Laparoscopic Conservative Surgery for Endometriosis

Conservative surgery for laparoscopic endometriosis, the main advantage is that no laparotomy, less tissue damage, rapid recovery after surgery, pregnancy rate is not lower than laparotomy. The main problem is that the exposure is not complete, and the possibility of deep lesions is large; the patients in the advanced stage are not suitable; the laparotomy is still needed after the symptoms are aggravated in the future. Treating diseases: endometriosis Indication 1. Same as conservative surgery for endometriosis in laparotomy. 2. The disease period is not too late, and there are still conditions to restore fertility. 3. Willing to cooperate and continue to receive treatment after surgery. Contraindications 1. Age greater than 35 years old, or abnormal ovarian function, such as long-term amenorrhea, no ovulation function. 2. The lesion is excessively extensive, and the surrounding tissue is infiltrated severely, and the frozen pelvis or pelvic adhesion is tight. 3. The ovarian door is invaded, it is impossible to restore normal blood supply; or the bilateral chocolate cysts are larger than 15cm in diameter. 4. With serious heart, lung, liver, kidney and other diseases, not suitable for childbearing. Preoperative preparation 1. Make a comprehensive assessment of the patient's fertility, including related endocrine tests, diagnostic curettage, etc. 2. If necessary, perform cystoscopy or fiber colonoscopy to rule out the invasion of the lesion. 3. Critically ill patients should be aware that the sigmoid colon and rectum may be involved, and should be prepared for intestinal cleansing before surgery. If there is a suspected ureteral adhesion or compression, a renal map (isotope) examination or pyelography should be performed; a ureteral catheter and a catheter should be placed half an hour before surgery. 4. If the lesion is serious, it is estimated that it is not easy to separate. Before use, high-efficiency progesterone, danazol or GnRH-a can be used for 3 months to soften the lesion, and the adhesion is easy to decompose and reduce bleeding, but it is not suitable for taking too long, resulting in lesions. The boundaries are unclear and easy to miss. 5. While doing diagnostic laparoscopic surgery, it is very likely that some cosmetic surgery under the microscope should be done by the way, and should be prepared mentally and on the instrument. Surgical procedure 1. Inflate according to the routine and place it into the laparoscope, carefully observe and define the extent of the lesion. Under the laparoscope, the special micro-scissors are used to separate the adhesion, and the non-vascular area is directly cut. The vascular area is cut by a special suture. 2. Use laser or bipolar coagulation to burn the lesions of the uterine ligament and other parts. 3. Prick the needle into the chocolate sac, suck out the chocolate-like contents, rinse it with physiological saline, and then inject 95% absolute ethanol or 10% carbolic acid, keep it for 10-30 minutes, then aspirate it, then rinse the capsule with normal saline. This method is safe and easy. The effect of adding drugs after surgery is better. The chocolate sac can also be peeled off under laparoscopy. Oral administration of danazol or GuRH-a for 3 to 6 months. 4. If the uterus is tilted backward, the round ligament shortening can be done to keep the uterus in the forward tilt position. complication 1. Organ damage is most likely to damage the internal organs when the pneumoperitoneum is insufficient and the exposure is not clear. 2. When the artificial pneumoperitoneum is too fast and the CO2 intake is too large, the diaphragm may rise, the vagus nerve is excited, the patient has chest tightness, difficulty in breathing, and even blood pressure drops. At this time, the position is flattened, and the hip height is lowered. CO2 is concentrated in the pelvic cavity, sucking O2, and the operation is continued after the sputum is improved.

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