myomectomy

Large myoma is located in the anterior and posterior wall of the uterus, and the myometrial fibroids are removed by vaginal hysteromyoma. It is ideal if the uterus volume is less than 14 weeks of gestation or the uterine fibroids are less than 10 cm in diameter. Open surgery should be performed for patients with multiple fibroids and fibroids who have a large history of pelvic surgery and have severe pelvic adhesions and associated tumors. Laparoscopic surgery is more suitable for single-shot or small-volume subserosal fibroids. Indication 1. Single or multiple uterine fibroids affect fertility. 2. Uterine fibroids cause menstrual disorders, dysmenorrhea. 3. Cervical fibroids need to retain fertility. Preoperative preparation Cervical smear and diagnostic curettage were performed before surgery to exclude cervical and uterine malignant tumors. Surgical procedure 1. Incision in the inferior median incision or pubic symphysis combined with a transverse incision 2. Explore the location, size, and number of uterine fibroids to determine the uterine incision. 3. Block the uterine blood supply before the removal of the uterine body fibroids, in the uterine isthmus, the left and right side of the broad ligament avascular zone for each small mouth, through the rubber tube tourniquet, bundle the uterus, veins, temporarily block its blood supply. If the operation time is longer, relax the tourniquet for 1 min every 10 to 15 minutes. At the time of surgery, uterine contractions can also be injected into the myometrium to reduce intraoperative bleeding. 4. The interstitial myoma is removed from the surface of the fibroid with less blood vessels. The size of the fibroids is longitudinal, fusiform or curved incision, deep into the fibroid envelope, and bluntly separated along the surface of the capsule to the base. When there are many blood vessels, the tumor can be cut out after clamping and the stump can be sewed. Use the absorbable line to "8" or suture the muscle layer 1 to 2 layers. Take care to avoid dead space when sewing. The sarcoplasmic layer is sutured with No. 0 absorbable line or continuous suture. For multiple fibroids, multiple fibroids should be removed from one incision as much as possible. Close to the corner of the palace, the incision should be as far as possible from the corner of the palace, so as to avoid postoperative scars affecting the fallopian tube. 5. Subserosal fibroids removal of such fibroids often with pedicles, can be attached to the uterine wall to clamp the tumor pedicle, remove fibroids. When the tumor pedicle is wide, a fusiform incision can be made at the base to remove the superficial muscle layer of the fibroids and the pedicle of the uterus. 6. Submucosal myoma resection If the fibroids protrude into the uterine cavity, it is necessary to enter the uterine cavity to remove the tumor. When suturing the muscular layer, the mucosal layer should be avoided to prevent the endometrium from being implanted into the muscular layer and artificially causing endometriosis. Submucosal fibroids with pedicles can be removed by the vagina. 7. Cervical myoma removal should understand the relationship between fibroids and bladder, rectum and ureter. For cervical anterior wall fibroids, first open the bladder to reverse the peritoneum, sharply separate the bladder to the lower edge and lateral edge of the fibroid, cut the anterior wall tissue of the cervix to the surface of the tumor, bluntly separate to the base along the tumor capsule, clamp , the removal of fibroids, stump suture. The cervical muscle layer was sutured with an absorbable thread in an "8" shape or a continuous suture of 1 to 2 layers, and the bladder peritoneal reflex was sutured. If it is a posterior wall of the cervix, the cervix-rectal space should be opened to reverse the peritoneum, push the rectum, and then remove the fibroids. For large cervical fibroids, open the posterior lobe of the broad ligament, find the ureter, cut the ureteral tunnel if necessary, free the ureter, and then remove the myoma. 8. Close the layers of the abdominal wall by layering the abdomen. complication Injury: The damage of fibroid resection is more common in cervical fibroids and broad ligament fibroids. As the tumor is gradually enlarged here, the uterine blood vessels and ureters can be displaced. According to the location of the tumor and its growth direction, the ureter can be pushed to the caudal side, the lateral side, or even the cephalad, and is elongated and flat, which is very different from the normal ureter. If it is not noticed, it is easy to be injured.

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