Federalnoe gosudarstvennoe byudzhetnoe uchrezhdenie "Nauchnyj tsentr akusherstva; ginekologii i perinatologii imeni akademika V.I. Kulakova" Ministerstva zdravookhraneniya Rossijskoj Federatsii
发明人:
Shmakov Roman Georgievich,Шмаков Роман Георгиевич,Chuprynin Vladimir Dmitrievich,Чупрынин Владимир Дмитриевич,Kan Natalya Enkynovna,Кан Наталья Енкыновна,Tyutyunnik Viktor Leonidovich,Тютюнник Виктор
申请号：
RU2016138106
公开号：
RU0002625286C1
申请日:
2016.09.26
申请国别(地区):
RU
年份:
2017
代理人:
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 The uterus body is removed to the wound, the free loops of the intestine are withdrawn in the head direction with the use of a large wet wipe, thereby exposing the parietal peritoneum over the lower third of the aorta and the iliac vessels.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 tigh
