1. Uterine fibroids, uterine functional bleeding, uterine adenomyoma, the cervical examination is normal, and the patient requests to keep the cervix.
2. It is necessary to remove the uterus for various reasons, but it is difficult to remove the cervix. 1. Continuous epidural block anesthesia.
2. General anesthesia with endotracheal intubation. 1. The incision is the same as myomectomy. 2. Explore the size, mobility and cervix of uterus.
3. Cut off the uterine horn on both sides of the round ligament and pull it out of the abdominal cavity. Clamp the round ligament 1cm away from the uterine horn, and sew the distal end
4. Handle the attachment at the uterine horn, clamp the ovarian proper ligament and fallopian tube interstitial part, and sew the broken end in the figure of 8.
5. Expose the lower part of the uterus, and open the anterior lobe of ligament and the retroflex peritoneum of bladder along both sides of the uterus. Lift the inverted peritoneum of the bladder, separate the bladder from the loose tissue space between the bladder fascia and the cervical fascia, and then cut the posterior lobe of the ligament to the uterine isthmus along both sides of the uterus.
6. The uterine blood vessels are handled horizontally in the isthmus of the uterus, and the uterine arteries, veins and parauterine tissues are clamped to cut off, and the stump is sutured.
7. remove 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 the cervical stump was disinfected, it was sutured with absorbable thread "8".
8. Reconstruct pelvic peritoneum, suture pelvic peritoneum, and embed the broken ends of bilateral appendages, round ligament and cervical stump.
9. Close the abdomen and sew the layers of abdominal wall in layers. There are several reasons for hysterectomy, including: (1) severe chronic infection (pelvic infectious diseases)
(2) severe endometrial infection
(3) hysteromyoma
(4) uterine fibroids, endometrial cancer
(5) cervical cancer, ovarian cancer
(6) severe uterine bleeding (uterine rupture, uterine bleeding, uterine bleeding, uterine bleeding, uterine bleeding, uterine bleeding, uterine bleeding, uterine bleeding, uterine bleeding, uterine bleeding, uterine bleeding, uterine Partial hysterectomy only removes the upper part of the uterus, leaving the base of the uterus and the cervix 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 through 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 walls around the uterus are cut off by laparoscopy, and then the uterus is removed from 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 summed up in a few words, namely, minimal injury, minimal inflammatory reaction and optimal incision healing, minimal tissue scar and optimal treatment effect. Laparoscopic hysterectomy began in 1989. With the development of various surgical instruments, this operation has been widely carried out. Although LAVH is easy to perform because of relatively few laparoscopic operations, for some difficult cases, such as endometriosis and pelvic adhesion, the vaginal operation of LAVH is very difficult. 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 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, and expands the scope of minimally invasive surgery, which is more advantageous.
At the same time of laparoscopic total 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. The small incision of laparoscopy is more beneficial to obese patients, and the field of vision is clear during operation, avoiding 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 they all recover much faster than open hysterectomy, but there is no difference in postoperative recovery 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 and clear the surgical field, and can simultaneously treat the diseases that coexist in the pelvic cavity. 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, they can't complete hysterectomy for patients with huge uterus or severe pelvic adhesion. For such patients, it should be fully estimated before operation to choose open surgery, or if they encounter difficulties during operation, they will switch to open surgery.