS, perineal birth trauma, anal incontinence, urinary incontinence, endometriosis

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Список литературы

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DOI:10.1016/S0029-7844(97)00058-6
3. Eva UF, Gun W, Preben K. Prevalence of urinary and fecal incontinence and symptoms of genital prolapse in women. Acta Obstet Gynecol Scand. 2003;82:280-6.
DOI:10.1034/j.1600-0412.2003.00103.x
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5. De Lancey JO. Anatomic aspects of vaginal eversion after hysterectomy. Am J Obstet Gynecol. 1992;166:1717-24. DOI:10.1016/0002-9378(92)91562-o
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16. Shull BL, Bachofen C, Coates KW, Kuehl TJ. A transvaginal approach to repair of apical and other associated sites of pelvic organ prolapse with uterosacral ligaments. Am J Obstet Gynecol. 2000;183:1365-73. DOI:10.1067/mob.2000.110910
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27. Harvey MA, Pierce M, Alter JE, et al.; Society of Obstetricians and Gynaecologists of Canada. Obstetrical Anal Sphincter Injuries (OASIS): Prevention, Recognition, and Repair. J Obstet Gynaecol. 2015;37:1131-48. DOI:10.1016/s1701-2163(16)30081-0
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32. Rafique S, Decherney AH. Medical Management of endometriosis. Clin Obstet Gynecol. 2017;60(3):485-96. DOI:10.1097/GRF.0000000000000292

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1. Leroi AM, Weber J, Menard JF, et al. Prevalence of anal incontinence in 409 patients investigated for stress urinary incontinence. Neurourol Urodyn. 1999;18:579-90. DOI:10.1002/(sici)1520-6777(1999)18:6<579::aid-nau8>3.0.co;2-5
2. Olsen AL, Smith VJ, Bergstrom JO, et al. Epidemiology of surgically managed pelvic organ prolapse and urinary incontinence. Obstet Gynecol. 1997;89:501-6.
DOI:10.1016/S0029-7844(97)00058-6
3. Eva UF, Gun W, Preben K. Prevalence of urinary and fecal incontinence and symptoms of genital prolapse in women. Acta Obstet Gynecol Scand. 2003;82:280-6.
DOI:10.1034/j.1600-0412.2003.00103.x
4. Swift SE. The distribution of pelvic organ support in a population of female subjects seen for routine gynecologic health care. Am J Obstet Gynecol. 2000;183:277-85. DOI:10.1067/mob.2000.107583
5. De Lancey JO. Anatomic aspects of vaginal eversion after hysterectomy. Am J Obstet Gynecol. 1992;166:1717-24. DOI:10.1016/0002-9378(92)91562-o
6. Kearney R, Miller JM, Ashton-Miller JA, et al. Obstetric factors associated with levator ani muscle injury after vaginal birth. Obstet Gynecol. 2006;107(1):144-9. DOI:10.1097/01.AOG.0000194063.63206.1c
7. Barber MD, Bremer RE, Thor KB, et al. Innervation of the female levator ani muscles. Am J Obstet Gynecol. 2002;187:64-71. DOI:10.1067/mob.2002.124844
8. De Lancey JO. Structural support of the urethra as it relates to stress urinary incontinence: the hammock hypothesis. Am J Obstet Gynecol. 1994;170:1713-20.
DOI:10.1016/s0002-9378(94)70346-9
9. Leffler KS, Thompson JR, Cundiff GW, et al. Attachment of the rectovaginal septum to the pelvic sidewall. Am J Obstet Gynecol. 2001;185:41-3. DOI:10.1067/mob.2001.116366
10. Richardson AC, Lyon JB, Williams NL. A new look at pelvic relaxation. Am J Obstet Gynecol. 1976;126:568-73. DOI:10.1016/0002-9378(76)90751-1
11. Achtari C, Hiscock R, O’Reilly BA, et al. Risk factors for mesh erosion after transvaginal surgery using polypropylene (Atrium) or composite polypropylene/polyglactin 910 (Vypro II) mesh. Int Urogynecol J Pelvic Floor Dysfunct. 2005;16:389-94. DOI:10.1007/s00192-004-1272-3
12. Higgs PJ, Chua HL, Smith AR. Long term review of laparoscopic sacrocolpopexy. BJOG. 2005;112:1134-8. DOI:10.1111/j.1471-0528.2005.00646.x
13. Consten EC, van Iersel JJ, Verheijen PM, et al. Long-term outcome after laparoscopic ventral mesh rectopexy: an observational study of 919 consecutive patients. Ann Surg. 2015;262(5):742-7. DOI:10.1097/SLA.0000000000001401; PMID: 26583661
14. Randall CL, Nichols DH. Surgical treatment of vaginal inversion. Obstet Gynecol. 1971;38:327-32.
15. Meeks GR, Washburne JF, McGehee RP, Wiser WL. Repair of vaginal vault prolapse by suspension of the vagina to iliococcygeus (prespinous) fascia. Am J Obstet Gynecol. 1994;171:1444-52. DOI:10.1016/0002-9378(94)90386-7
16. Shull BL, Bachofen C, Coates KW, Kuehl TJ. A transvaginal approach to repair of apical and other associated sites of pelvic organ prolapse with uterosacral ligaments. Am J Obstet Gynecol. 2000;183:1365-73. DOI:10.1067/mob.2000.110910
17. DeLancey JO. Structural anatomy of the posterior pelvic compartment as it relates to rectocele. Am J Obstet Gynecol. 1999;180:815-23.
DOI:10.1016/s0002-9378(99)70652-6
18. Shorvon PJ, McHugh S, Diamant NE, et al. Defecography in normal volunteers: results and implications. Gut. 1989;30:1737-49. DOI:10.1136/gut.30.12.1737
19. Achtari C, Dwyer PL. Sexual function and pelvic floor disorders. Best Pract Res Clin Obstet Gynaecol. 2005;19:993-1008. DOI:10.1016/j.bpobgyn.2005.08.012
20. Milani R, Salvatore S, Soligo M, et al. Functional and anatomical outcome of anterior and posterior vaginal prolapsed repair with prolene mesh. BJOG. 2005;112:107-11. DOI:10.1111/j.1471-0528.2004.00332.x
21. Dwyer PL, O’Reilly BA. Transvaginal repair of anterior and posterior compartment prolapse with Atrium polypropylene mesh. BJOG. 2004;111:831-6.
DOI:10.1111/j.1471-0528.2004.00194.x
22. Nieminen K, Hiltunen KM, Laitinen J, et al. Transanal or vaginal approach to rectocele repair: a prospective, randomized pilot study. Dis Colon Rectum. 2004;47:1636-42. DOI:10.1007/s10350-004-0656-2
23. Hannestad YS, Rortveit G, Sandvik H, et al. A community-based epidemiological survey of female urinary incontinence: the Norwegian EPINCONT study. Epidemiology of Incontinence in the County of Nord-Trondelag. J Clin Epidemiol. 2000;53:1150-7. DOI:10.1016/s0895-4356(00)00232-8
24. Ward K, Hilton P. Prospective multicentre randomized trial of tension-free vaginal tape and colposuspension as primary treatment for stress incontinence. BMJ. 2000;325:67-74. DOI:10.1136/bmj.325.7355.67
25. Laurikainen E, Valpas A, Kivela A, et al. Retro pubic compared with transobturator tape placement in treatment of urinary incontinence: a randomized controlled trial. Obstet Gynecol. 2007;109:4-11.
DOI:10.1097/01.AOG.0000249607.82768.a1
26. Sideris M, McCaughey T, Hanrahan JG, et al. Risk of obstetric anal sphincter injuries (OASIS) and anal incontinence: A meta-analysis. Eur J Obstet Gynecol Reprod Biol. 2020;252:303-12. DOI:10.1016/j.ejogrb.2020.06.048
27. Harvey MA, Pierce M, Alter JE, et al.; Society of Obstetricians and Gynaecologists of Canada. Obstetrical Anal Sphincter Injuries (OASIS): Prevention, Recognition, and Repair. J Obstet Gynaecol. 2015;37:1131-48. DOI:10.1016/s1701-2163(16)30081-0
28. Khryanin AA, Tapilskaya NI, Knorring GY. Modern concepts of papillomavirus infection: epidemiology and tactics of management of patients with anogenital warts. Clinical dermatology and venereology. 2020;19(5):719-28 (in Russian).
DOI:10.17116/klinderma202019051719
29. Bulletti C, Coccia ME, Battistoni S, et al. Endometriosis and infertility. J Assist Reprod Genet. 2010;27(8):441-7. DOI:10.1007/s10815-010-9436-1
30. Donnez J, Van Langendonckt A, Casanas-Roux F, et al. Current thinking on the pathogenesis of endometriosis. Gynecol Obstet Invest. 2002;54:52-62. DOI:10.1159/000066295
31. Nnoaham KE, Hummelshoj L, Webster P, et al. Impact of endometriosis on quality of life and work productivity: a multicenter study across ten countries. Fertil Steril. 2011;96(2):366-73.e8. DOI:10.1016/j.fertnstert.2011.05.090
32. Rafique S, Decherney AH. Medical Management of endometriosis. Clin Obstet Gynecol. 2017;60(3):485-96. DOI:10.1097/GRF.0000000000000292

Авторы

А.А. Хрянин*1,2, Д.Р. Маркарьян3, М.А. Агапов3, В.К. Бочарова4

1 ФГБОУ ВО «Новосибирский государственный медицинский университет» Минздрава России, Новосибирск, Россия;
2 РОО «Ассоциация акушеров-гинекологов и дерматовенерологов», Новосибирск, Россия;
3 ФГБОУ ВО «Московский государственный университет им. М.В. Ломоносова», Москва, Россия;
4 ФГБОУ ВО «Первый Санкт-Петербургский государственный медицинский университет им. акад. И.П. Павлова» Минздрава России, Санкт-Петербург, Россия

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Aleksey A. Khryanin*1,2, Daniil R. Markaryan3, Mikhail A. Agapov3, Valentina K. Bocharova4

1 Novosibirsk State Medical University, Novosibirsk, Russia;
2Association of Obstetricians-Gynecologists and Dermatovenereologists, Novosibirsk, Russia;
3 Lomonosov Moscow State University, Moscow, Russia;
4 Pavlov First Saint Petersburg State Medical University, Saint Petersburg, Russia

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