2. It is necessary to remove the uterus for various reasons, but it is difficult to remove the cervix. 1. Continuous epidural anesthesia.
2. General anesthesia with tracheal intubation. 1. The incision is the same as myomectomy. 2. Explore the size, mobility and cervix of uterus.
3. Cut off the uterine horns on both sides of the round ligament forceps and pull out the abdominal cavity. At the distance of 65438±0cm from the uterine horn, the round ligament was cut and the distal end was sutured.
4. The attachment is clamped at the uterine horn, the proper ligament of the ovary and the interstitial part of the fallopian tube are cut off, and the end is tied with an 8-shaped seam.
5. Expose the lower part of the uterus, and open the anterior ligament and the retroperitoneum of the bladder along both sides of the uterus. Lift the everted peritoneum of bladder, separate the bladder from the loose tissue gap between bladder fascia and cervical fascia, and then cut the posterior lobe of ligament along both sides of uterus to the isthmus of uterus.
6. Treat uterine blood vessels at the isthmus level near the uterine side wall, pinch off uterine arteries, veins and tissues beside the uterus, and suture the stump.
7. Take out the uterine body, open the bladder, expose the isthmus of the uterus, make an annular incision in the isthmus, and cut out the uterus through the mucosa of the cervical canal. After disinfection, the cervical stump was sutured with absorbable thread "8".
8. Reconstruct the pelvic peritoneum, suture the pelvic peritoneum, and embed bilateral appendages, ligamentum teres, and cervical stump.
9. Abdomen, suture the abdominal wall layer by layer. There are several reasons for hysterectomy, including: (1) Severe chronic infection (pelvic infectious disease).
(2) Severe endometrial infection
(3) hysteromyoma
(4) Uterine fibroma and endometrial carcinoma
(5) Cervical cancer and ovarian cancer
(6) Severe uterine bleeding (uterine rupture, postpartum hemorrhage)
Hysterectomy is a common gynecological operation, which can be divided into total hysterectomy, partial hysterectomy and extended hysterectomy. Partial hysterectomy only removes the upper part of the uterus, leaving the base and cervix of the uterus intact. Total hysterectomy is to remove the uterus together with the cervix. Extended hysterectomy removes the uterus, bilateral fallopian tubes and ovaries, as well as the upper tissues of the vagina. Hysterectomy can be performed by abdomen or vagina. The former is called abdominal hysterectomy and the latter is called vaginal hysterectomy.
Because of the structural characteristics of female reproductive tract, there are many methods to remove the diseased uterus. The traditional surgical method is abdominal or vaginal hysterectomy. Laparoscopic total hysterectomy means that the ligaments, blood vessels and vaginal wall around the uterus are cut off by laparoscopy, and then the uterus is taken out of the vagina, and then the vaginal stump is sutured again by laparoscopy. In addition to total hysterectomy, there are several different types of laparoscopic hysterectomy, including laparoscopic assisted vaginal hysterectomy (LAVH), laparoscopic subtotal hysterectomy and laparoscopic intrafascial hysterectomy. Endoscopic technology has brought medicine into the era of minimally invasive surgery, which can be summarized in several words, namely, minimal injury, minimal inflammatory reaction, optimal incision healing, minimal tissue scar and optimal treatment effect. Laparoscopic hysterectomy started on 1989. With the development of various surgical instruments, this kind of operation has been widely carried out. Although LAVH is easy to perform due to relatively few laparoscopic operations, it is very difficult for some difficult cases, such as endometriosis and pelvic adhesion. For such patients, laparoscopic total hysterectomy is relatively easy because it is completely performed under laparoscopy. Compared with abdominal hysterectomy and vaginal hysterectomy, laparoscopic hysterectomy has a clearer field of vision. For patients with endometriosis and pelvic adhesion, laparoscopic hysterectomy not only avoids the difficulty of vaginal surgery, but also avoids the trauma of open surgery, which expands the scope of minimally invasive surgery and has more advantages.
In addition to laparoscopic hysterectomy, other diseases can also be treated by laparoscopic surgery, such as endometriosis focus resection, ovarian tumor resection, vaginal stump suspension, laparoscopic pelvic floor defect repair, bladder neck pubic comb ligament suspension and so on. At the same time, laparoscopic lymph node dissection can also be performed to treat endometrial cancer and cervical cancer.
Compared with open hysterectomy, because of its small incision, the postoperative complications are lower, the chances of postoperative analgesia are less, and it can return to normal work and life more quickly. Laparoscopic small incision is more beneficial to obese patients, and the field of vision during operation is clear, which avoids the problem of poor healing caused by large abdominal incision. Laparoscopic hysterectomy, vaginal hysterectomy and open hysterectomy, the former two have the characteristics of minimally invasive, and the recovery speed is much faster than open hysterectomy, but there is no difference between laparoscopic surgery and vaginal surgery. Nevertheless, laparoscopic total hysterectomy still has incomparable advantages over vaginal hysterectomy, mainly because it can clearly understand the pelvic cavity, clear the operating field and treat diseases coexisting in the pelvic cavity at the same time. For complicated cases, laparoscopic surgery is much safer than vaginal surgery. Therefore, for simple total hysterectomy, vaginal surgery or laparoscopic surgery can be the first choice. Laparoscopic total hysterectomy should be the first choice when the uterus needs to be removed due to pelvic adhesion, endometriosis and other diseases. However, laparoscopic hysterectomy and vaginal hysterectomy still have their limitations, that is, hysterectomy cannot be completed for patients with huge uterus or serious pelvic adhesion. For such patients, it is necessary to fully estimate the choice of open surgery before operation, or switch to open surgery when encountering difficulties during operation.