total vaginal hysterectomy

As the name suggests, vaginal surgery is the use of the natural vagina for surgery. Its trauma is small and its recovery is fast. It is a very long-term surgical procedure for gynecological surgery. Vaginal surgery includes transvaginal hysteromyoma removal, subtotal hysterectomy, total hysterectomy, extensive or extensive resection of the vaginal uterus, and a series of vaginal sigmoid vaginoplasty for congenital vaginal and uterine patients. Treating diseases: uterine prolapse Indication There are no pelvic adhesions in the following cases: 1. Uterine prolapse. 2. Functional uterine bleeding. 3. Benign tumors of the uterus. 4. Endometrial hyperplasia. Preoperative preparation 1. Vaginal rinse for 3 consecutive days before surgery. 2. Oral antibiotics were taken 3 to 5 days before surgery. 3. Clean the enema 1 time before the operation and the morning of the operation. 4. 1 day before surgery, the vulva is prepared for skin. Surgical procedure 1. Position and disinfection: the lithotomy position. Routine disinfection of the vulva, vagina, lower abdomen and upper third of the thigh. 2. Exposure surgery: sutures fix the labia minora on the vulva skin. Use a cervical clamp to clamp the cervix for pulling. 3. Cervical anterior lip mucosal incision: insert the metal catheter into the bladder, identify the attachment point of the posterior wall of the bladder in the anterior lip of the cervix, and cut the cervical mucosa by 0.5cm transverse arc under this attachment point. The location of the incision can affect the subsequent surgery. If the incision is too close to the cervix, it is difficult to find the vaginal space If the incision is too high, it is easy to hurt the bottom of the bladder. 4. Separation of the bladder: Lift the edge of the vaginal incision, use the metal catheter to provoke the bladder wall, see the lower boundary of the bladder, and cut the loose tissue of the posterior wall of the cervix. Find the gap between the bladder and the cervix and separate the bladder and cervical space from the midline of the cervix. Pull the bladder up with a vaginal pull hook, and see the bladder ligaments on both sides of the bladder. Cut it off close to the cervix. Continue to dissociate up to the bladder to reflex the peritoneum. When the peritoneum is separated, the tissue is loosened, and the finger touch has a film sliding feeling. 5. Cut the bladder uterus reflexed peritoneum: Pull the bladder upwards, expose the reflexed peritoneal folds, cut it and extend it to both sides. A needle thread was sewn into the peritoneal margin to make a traction mark. 6. Incision of the posterior lip of the cervix: The cervical mucosa incision is extended posteriorly along both sides of the anterior lip of the cervix, and the entire cervical mucosa is cut open. Close to the posterior wall of the cervix to separate the cervix and vaginal mucosa until the uterus rectum reflexes the peritoneum. 7. Cut the uterus rectal fossa peritoneum: Cut the uterus rectal fossa to reflex the peritoneum and extend to both sides. A needle was sutured at the midpoint of the peritoneal resection for the traction mark. 8. Exposure of the uterine ligament and uterine ligament: the main ligament and uterine ligament are exposed on both sides and posterior to the cervix. 9. Treatment of uterine ligament ligament: pull the cervix to the upper side, expose the contralateral palpebral ligament, close to the cervical clamp, cut, sew, and keep the suture for later use. 10. Treatment of the uterine main ligament and uterine blood vessels: the cervical ligament is exposed by pulling the cervix to the opposite side. Close to the cervix from bottom to top, clamp, cut, suture the main ligament and uterine blood vessels, and retain the suture. Deep into the level of the uterus isthmus. 11. Treatment of round ligaments: Pull the uterus down to expose the round ligaments. The ligament was clamped 1 to 2 cm from the uterus, the round ligament was cut, and the suture was retained after the suture. 12. Treatment of uterine attachment: The uterus is pulled down to expose the broad ligament, fallopian tube and ovarian intrinsic ligament. Clamp, cut, and sew. The uterus can be removed after the same side is treated in the same way. 13. Check the ovary after removal of the uterus, check the size of each ligation stump and bilateral ovary, texture. 14. The stump tissue on both sides of the suture was sutured to the vaginal mucosa on both sides and the ipsilateral pelvic peritoneal margin, so that the stumps were embedded. 15. Suture the peritoneum and vaginal mucosa from one side through the anterior vaginal mucosa, the anterior and posterior margin of the peritoneum and the posterior wall of the vagina for continuous or intermittent suture, close the pelvic cavity and vagina. A sterile tampon is built into the vagina.

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