METHOD FOR LAPAROSCOPIC ORGAN-SAVING TREATMENT OF INVASIVE CERVICAL CANCER

摘要

FIELD: medicine.SUBSTANCE: invention relates to oncology and gynecology. Perform a radical trachelectomy. Isolate uterine artery and vein from the level of their departure from the system of internal iliac vessels. Nondecreasing branches of the uterine vessels intersect, and the ascending arterial and venous branches retain, allocating them to a level 2-3 mm above the area of the internal uterine throat. With the help of laparoscopic technique, pelvic lymphadenectomy is performed. Consistently provide access to the cells of the small pelvis: vesical-vaginal, rectal-vaginal, pararectal and paravezical. Skeletal uterine arteries from the point of departure to bifurcation on the ascending and descending branches in the uterus isthmus. Laparoscopic resection of the parameters, tunneling of the ureters, crossing the cervical branch of the uterine artery and separating the surrounding tissues from the vaginal vaults for 2 cm is carried out. Further from the vaginal access, a colpotomy is performed by circular dissection of the vaginal vault with the formation of a vaginal cuff as wide as 2 cm, and the edges of the cuff are fixed in such a way that the cervix is completely covered by the vaginal mucosa, and the remaining part of the cervical canal is scraped out. Histologically, the distance from the tumor to the edge of the resection should be at least 5 mm. Then a circular continuous suture is applied to the preserved part of the cervix, a utero-vaginal anastomosis is formed by applying separate nodal sutures to the wall of the vagina and the stump of the cervix. Further a silicone catheter is inserted into the stored part of the cervical canal, which is fixed with a nodular seam to the thickness of the cervical tissue of the cervix. After that repeat laparoscopic revision of the pelvic organs and hemostatic measures are performed, the operation is completed by draining the small pelvis.EFFECT: method allows to perform organ-preserving volume of treatment of invasive cervical cancer in young patients with minimal trauma and with adequate oncological radicality, and also to minimize the risk of developing a characteristic complication of radical trachelectomy - stenosis of the cervical canal.1 cl, 2 ex