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2012, vol. 140, br. 9-10, str. 666-672
Prolaps vaginalnih zidova nakon histerektomije - izbor hirurškog postupka
Klinički centar Srbije, Klinika za ginekologiju i akušerstvo, Beograd + Univerzitet u Beogradu, Medicinski fakultet

e-adresacvijiceva@yubc.net
Ključne reči: posthisterektomijski prolaps vaginalnih zidova; sakrospinalna fiksacija; sakrokolpopeksija; mrežice
Sažetak
Posthisterektomijski prolaps vaginalnih zidova je česta komplikacija koja se javlja posle različitih tipova histerektomije i veoma loše utiče na kvalitet života žene. Ona ometa funkciju donjeg urinarnog trakta, utiče na akt defekacije i na kvalitet seksualnog života. Ključni faktor o odabiru hirurškog postupka je dobro poznavanje potpornog aparata materice i vagine, što smanjuje i mogućnost nastanka prolapsa nakon histerektomije. Najznačajniji faktor rizika za nastanak prolapsa vaginalnih zidova jeste postojanje oštećenja potpornog aparata pre histerektomije. Postoje različite hirurške tehnike koje se mogu primeniti prilikom histerektomije, kako bi se sprečila pojava prolapsa vaginalnih zidova. Korekcija posthisterektomijskog prolapsa može da se izvodi abdominalnim i vaginalnim putem. Najčešće korišćene tehnike su sakrospinalna fiksacija i abdominalna sakrokolpopeksija. Vaginalni pristup ima prednosti u odnosu na abdominalni zbog manjeg broja komplikacija, manjeg gubitka krvi, boljeg i bržeg oporavka žene nakon operacije, kraćeg bolničkog lečenja i manje cene. Štaviše, on omogućava istovremeno korekciju svih postojećih oštećenja karličnog dna, odnosno cistocele, enterocele i rektocele. Abdominalna sakrokolpopeksija je udružena s manjim procentom recidiva i dispareunije u poređenju sa sakrospinalnom fiksacijom. Nešto ređe korišćene tehnike su suspenzija uterosakralnih ligamenata i ileokokcigealna fiksacija. Obe tehnike nose veliki rizik od povrede uretera. U poslednje vreme sve češće se upotrebljava mrežica od neresorptivnog materijala, a prvi rezultati primene transvaginalne mrežice su ohrabrujući.
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O članku

jezik rada: srpski
vrsta rada: prikaz
DOI: 10.2298/SARH1210666A
objavljen u SCIndeksu: 22.03.2013.