METHOD FOR TEMPORARY OCCLUSION OF COMMON ILIAC ARTERIES DURING ORGAN-PRESERVING OPERATIVE DELIVERY IN PATIENTS WITH PLACENTAR INGROWTH

摘要

FIELD: medicine.;SUBSTANCE: mid-lower-middle laparotomy is performed. A bottom cesarean section is performed, the fetus is removed, the umbilical cord is cut, the wound in the uterus is sutured, the placenta is left in the uterine cavity without separation. The uterus body is removed to the wound, the free loops of the intestine are withdrawn in the head direction with the use of a large wet wipe, thereby exposing the parietal peritoneum over the lower third of the aorta and the iliac vessels. After visualization of common iliac vessels and aortic bifurcations, the peritoneum is excised using a desector and a bipolar coagulator. The common iliac arteries are exposed to the left and to the right, distal reduction of the bladder is performed using surgical hemostasis by flashing and bipolar coagulation. At the level of the preserved cervix, a large needle with a thread of 1/0 is used to stitch with an U-shaped suture over the whole width in the anteroposterior direction, thus the neck is taken on the holder, which is used as a reference point for excision of the ingrown placenta together with the uterine wall. On the broad ligament of the uterus elastic tourniquets are imposed, the uterus is taken to the bosom. Common iliac arteries after preliminary intravenous administration of 2500 units of heparin are clamped with a direct vascular Satinsky clamp, the clamping time is noted, single clamping time does not exceed 40 minutes, oxygen saturation of the lower limbs during clamping is evaluated with a pulse oximeter, the sensor of which is fixed on the phalanx of the big toe to the left and to the right. Further resection of the uterine wall with an ingrown placenta is performed. Metroplasty is performed, then the clamps are removed from the common iliac arteries, pulse in the projection of the posterior tibial and anteropletharar artery is palpatorily assessed on the foot. Peritoneum defect above the aorta is sutured, the wound of the anterior abdominal wall is sewn tightly, an aseptic bandage is applied, after the end of the operation, ultrasound examination of the lower limb veins is performed.;EFFECT: method allows to minimize anatomical and functional damage by isolation and capture of the common iliac arteries for a limited time, preserve the reproductive function, avoiding changes in the hormonal background coordinated by the posthysterectomy syndrome, improving the patients' quality of life.;3 ex