medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/2079-701X-2022-16-23-231-235medsovet-7323Research ArticleГИНЕКОЛОГИЯGYNECOLOGYЛапароскопический серкляж – эффективный метод лечения истмико-цервикальной недостаточностиLaparoscopic cerclage – an effective method of treating cervical insufficiencyhttps://orcid.org/0000-0002-9442-8360АверяскинаМ. Н.AveriaskinaM. N.

Аверяскина Мария Николаевна – студент.

119991, Москва, ул. Трубецкая, д. 8, стр. 2

Mariia N. Averiaskina - Student of the Sechenov First Moscow State Medical University (Sechenov University).

8, Bldg. 2, Trubetskaya St., Moscow, 119991

averyaskina_m_n@student.sechenov.ruhttps://orcid.org/0000-0001-7114-4050БахтияровК. Р.BakhtiyarovK. R.

Бахтияров Камиль Рафаэльевич - доктор медицинских наук, профессор кафедры акушерства, гинекологии и перинатологии.

119991, Москва, ул. Трубецкая, д. 8, стр. 2

Kamil R. Bakhtiyarov - Dr. Sci. (Med.), Professor, Department of Obstetrics, Gynaecology and Perinatology, Sechenov First Moscow State Medical University (Sechenov University).

8, Bldg. 2, Trubetskaya St., Moscow, 119991

doctorbah@mail.ruhttps://orcid.org/0000-0001-6331-3109ЧиловаР. А.ChilovaR. A.

Чилова Раиса Алексеевна – доктор медицинских наук, доцент.

119991, Москва, ул. Трубецкая, д. 8, стр. 2

Raisa A. Chilova - Dr. Sci. (Med.), Associate Professor, Sechenov First Moscow State Medical University (Sechenov University).

8, Bldg. 2, Trubetskaya St., Moscow, 119991

rtchilova@gmail.comПервый Московский государственный медицинский университет имени И.М. Сеченова (Сеченовский Университет)РоссияSechenov First Moscow State Medical University (Sechenov University)Russian Federation202220012023023231235Copyright © Аверяскина М.Н., Бахтияров К.Р., Чилова Р.А., 20232023Аверяскина М.Н., Бахтияров К.Р., Чилова Р.А.Averiaskina M.N., Bakhtiyarov K.R., Chilova R.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/7323

Лапароскопический трансабдоминальный серкляж становится предпочтительным методом лечения пациентов с повторными случаями прерывания беременности в связи с истмико-цервикальной недостаточностью. Эта методика уменьшает частоту выкидышей во втором триместре и является эффективной профилактикой преждевременных родов. Данная работа проводит анализ современных техник наложения серкляжа через трансабдоминальный доступ: лапаротомный, лапароскопический и робото-ассистированный – с помощью аппарата da Vinci. Учитывая преимущества и недостатки каждого из этих подходов, в клинической практике предпочтение следует отдать лапароскопическому подходу, поскольку это самый безопасный (в отношении кровопотери, риска выкидыша, тромбоза вен нижних конечностей, а также косметического эффекта  и времени пребывания в стационаре) и эффективный метод лечения истмико-цервикальной недостаточности при повторных выкидышах (частота родов в доношенном сроке после данной операции составляет от 82 до 86%). Трансабдоминальный серкляж может быть наложен профилактически у пациенток с повторными выкидышами и истмико-цервикальной недостаточностью, трансабдоминальный серкляж не оказывает негативного влияния на фертильность. Многообещающая операция с помощью аппарата da Vinci уступает традиционному лапароскопическому подходу, поскольку сильно превосходит его как по длительности операции, так и по стоимости, имея при этом сопоставимую эффективность. Возможность проведения высокоэффективного лечения с использованием малоинвазивных методов позволяет предположить, что лапароскопический трансабдоминальный серкляж станет стандартом лечения рефрактерной истмико-цервикальной недостаточности. В этом обзоре рассматривается литература в отношении показаний и результатов лапароскопического серкляжа.

Laparoscopic transabdominal cerclage is becoming the preferred method of treating patients with repeated cases of preterm birth due to cervical insufficiency. This technique reduces the frequency of miscarriages in the second trimester and is an effective prevention of premature birth. This work analyzes modern techniques of applying serclage through transabdominal access: laparotomic, laparoscopic and robot-assisted using the da Vinci® device. Taking into account the advantages and disadvantages of each of these approaches, in clinical practice, preference should be given to the laparoscopic approach, since it is the safest (in terms of blood loss, risk of miscarriage, thrombosis of the veins of the lower extremities, as well as the cosmetic effect and hospital stay) and effective method of treating cervical insufficiency in repeated miscarriages (the frequency of childbirth in the full-term period after this operation is from 82% to 86%). Transabdominal serclage can be applied prophylactically in patients with repeated miscarriages and cervical insufficiency, transabdominal serclage does not have a negative effect on fertility. A promising operation using the da Vinci® device is inferior to the traditional laparoscopic approach, since it greatly exceeds it both in terms of the duration of the operation and in terms of cost, while having comparable efficiency. The option of highly effective treatment using minimally invasive methods suggests that laparoscopic transabdominal cerclage will become the standard of treatment for refractory isthmic-cervical insufficiency. This review examines the literature regarding the indications and results of laparoscopic cerclage.

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