Abdominal uterine suspension

Abdominal wall uterus suspension for surgical treatment of uterine prolapse. Abdominal wall uterus suspension is one of the methods to correct the uterus backward tilt. Because the uterus is pulled forward and upward, close to the abdominal wall, it can correct the uterine prolapse. However, if the bladder and rectum are bulged, the anterior and posterior walls of the vagina must be repaired at the same time Treating diseases: uterine prolapse Indication 1. Mild uterine prolapse, young and hopeful women, should use round ligament suspension. 2. Middle-aged and elderly people who do not need to have birth, uterine prolapse and vaginal wall bulging is not serious, it is best to use abdominal wall fixation. Contraindications 1. Poor general condition, such as severe heart disease, hypertension, nephritis, diabetes, cirrhosis, liver damage, active tuberculosis, pulmonary insufficiency, long-term cough, mental disorders, malignant tumors, bleeding disorders and severe anemia It is not suitable for surgery, and then consider it after improvement. 2. Vulvitis, vaginitis (trichomoniasis, fungi or senile), severe cervical erosion or pelvic inflammatory disease, etc., should be administered after control. 3. Cervical and/or vaginal ulcers are not suitable for surgery when they are not healed; if the ulcer is superficial and located within the resection range, surgery may also be performed. 4. Patients with malignant lesions in the cervix or uterus. It is not suitable for uterine prolapse surgery. Cervical carcinoma in situ or very early uterine body cancer, may be considered for vaginal removal of the uterus, repair the anterior and posterior wall of the vagina. 5. It is not suitable for surgery during menstruation, pregnancy and lactation. After 3 to 7 days of menstruation, the incision will be healed before the next menstrual cramp. If surgery is performed during pregnancy, the possibility of recurrence of uterine prolapse is high. The tissue is weak during lactation, the suture is easy to cut, easy to bleed, and the infection is easy to spread. Preoperative preparation 1. Eat eutrophic, digestible diet, 2d less slag diet before surgery, a small amount of pre-operative dinner, and breakfast on the day of surgery to avoid vomiting during surgery. 2. Start 3 days before surgery, gently scrub the vaginal wall with soapy liquid every day, then rinse with water, then rinse with 1:1000 Xinjieer liquid and dry the vaginal wall. 3. Clean the enema before the operation. 4. Prepare the skin 1 day before the operation. The preparation range includes the pubic symphysis, the genital area, the upper third of the upper thigh and the lower part of the thigh and the anus. It is estimated that the operation is difficult, and the abdominal surgery is required. 5. The preparation of the surgical field is based on the xiphoid process, and the pubic symphysis is released. The two sides are connected to the midline of the iliac crest, and the vulva and the inner thigh are added. The liquid is cleaned with soapy liquid, shaved, and the dirt and dirt of the umbilicus are wiped off with gasoline. Surgical procedure Abdominal wall fascia ligament suspension fixation (1) From the midline of the umbilicus, the abdominal wall is cut layer by layer, and the incision is about 8 to 10 cm long. The uterus is removed by hand into the pelvic cavity. (2) The round needle is threaded through the serosa of the lower edge of the round ligament, and the puncture point is about 4 to 5 cm from the uterine horn. (3) At the inner ring corresponding to the inguinal region, the outer edge of the rectus abdominis is freed with a shank. (4) Using a large curved hemostat to penetrate the peritoneal cavity along the outer edge of the rectus abdominis, to reach the peritoneum near the inner ring of the inguinal region, open the clamp head, and cut a small incision between them. Pliers into the abdominal cavity, clamp the end of the line on the round ligament, pull out the abdominal cavity, so that the round ligament is under the fascia. (5) Tighten the round ligaments on both sides so that the uterus fits close to the anterior abdominal wall, and the top of the double pleats of the round ligaments are sutured under the fascia of the rectus abdominis with silk thread, and two or three stitches are sewed on both sides of the double pleats. (6) After the operation is completed, the uterus is seen in the abdomen and rises to the top of the pelvis and is suspended from the anterior abdominal wall. (7) With the No. 0 chrome gut or the No. 4 silk thread, the posterior surface of the cervix ligaments on both sides will be closed together for 2 to 4 stitches to shorten the uterine ligament and strengthen the anterior tilt of the uterus. (8) suture the abdominal wall layer by layer. 2. Abdominal wall uterus fixation (1) Incision in the midline of the umbilicus, about 8 to 10 cm in length, the abdominal wall is cut layer by layer, the abdominal cavity is exposed, and the uterus is taken out. (2) On the anterior surface of the uterus, a knife is used to make a rough surface, about 4 cm × 2 cm. (3) Three 8-word sutures were ligated on the rough surface with a No. 4 silk thread. The 8-word suture ligatures on both sides pass through the peritoneum, rectus abdominis and fascia on each side and are ligated. Two middle sutures were ligated and ligated through the bilateral peritoneum, rectus abdominis and fascia, and then ligated after peritoneal and fascia suture. Or use a round needle with a 7-gauge thread, through the fascia, rectus abdominis and peritoneum, across the muscular layer of the rough surface of the uterus, and then through the contralateral peritoneum, rectus abdominis and fascia. A total of 3 lines are worn in the upper middle and lower, with a spacing of 1 cm, and the lower line should pass through the lower part of the palace. After suturing the peritoneum and fascia, the 3 lines were ligated separately. (4) suture the abdominal wall layer by layer. complication 1. Frequent urination, low fixation of the uterus, and difficulty in filling the bladder. 2. Lower abdominal discomfort, falling, traction pain, lower abdomen depression, etc., caused by high fixed position of the factor palace. 3. Recurrence, adhesion of the factor palace to the peritoneum, rectus abdominis and fascia is not strong.

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