[intro-text]Операция Иваниссевича – является наиболее популярной среди более 120-ти способов хирургического устранения варикоцеле. Операция проста в исполнении и доступна по стоимости, но травматична и характеризуется высоким риском повторного возникновения варикоцеле. Чаще всего применяется взрослым. Детям и подросткам показана редко: при наличии соответствующих показаний и невозможности проведения хирургических вмешательств других видов.[/intro-text]
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Преимущества и недостатки операции
Под операцией Иваниссевича подразумевается перевязка пораженных яичковых вен через доступ из-за брюшинного пространства. У этого способа устранения варикоцеле есть положительные и отрицательные стороны применения.
Операция Иваниссевича | |
Преимущества | Недостатки |
Низкая стоимость | Травматичность |
Проста в исполнении | Долгий период реабилитации |
Видимый шрам | |
Низкий риск развития осложнений | Высокая вероятность повторного появления патологии |
Существуют малоинвазивные и более эффективные методы удаления варикоцеле, но их выполнение требует наличия дорогостоящей аппаратуры. По этой причине во многих клиниках операция Иваниссевича – единственный способ устранения патологии.
Показания
Показана при следующих проблемах:
- Болевой синдром высокой интенсивности.
- Атрофия яичка, уменьшение его размеров.
- Сильное отклонение от нормы результатов спермограммы.
- Не эстетический внешнем вид мошонки.
- Бесплодие.
- Риск нарушения фертильности у подростков.
Операцию Иваниссевича выполняют на поздних и ранних этапах развития варикоцеле. Может назначаться взрослым мужчинам, подросткам и маленьким детям.
Противопоказания
К факторам, исключающим возможность проведения операции относятся:
- Заболевание брюшной полости воспалительного характера (аппендицит, перитонит).
- Плохая свертываемость крови.
- Острые вирусные, инфекционные заболевания.
- Цирроз, сахарный диабет, другие болезни тяжелой формы в стадии декомпенсации.
- Гнойно-воспалительные процессы на коже.
- Артериальная гипертензия.
- Воспаление простаты, почек, уретры и мочевого пузыря.
Если у маленьких детей, подростков выявлено варикоцеле первой степени, но нет дискомфорта и болей в мошонке, операция Иваниссевича откладывается до 18 лет. Основная причина – высокий риск рецидива и недоразвития яичек. Взрослым и пожилым мужчинам, у которых есть дети, проводить хирургическое вмешательство на ранних стадиях развития варикоцеле, при отсутствии клинических признаков, также не обязательно. В обоих случаях за течением болезни просто наблюдают.
Где и кем проводится
Оперативное вмешательство по методу Иваниссевича характеризуется высокой травматичностью. Поэтому оно осуществляется в стационаре – в хирургическом или урологическом отделении больницы.
Операцию выполняет хирург-уролог или андролог. Состояние мужчины во время пребывания под наркозом контролирует анестезиолог. При необходимости прибегают к помощи других специалистов.
Подробнее об операции:
Подготовка
Для исключения наличия противопоказаний к операции Иваниссевича, оценки общего состояния здоровья за 1-2 недели до вмешательства больному назначается прохождение комплексного обследования. Оно включает:
- Общий, развернутый анализ крови.
- Рентгенографию легких.
- Анализ мочи.
- Тест на скорость свертывания крови.
- Спермограмму.
- Анализы на обнаружение вирусов гепатита B и C, ВИЧ-инфекции, заболеваний, передающихся половым путем.
- Исследование гормонального фона.
- Электрокардиограмму.
Если помимо варикоцеле не выявлено других патологий, показана консультация уролога, анестезиолога. Заключение об отсутствии противопоказаний к вмешательству выдает терапевт.
При наличии сопутствующих заболеваний рекомендуется осмотр у нефролога, эндокринолога, кардиолога, других узких специалистов.
После получения результатов диагностики больной должен явиться в медицинское учреждение в указанный врачом срок. С вечера необходимо провести гигиенические процедуры. В день, когда назначено вмешательство, не рекомендуется принимать пищу. Ограничений по поводу употребления воды нет.
Техника выполнения
Начинается операция с обезболивания. После того как подействует анестетик, приступают к удалению варикоцеле.
Этапы хирургического вмешательства по Иваниссевичу | Суть |
Разрез брюшной стенки | Дезинфицируют область вмешательства, в поперечно-косом направлении разрезают кожу, жировую клетчатку. Разрез выполняют на уровне верхней передней ости подвздошной кости. Его длина – до 5 см |
Удаление пораженной яичковой вены | Мышечную ткань рассекают, раздвигают и закрепляют зажимами. Достают сосуды, отделяют вену яичка, фиксируют ее и перетягивают в двух местах лигатурой, затем – пересекают. Если необходимо, перевязывают другие крупные ветви венозных сосудов |
Проверка гемостаза | Расширяют дистальный конец вены, массируют мошонку. Убирают вытекающую венозную кровь, промывают и высушивают рану, перевязывают (коагулируют) сосуд |
Накладывание швов | Послойно зашивают ткани рассасывающейся и специальной нитью. Если нужно, для оттока лишней жидкости в ране оставляют дренаж |
В среднем операция длится 45-60 минут. По завершению на шов накладывается стерильная повязка.
Особенности выбора наркоза
Способ обезболивания во время проведения операции по удалению варикоцеле выбирает хирург и анестезиолог: он зависит от длительности процедуры, состояния здоровья больного, оборудования операционной.
Вид наркоза | Используемые анестетики | Особенности применения | |
Местный | Новокаин | Используется, если длительность операции – не больше получаса. Обезболивают место предполагаемого разреза и область вокруг него | |
Лидокаин | |||
Ультракаин | |||
Эпидуральный | Тетракаин | Применяется при хирургических вмешательствах длительностью до 60 минут. Обезболивающее средство вводят между 3-4 поясничными позвонками. После начала действия анестезии пропадает чувствительность в теле ниже уровня укола. Не используется при высоком внутричерепном давлении, аортальном стенозе, выраженной деформации позвоночника | |
Лидокаин | |||
Общий | Эндотрахеальный | Фторотан | Рекомендуется, если длительность операции – час и более. При воспалении верхних дыхательных путей, бронхиальной астме не применяется: анестетик поступает в трахею, а больного интубируют. Работа органов дыхательной системы поддерживается аппаратом для искусственной вентиляции легких |
Закись азота | |||
Галотан | |||
Внутривенный | Кетамин | Пациент погружается в глубокий сон, но дышит самостоятельно | |
Диприван | |||
Гексенал |
При операции Иваниссевича используют местную анестезию или внутривенный наркоз. Более безопасный – первый способ обезболивания. Но во время вмешательства с его применением может возникать ощущение легкого дискомфорта. Побочные действия общего наркоза – тошнота, головная боль, сонливость. Функции нервной системы восстанавливаются по истечении суток.
Период после операции
После накладывания швов к месту разреза прикладывают пузырь, наполненный льдом: это способствует уменьшению отеков, помогает остановить кровотечение, предотвратить появление гематом. На мошонку надевают бандаж: он снижает нагрузку на семенной канатик, препятствует его растяжению и движению яичка при смене положения тела с горизонтального на вертикальное. Ее носят несколько суток. Из операционной больного доставляют в палату для дальнейшего наблюдения.
В первые несколько дней возможны боли в области накладывания шва и мошонке умеренного или выраженного характера. Для их купирования назначают обезболивающие средства – Ибупрофен, Дексалгин, Кетопрофен. Во избежание появления инфекционных осложнений, рекомендуется прием антибиотиков в течение 5 дней.
Повязку на ране меняют на следующие сутки после вмешательства. Если в ходе операции была установлена дренажная система, она извлекается спустя несколько дней.
При отсутствии осложнений мужчину выписывают из стационара через 1-1,5 недели. Швы снимают в последний день пребывания в больнице.
Восстановление
После перенесения операции по технике Иваниссевича нужно носить обтягивающее белье, отказаться от половых контактов. Полное восстановление происходит через 3-6 месяцев. До окончания этого срока рекомендуется избегать:
- Походов в баню, сауну.
- Приема горячей ванны.
- Переохлаждения организма.
- Тяжелых нагрузок.
- Занятий силовыми видами спорта.
- Поднятия тяжелых предметов.
- Упражнений, выполнение которых требует напряжения брюшной стенки.
Возобновлять половую жизнь можно после исчезновения болей, разрешения врача. Как правило, это происходит через 3,5 недели после операции, но все зависит от общего состояния мужчины, его возраста. Сначала во время полового акта могут появляться болевые ощущения в мошонке. После налаживания регулярной половой жизни дискомфорт исчезает, полностью восстанавливается репродуктивная функция.
Возможные осложнения
Операция Иваниссевича помогает устранить симптомы патологии, нормализовать кровообращение в яичках, предупредить возникновение бесплодия. Но она может стать причиной появления таких осложнений:
- Травмирование нерва, проходящего через паховый канал. Проявляется в виде постоянных болей в паху, расстройств чувствительности на внутренней стороне бедра. Поврежденные небольшие нервные стволы семенного канатика вовлекаются в процесс формирования рубцовой ткани.
- Атрофия яичка. Происходит при травмировании здоровых сосудов – перевязке подвздошной артерии: питание тестикул нарушается, а их ткани отмирают.
- Гидроцеле – скопление жидкости в оболочке тестикул. Проявляется в виде увеличения их размеров. Причина – травмирование, пересечение лимфатических сосудов. Возникает у 0,5-9% мужчин через 6 месяцев или 2 года после удаления варикоцеле.
- Инфицирование раны – следствие несоблюдения правил стерильности при перевязывании пораженной яичковой вены. Основные симптомы: резкие и острые боли в месте накладывания шва, высокая температура, лихорадка.
[frame-icon type=»2″ color=»yellow»]Из всех этих осложнений операции Иваниссевича чаще всего встречается гидроцеле. Наиболее опасное последствие вмешательства – атрофия яичка. Она приводит к необратимым изменениям в процессе выработки спермы (возникает бесплодие), нарушению гормонального фона мужчины. Эффективных мер борьбы с развивающейся атрофией тестикул на сегодняшний день не существует.[/frame-icon]
[frame-text-big]«Водянка яичка после проведения операции Иваниссевича диагностируется наиболее часто. Устраняется она хирургическим путем. После вмешательства яичко возвращается к нормальным размерам»
Плеханов А. Ю., врач уролог-андролог, г. Санкт-Петербург
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Эффективность операции
Основной недостаток операции Иваниссевича – частые рецидивы варикоцеле: в 40% случаях оно развивается вновь. Причина – затрудненный доступ к ответвлениям вены яичка или семенного канатика.
Рецидивы чаще всего происходят у мужчин с третьей и четвертой степенью варикоцеле: на последних стадиях развития патологии яичковая вена полностью поражена, наблюдается варикозное расширение ее ответвлений. Без дополнительного вмешательства убрать больные сосуды трудно, иногда – вовсе невозможно. По этой причине эффективность операции Иваниссевича намного ниже, чем малоинвазивных вмешательств: всего 70%.
Стоимость
Цена операции Иваниссевича зависит от:
- Вида наркоза.
- Места проведения оперативного вмешательства (государственная или частная клиника).
- Стоимости госпитализации в стационар, ухода после операции.
- Географического расположения медицинского учреждения.
- Стадии варикоцеле.
В России стоимость такого хирургического вмешательства – от 5 до 25 тыс. руб.
Расположение медицинского учреждения в России, где выполняют операцию Иваниссевича | Средняя цена, тыс. руб. |
Новосибирск | 18 |
Краснодар | 13,5 |
Санкт-Петербург | 5-20 |
Самара | 10-25 |
Воронеж | |
Челябинск | |
Тольятти | |
Смоленск | |
Москва | 8-23 |
Саратов | 10 |
Волгоград | 5-10 |
Омск | |
Ульяновск | |
Нижний Новгород | |
Уфа |
Цена операции Иваниссевича в Украине – 4-10 тыс. грн.
В государственных клиниках стоимость оперативного лечения варикоцеле намного ниже, чем в частных. Но при выборе места проведения операции рекомендуется обращать внимание на уровень квалификации врача.
[frame-icon type=»4″ color=»blue»]При наличии страхового полиса удалить варикоцеле можно бесплатно. Договором страхования предусмотрена система квот, в соответствии с которыми выделяют средства на проведение оперативного вмешательства определенного вида по показаниям. Квота действительна полгода и включает в себя реабилитационный период.[/frame-icon]
Отзывы
Мнения по поводу эффективности операции Иваниссевича разные. Многим мужчинам она помогла избавиться от варикоцеле, улучшить качество жизни и завести ребенка. Но согласно отзывам, у хирургического вмешательства есть недостатки – долгий период реабилитации, послеоперационные боли:
[frame-text-big]«Перенес операцию Иваниссевича 2 месяца назад. Прошла она хорошо. Остался шрам, как после удаления аппендицита. Иногда возникают боли в паху тянущего и ноющего характера. Но врач говорил, что это нормально. Болевой синдром исчезнет со временем»
Михаил, 35 лет
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[frame-text-big]«Убирал варикоцеле по методу Иваниссевича. От наркоза отходил тяжело. Несколько дней из-за интенсивных болей трудно было ходить. Потом организм начал быстро восстанавливаться, осложнений не возникало. Но об эффективности лечения сказать ничего не могу: результата еще не заметил. Может, времени не так уж много прошло»
Алексей
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[frame-text-big]«Диагностировали 3 степень варикоцеле еще в 15 лет. Патологию яичковых вен убрали оперативным путем – по методике Иваниссевича. Думал, что не смогу иметь детей и понадобится повторная операция из-за рецидива заболевания. Но все закончилось благополучно: на данный момент у меня 2 ребенка. Лишь небольшой шрам в паху напоминает о варикоцеле»
Олег, 37 лет
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[frame-text-big]«Во время профилактического медосмотра обнаружили левостороннее варикоцеле (2 стадия). Назначили операцию Иваниссевича. Делал ее в государственном учреждении. Из стационара выписали через неделю. Еще через 3 дня сняли швы. Сначала были боли в мошонке, отеки. Но сейчас все нормально. Рецидивов заболевания, осложнений не возникало»
Евгений, 23 года
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[frame-text-big]«Когда был в 9 классе, выявили варикоцеле. Провели операцию по Иваниссевичу. Восстановление длилось долго, беспокоили боли. Сейчас все в порядке. Сдавал еще анализы. Отклонений не обнаружили»
Аркадий, г. Екатеринбург
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[frame-text-big]«Перенес операцию Иваниссевича 10 лет назад. Период реабилитации был тяжелым: из раны сочилась жидкость розового цвета, долго беспокоили болевые ощущения в паху, была высокая температура. Но терпеть все это стоило: у меня есть ребенок»
Валентин
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Ответы на частые вопросы
Как делают операцию Иваниссевича?
Разрезают переднюю брюшную стенку в подвздошной области (на уровне передне-верхней ости подвздошной кости параллельно от хода пахового канала), рассекают подкожную жировую клетчатку и мягкие ткани, раздвигают их и закрепляют зажимами. Выделяют из сосудистого сплетения яичковую вену. Мобилизуют ее, пересекают и перевязывают между двумя лигатурами. Если возможно, убирают все пораженные ветви варикозно расширенной вены. Затем послойно ушивают ткани, накладывают на место разреза стерильную повязку.
Какой наркоз при операции Иваниссевича?
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لازم به ذکر است تمامی پرسنل نمونه گیر از آزمایشگاههای مرجع ارسال خواهند شد
و آنی آزما صرفا نقش معرفی بیماران به آزمایشگاهها را دارد.
همکاران ما پس از ثبت درخواست شما به منزل یا محل کار و … می آیند، نسخه شما
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هزینه های مشاوره پزشک کمتر یا برابر با هزینه های ویزیت بیمارستان است، بنابراین
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همچنین از دیگر مراقبتهای متخصص بیهوشی
تزریق بی حسی موضعی برای بی حس کردن قسمتی از بدن در مواقع درد شدید است.
گاهی اوقات بیماران ترجیح میدهند دوران نقاهت بعد از عمل
خود را در منزل سپری کنند، در چنینن مواقعی برای
راحتتر بودن بیمار میتوانید برای انجام مراقبتهای بعد از عمل
از ویزیت پزشک متخصص بیهوشی در منزل
کمک بگیرید. علاوه بر موارد
گفته شده امکان تراکوستومی بیمار
نیز توسط متخصص بیهوشی در منزل وجود دارد.
اگر نیاز به یک پزشک یا متخصص در منزل دارید؟
اگر از هزینه های بالای نگهداری
در بیمارستان آگاه هستید؟ از پزشک در منزل استفاده کنید.
شما می توانید با استفاده از ویزیت پزشک متخصص در منزل، با هزینه ای مناسب
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نمایید.
با داشتن بیش از 200 استخوان در بدن انسان ، این یک
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دارید، علاوه بر خدمات حضوری در کلینیک، میتوانید با تهیه دوره جامع درمان
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است، بی خوابی تان را بدون دارو و
در منزل درمان کنید. از نظر درآمد ، تخصص پزشکی قانونی کمتر از سایر تخصص ها درآمد دارد و وزارت بهداشت حقوق three تا 4 میلیون
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بیماریهای عفونی از جمله بیماریهای شایع و خطرناک در میان انسانهاست و متخصصهای عفونی میکوشند تا در زمینهی شناسایی و پیشگیری و درمان این بیماریها گامی موثر
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ابتدا عفونت را به درستی تشخیص داده و سپس بر اساس آن برای شما تجویزها و توصیههای
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این تخصص نیز مثل تخصص های جشم پزشکی ، ارتوپدی ، گوش و حلق و بینی و …
از آن دسته تخصص هایی است که چند سال اول فارغ
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انجام دهید و اقدامات درمانی لازم همان جا صورت پذیرد .
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از جمله اختلالات مهمی که متخصص
مغز و اعصاب به آنها میپردازد میتوان به اختلالاتی مانند سردرد، صرع، آسیبهای نخاعی، سکته و ..
متخصصین روانپزشکی معمولا به ارزیابی ذهنی و فیزیکی بیماران و انجام تستهای مختلف
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اسنپدکتر راهکاری ساده و سریع و
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با ورود به سرویس پزشک و مشاور اسنپ دکتر و
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تحت عمل جراحی قرار گرفته اند و دامنه ی حرکتی آنان به دلیل این جراحی ها محدود شده است، می توانند بدن حضور در مطب
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طور فزاینده ای تبدیل به هنجار روز می شود.
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یکی از خدمات اصلی در این روزها ویزیت بیماران مبتلا
به کرونا است در آنی آزما ما خدمات آزمایش کرونا در منزل، ویزیت متخصص عفونی و فوق تخصص ریه را برای بیماران مبتلا به کووید 19 یا کرونا ارائه میدهیم.
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برخی از افراد (از جمله سالمندان) به دلیل شرایط
جسمانی نامساعد، ضعف سیستم ایمنی یا … در مقایسه با دیگر افراد در برابر
ویروس ها و باکتری ها حساسیت بیشتری نشان داده و سریعا بیمار می شوند.
متخصص ارتوپد در منزل بعد از تشخیص اولیه با معاینه فیزیکی؛ تشخیص های تکمیلی مانند انواع آزمایشات ،
عکسبرداری ها را جهت تشخیص دقیق و درست تجویز می کند.
با توجه به این که در مراکز درمانی
پزشک دائم در حال ویزیت کردن بیمارانش است احتمال خطا و بی دقتی ممکن است رخ دهد.
همه بیماری ها نیاز به بستری شدن ندارند، اما به دلیل عدم حمایت در خانه، بیماران به
طور ناخواسته برای مراقبت های پزشکی به خانه های سالمندان و بیمارستان ها می روند.
هزینه پزشک در منزلقطعا این مشکلات را ندارد و صرفا بسته به نوع بیماری و روند درمان شخص می
تواند متفاوت باشد.باید با بررسی و مشاوره بهترین انتخاب را برای بیمار خود انجام دهید.
قیمت ویزیت پزشک متخصص در منزل، با توجه به شرایط بیمار و نوع
درخواست متفاوت می باشد. شما می توانید جهت آگاهی از قیمت های دقیق خدمات پزشکی در منزل با مشاوران ما
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حضورش در منزل میتواند بسیار کمککننده و موثر باشد.
چرا که بسیاری از کودکان از حضور در مراکز
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مکانها به آنها استرس و اضطراب وارد میکند.
متخصص اطفال با بیماریها و اختلالات مربوط به کودکان سروکار دارد و
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