Conclusion. Pelvic exenteration at a reference center allows patients to achieve rather high survival rates and quality of life. Key words: pelvic exenteration, bladder cancer, cervical cancer, survival, quality of life ВведениеЛокализация опухоли в зоне малого таза у женщин наблюдается достаточно часто в онкологической пра-ктике. Так, по данным последнего отчета об онколо-гической заболеваемости в Российской Федерации, рак тела матки (удельный вес в структуре заболева-ний -7,7 %), рак шейки матки (РШМ) (5,3 %), рак прямой кишки, ректосигмоидного соединения и ану-са (4,7 %), рак яичника (4,6 %) и рак мочевого пузыря (РМП) (1,1 %) входят в число самых распространен-ных злокачественных опухолей у женского населения [1]. В нашей стране остается достаточно высокой доля местно-распространенных и запущенных форм, т. е. III и IV стадий, таких заболеваний. К примеру, в 2013 г. из всех впервые выявленных случаев рака яичника на III-IV стадии пришлось 61,4 %, рака прямой киш-ки, ректосигмоидного соединения и ануса -48,8 %, РШМ -36,5 %, РМП -27,3 % и рака тела матки -16,6 % [2]. При местно-распространенных формах и местных рецидивах злокачественных новообразова-ний тазовых органов применяют экзентерацию (эвис-церацию), включающую радикальное иссечение со-держимого таза в той степени, в которой вовлечены в опухолевый процесс тазовые структуры. Операция может включать удаление многочисленных тазовых структур, в том числе мочевого пузыря, матки и ма-точных труб, влагалища, прямой кишки, тазовых со-судов и нервов и тазовой кости [3,4].Выделяют 3 типа тазовой экзентерации: переднюю, заднюю и тотальную [5]. Передняя экзентерация вклю-чает удаление тазовых структур передней части полости малого таза (половых органов, мочевого пузыря и мо-
Introduction. Sling urethropexy is considered the «gold standard» surgical treatment for stress urinary incontinence in women. However, the long-term results of such operations have not yet been fully studied.Purpose of the study. To evaluate the results of using various options for sling operations at different periods of postoperative follow-up.Materials and methods. In 698 women aged 42 - 68 years (median — 54 years) suffering stress incontinence were used 4 variants of sling operations according to the database of the S.P. Botkin City Clinical Hospital: TVT retropubic technique; transobturator technique TVT-O («inside-out»); transobturator technique TOT («outside-in»); mini sling system. The period of postoperative follow-up was 6 - 139 months (median 79 months). Evaluation of treatment results was carried out according to the following periods of postoperative follow-up: short-term (up to 1 year inclusive); mediumterm (a period from 1 to 5 years inclusive); long-term (over 5 years). The success of the treatment was determined by the criterion of the absence of urine involuntary loss during the cough test and the 1-hour pad test.Results. Treatment success in the entire sample of patients was 96.1% (671 / 698) for the short-term criterion, 93.1% (591 / 635) for the medium-term criterion and 86.2% for the long-term criterion (467 / 642). The effectiveness of short-term treatment after TVT was 97%, TVT-O — 95.8%, TOT — 96.2%, mini-sling system — 95.5%, in medium-term — 92.2%, 93.1%, 90.9% and 92.3%, respectively, for long-term — 87.1%, 86.2%, 85.2% and 85%, respectively. There were no significant differences between the indicated variants of sling operations in terms of treatment efficacy for all observation periods (p > 0.05). Intra and early postoperative complications were noted in 51 (7.3%) cases, late — in 79 (11.3%). There were no significant differences in the incidence of both categories of complications between the surgical techniques used (p > 0.05). Only surgical experience significantly affects the risk of recurrent urinary incontinence after surgery, early and late postoperative complications.Conclusions. The success of surgical treatment for stress urinary incontinence in women does not significantly depend on the type of sling surgery but depends mainly on the surgical experience. Therefore, it is advisable to use sling operations in hospitals with extensive experience in this area.
Introduction. The review is aimed at analyzing the worldwide experience in the use of the oral mucosa in ureteroplasty due to benign ureteral strictures.Objective. To study the features of the use of the oral mucosa in ureteral reconstruction based on a review of the worldwide literature.Materials and methods. The review was conducted using the PubMed, EMBASE, and the Russian Science Citation Index database. In the first stage, 1013 sources were found, of which 38 articles were selected for inclusion in the review. Of these, 13 studies used an open approach, 15 — robotic, 6 — laparoscopic, 3 — laparoscopic and robotic, 1 — open and laparoscopic. A buccal graft was used in 29 studies and a lingual graft was used in 9 studies.Results. In total, oral mucosal ureteroplasty was performed 308 times in 306 patients: open technique — 64 times, robotic — 145 times, laparoscopic — 99 times. A buccal graft was used in 67.9% (209/308) of the cases, a lingual graft was used in 32.1% (99/308). Postoperative complications were observed in 15.9% (49/308) of the cases: 12.2% after the open technique, 10.4% after the robotic technique and 20.2% after the laparoscopic technique. With a postoperative follow-up period of 1 to 85 months (average 15.3 months), treatment success was achieved in 92.5% (285/308) of the cases: 93.8% for open technique, 88.2% for robotic, 98.0% for laparoscopic.Conclusion. The use of the oral mucosa for ureteroplasty due to benign ureteral stricture allows high rates of efficiency and safety. The results of ureteroplasty do not depend on the choice of surgical approach, type of graft and graft transplantation technique.
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