urmjУральский медицинский журналUral Medical Journal2949-4389Ural State Medical University10.52420/umj.24.6.30ZJDLRQurmj-2031Research ArticleОригинальные статьи | Original articlesOriginal articlesОтдаленные результаты и качество жизни после пластики ректовагинальной перегородки местными тканями у пациенток с нижним ректоцеле 2–3‑й степенейAssessment of the Quality of Life of Patients Suffering from Lower Anterior Rectocele Grades 2–3 Using The SF‑36 Questionnairehttps://orcid.org/0009-0000-1963-8686БогдановА. В.BogdanovA. V.

Алексей Владимирович Богданов  – заведующий онкологическим отделением хирургических методов лечения (отделением абдоминальной онкологии и колопроктологии), ассистент кафедры хирургических болезней, ассистент кафедры хирургии, колопроктологии и эндоскопии

Екатеринбург

Aleksey V. Bogdanov – Head of the Oncology Department of Surgical Treatment Methods (Departmentof Abdominal Oncology and Proctology),  Assistant of the Department of Surgical Diseases, Assistant of the Department of Surgery, Proctology and Endoscopy

Ekaterinburg

odinekb@gmail.comСвердловская областная клиническая больница № 1; Уральский государственный медицинский университет; Уральский институт управления здравоохранением имени А. Б. БлохинаРоссияSverdlovsk Regional Clinical Hospital No. 1; Ural State Medical University; Ural Institute of Healthcare Management named after A. B. BlokhinRussian Federation20252312202524630–42Copyright © Богданов А.В., 20252025Богданов А.В.Bogdanov A.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.umjusmu.ru/jour/article/view/2031Введение

Введение. Оценка отдаленных результатов пластики ректовагинальной перегородки после хирургической коррекции нижнего ректоцеле 2–3-й степеней является важной и актуальной задачей, включающей в себя диагностику как анатомического дефекта, так и рецидива клинических симптомов, ухудшающих качество жизни пациенток.

Материалы и методы

Материалы и методы. В одноцентровое проспективное обсервационное исследование с 2005 по 2019 г. включено 38 пациенток с нижним ректоцеле и потребностью в ручном пособии при дефекации, которым проведена пластика ректовагинальной перегородки местными тканями в отделении колопроктологии Свердловской областной клинической больницы № 1. У всех женщин до и через 3 года после операции проведены дефекография, заполнены опросник шкалы запоров Кливлендской клиники (шкалы Векснера) и SF-36.

Результаты

Результаты. Через 3 года по данным дефекографии ректоцеле определялось у 11/38 (29,0 %) пациенток. Показатель положения аноректальной зоны покоя снизился с 35,0 [30,0; 40,0] мм до 30,0 [30,0; 34,8] мм (p < 0,001), а показатель аноректальной зоны при натуживании — с 55,0 [50,0; 60,0] мм до 41,0 [40,0; 55,0] мм (p < 0,001). Повторная потребность в ручном пособии при дефекации появилась у 3/38 (7,9 %) женщин. Оценка по шкале запоров Кливлендской клиники снизилась с 9 до 7 баллов (р < 0,001). По 7 из 8 шкал SF-36 изменения не определены. Показатель шкалы «Интенсивность боли» через 3 года после коррекции уменьшился с (74,7±22,4) до (52,5±27,2) баллов (р = 0,001), что свидетельствует о возрастании общего болевого синдрома.

Заключение

Заключение. Пластика ректовагинальной перегородки местными тканями у пациенток с нижним ректоцеле 2–3-й степеней через 3 года после операции приводит к сохранению анатомического результата и улучшению функции опорожнения прямой кишки у большинства женщин, при этом интегральные показатели качества жизни существенно не изменяются.

Materials and methods

Materials and methods. A single-center, prospective, observational study from 2005 to 2019 included 38 patients with lower rectocele and the need for manual assistance during defecation, who underwent rectovaginal septum plastic surgery with local tissues in the proctology department of the Sverdlovsk Regional Clinical Hospital No. 1. All women underwent defecography, Cleveland Clinic Constipation Scale (Wexner Scale) and SF‑36 questionnaires before and 3 years after surgery.

Results

Results. After 3 years, defecography data showed that rectocele was detected in 11/38 (29.0 %) patients. The anorectal resting zone position index decreased from 35.0 [30.0; 40.0] mm to 30.0 [30.0; 34.8] mm (p < 0.001), and the anorectal straining zone index decreased from 55.0 [50.0; 60.0] mm to 41.0 [40.0; 55.0] mm (p < 0.001). 3/38 (7.9 %) women returned to the need for manual assistance during defecation. The Cleveland Clinic Constipation Scale score decreased from 9 to 7 points (p < 0.001). Six of the eight SF‑36 scales showed no changes. The scores of the «Pain Intensity» and «Social Functioning» scales decreased from 74.7 (22.4) to 52.5 (27.2) (p = 0.001) 3 years after the correction, respectively.

Conclusion

Conclusion. Rectovaginal septum plastic surgery with local tissues in patients with grades 2–3 lower rectocele 3 years after the surgery leads to the preservation of the anatomical result and improvement of the rectal emptying function in most women, while the quality of life indicators do not increase.

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