ligation surgery

Ligation surgery is divided into male ligation and female ligation. Female ligation is actually tubal ligation. Male plus surgery is also called vasectomy. Both male ligation and female ligation are both permanent contraceptive methods. This permanent contraceptive method is only suitable for couples who do not want to have another child. Treatment of diseases: fallopian tube cancer triad Indication There are two indications for the indication of female ligation: 1. A married woman gives birth to two births, or a couple who have a child and a child are willing to do so, and ask for a tubal ligation without contraindications. 2, suffering from a certain disease, such as heart disease, kidney disease, liver disease, severe anemia or mental illness is not suitable for childbearing, feasible therapeutic sterilization. Male ligation surgery indications: 1. Married men are undergoing family planning, and bilateral vasectomy is performed with the consent of both husband and wife. If there is chronic prostatitis, it can be treated after surgery to stabilize the condition; if there is chronic epididymitis and severe neurasthenia, other contraceptive measures should be taken. If there is testicular hydrocele, inguinal hernia or severe varicocele, surgery can be performed at the same time. Patients with scrotal skin disease should be treated after the cure. 2, due to other circumstances, the implementation of vasectomy. If one side of the epididymal tuberculosis is not expected to be born, the contralateral vas deferens can be ligated when the diseased side epididymis is removed to prevent the lesion from spreading to the contralateral epididymis. In the case of prostatic resection of prostate hypertrophy, in order to prevent postoperative epididymitis, bilateral vasectomy can also be performed. Contraindications Female ligation surgery contraindications: 1. Infection, including acute and chronic pelvic infections, abdominal wall skin infections, and surgery after the infection is cured. 2, the situation of the whole body is poor, can not tolerate the operator, such as postpartum hemorrhage and heart, liver, kidney and other diseases with dysfunction, should be treated after the general situation improved. 3. Severe neurosis. 4, within 24h, the body temperature twice more than 37.5 °C. Male ligation surgery contraindications: 1. Hemorrhagic disease, mental illness, severe neurosis, sexual dysfunction, acute or severe chronic disease. 2, acute or chronic inflammation of the genitourinary system, should be cured before surgery or other birth control measures. 3, scrotal skin acute or chronic inflammation, lymphedema or other skin diseases that hinder surgery, should be cured before surgery. 4, scrotal disease, such as inguinal hernia, hydrocele, varicocele, etc., should be cured after surgery, or vaginal scrotal surgery at the same time as vasectomy. Preoperative preparation Preoperative preparation for female ligation surgery: First, the operation time selection 1, non-pregnancy, 3 ~ 7d after menstruation is more appropriate. If there is a possibility of pregnancy beyond this period, try to avoid surgery before or during menstruation. {reproductive doctor 2, after the flow of people or take the ring, surgery can be immediately, or within 1 ~ 2d surgery, pathological abortion should be post-transfer surgery. 3, puerperium, such as delivery, the first day after delivery can be operated, dystocia or suspected infection may be hospitalized for 3 days, no abnormalities and then surgery. 4, those who have not been transferred during lactation, must rule out early pregnancy, for those who are suspected of pregnancy, should first be treated with scraping, and then sterilization. 5, mid-term pregnancy induction, surgery can be performed 24 hours after delivery. 6, cesarean section or other gynecological surgery, can be operated at the same time. Second, preoperative preparation 1, detailed medical history, physical examination and gynecological examination, strict control of indications and contraindications. 2. Do the ideological work of ligation objects and eliminate concerns. Especially for pure female households who have given birth to two children, we must focus on ideological work and eliminate their influence on surgical concerns, fear and traditional secularity, so that they can accept them happily. surgery. It is advisable for the husband and the elderly at home to support the operation of the surgeon who is required to have only one child to perform the ideological work and pre-operative preparation. 3, before the operation to clean the abdomen and vulva skin, shaving pubic hair, etc., the Umbilical wheel can be cleaned with a 75% ethanol cotton swab. 4. Give sedative and hypnotic drugs as appropriate before the operation to ensure adequate rest. 5, for procaine allergy test to prevent allergic reactions during local anesthesia. 6, fasting 4h before surgery or a small amount of diet. 7, for the gynecological examination for the posterior uterus, the surgeon is best to reset it to the anterior position, in order to facilitate the operation, the reset method has a manual and instrumental reset. The method of manual reduction is simple, and women have no discomfort. They are performed before or during surgery and are the most commonly used reset methods. Device resetting requires the use of a uterus device or a suction device, which is somewhat traumatic and rarely used in large-scale ligation. Third, anesthesia Local infiltration anesthesia or acupuncture anesthesia can be used. Generally, local infiltration anesthesia is often used. The method is simple and safe. 0.5% to 1% procaine 40ral is used in the incision site for local skin, subcutaneous, fascia, muscle sheath and peritoneal infiltration. Individual strainers can be treated. Before or during the surgery, add 50mg of cold and 0.3mg of scopolamine. Male ligation surgery preparation: 1. Explain to the operator, explain the importance of family planning, the physiological knowledge of male sexual function, and the safety, reliability and simplicity of vasectomy, and eliminate ideological concerns. 2, such as in rural housing surgery, need to have dust, fly-proof facilities. 3, acute and chronic infection of the urinary tract, scrotal skin disease and scrotal disease, to be cured and then vasectomy. 4, pay attention to the history of drug allergy, do procaine skin test. 5. Bathe before the operation, clean the vulva, and replace the cleansing pants. Shave the pubic hair before surgery. 6, prepare a blade, 5ml syringe, 1 small needle for skin test, 4 small gauze, 1 separate forceps separation pliers (with a mosquito-type curved hemostat to remove the clamp teeth, the tip sharpened), a vas deferens fixed clamp 1 (Or use a straight hemostatic forceps to grind the jaws, the end thickness is 1.2mm, bend into a circular hole with an inner diameter of 2mm and an outer diameter of 3.5mm. You can also narrow the front end of the tissue clamp and keep two teeth.) Put (sharp the wire, bend it into a hook, and put it on the handle.) 7. Cut or shave the pubic hair, wash the penis and scrotum with soapy water for 5 minutes, and disinfect the skin with a 1:1000 benzalkonium solution 3 times before surgery. Surgical procedure Female ligation surgery: Abdominal tubal ligation 1. During surgery, the patient will enter the general anesthesia state. The surgeon will make a small incision in the patient's abdomen and place the endoscope into the abdomen for surgery. The fallopian tubes on both sides will be cut and ligated, and the abdominal wounds will be sutured. The patient was discharged from the hospital several hours after surgery. 2. Fallopian tube ligation can be performed immediately after delivery. Most patients recovered well. It is not suitable for too much exercise within a few days after surgery. If the wound has pain, just take some painkillers orally. After a few days, the patient can go to work, and they can be in the same room after one week. Vaginal fallopian tube ligation First, the vaginal forehead incision 1. Put the weight vaginal speculum or right angle hook into the posterior wall of the vagina, and clamp the center of the anterior lip of the cervix with a cervical forceps or double-jaw forceps. 2. Empty the bladder with a metal catheter to determine the position of the bladder and understand the lowest position of the bladder. 3, in the vaginal anterior wall of the bladder groove 0,5cm transversely cut 3cm, deep into the submucosal loose connective tissue. 4. At the incision of the vaginal mucosa, use the shank to push gently along the cervix to separate the bladder from the cervix. The finger can also be used to bluntly separate the bladder from the cervix. 5. After the bladder is separated from the cervix, the peritoneum is exposed and clamped with two long vascular clamps. The peritoneum is cut or cut in the two forceps. 6. Insert the two fingers into the anterior sacral incision of the vagina, enlarge the peritoneal incision, or cut the peritoneum slightly to the sides, then suspend the peritoneal edge with a silk thread to prevent retraction. Second, the vaginal posterior incision 1. After putting the vaginal speculum or right angle hook into the vagina, use the cervical clamp to clamp the center of the posterior lip of the cervix and pull it forward and upward to fully expose the posterior iliac crest. 2, vaginal mucosa after slashing and cutting, connect the loose connective tissue under the mucosa. 3, blunt separation of loose connective tissue, to the uterus rectal fossa peritoneal reflex, the long vascular clamp extraction of the peritoneum and incision of the peritoneum. Third, looking for fallopian tubes 1. Direct extraction of the fallopian tube method: If the anterior sacral approach is sought, after the peritoneum is incision, the deep right angle pull hook is pressed against the anterior wall of the uterus, and the cervix is pulled downward. Since the uterus is backward, the position of the fallopian tube is relatively slightly forward so that Looking for. If you look into the pelvic cavity after the incision, before the incision, the uterus is turned into the posterior position, the posterior lip of the cervix is pulled upwards, and after the peritoneum is opened, the fallopian tube is seen near the uterus rectum, with long braids or no The ovate round forceps directly take the fallopian tube. 2, fallopian tube hook method: use the fallopian tube hook close to the anterior wall of the uterus (after the incision along the posterior wall) to reach the end of the uterus, sliding to the direction of the fallopian tube, equivalent to the middle of the fallopian tube, down to the fallopian tube. 3, ask to take the fallopian tube method: If you can not find the fallopian tube by the above two methods, you can use the left hand and the middle finger to reach the pelvis and touch one side of the ovary. After pulling out the ovary, you can find the fallopian tube around the ovary (such as For the anterior ankle incision, first find the round ligament and then find the fallopian tube). 4, gauze strip extraction method: If the subject is more obese, the vagina is deeper, it is more difficult to find the fallopian tube, a piece of gauze strip can be pushed against the uterus body to the side attachment, and slightly above it, from the attachment one The gauze strips are gradually pulled out under the side, and most of them can lead to the fallopian tubes. Fourth, check the ovary and umbrella end. 5. Ligation 1, double tie method 2, double fold ligation method. 3. Umbrella end cutting method. Six, inventory equipment Seven, close the abdominal cavity. Male ligation surgery: 1, position In the supine position, the two lower limbs are slightly separated. 2, fixed vas deferens Pull one side of the testicle gently downwards to tighten the spermatic cord into a straight line. The vaginal canal is fixed by the three-finger method, that is, the surgeon uses the left middle finger and the thumb to pinch the vas deferens, the middle finger is topped, and the finger is pressed down, so that the vas deferens is firmly fixed on the superficial superficial surface of the upper part of the scrotum. 3, local anesthesia Use 0.5% to 1% procaine to fix the anterior wall of the scrotum at the upper part of the scrotum. There is no obvious blood vessel at the anterior wall of the scrotum. Make a 1cm diameter ridge. Then close the needle and pierce it along the vas deferens. Inject 1~3ml of anesthetic solution. So that the anesthetic solution is infiltrated along the circumference of the vas deferens to achieve the effect of the closed loop of the spermatic cord. 4, separate incision Use a sharp knife or vas deferens to separate the forceps of the forceps, puncture the skin from the local anesthesia needle, and then puncture it into the direction of the vas deferens, directly to the fixed vas deferens, separate the small holes and enlarge the holes to 0.3-0.5cm to separate Skin, meat film, fascia of each layer and fascia around the vas deferens. 5, clamp the vas deferens Insert the vas deferens fixed forceps from the separated scrotal skin hole until the vas deferens, after the fixed forceps touch the vas deferens, open the clamp ring in the vertical position, use the left middle finger to push the vas deferens into the ring, fasten the forceps handle, and cover the vas deferens Together with some of the fascia tissue, the vas deferens is gently lifted out and turned outside the incision. 6, the vas deferens Use a sharp knife or a separation forceps to puncture the vas deferens to the wall. Carefully separate the film to reveal a white smooth vas deferens. The vas deferens is then used to hook the vas deferens through the wall of the tube and present it outside the vasectomy of the vas deferens. 7, separate vas deferens Use a separating forceps to close the vas deferens and peel off the attached tissue. When a small gap is separated, the tip of the forceps is passed through, and the tip of the forceps is slowly opened in parallel with the vas deferens. The length of the free vas deferens is about 1.5 to 2.0 cm. 8, seminal vesicle perfusion The needle is inserted into the vas deferens with an injection needle, and the spermicidal drug is slowly injected into the seminal vesicle. The commonly used one is 10,000 phenylmercuric acetate 2 to 3 ml. 9, ligating the vas deferens Gently press the ligature tube at one end of the ligature, ligature it with a medium thread, cut the vas deferens, clamp the vascular tube at the opposite end, check the ligation end without bleeding, cut the short tail, and then clamp with the vascular clamp The vas deferens fascia next to the broken end lifts it up and the vas deferens ligature is retracted downward. Then, at the appropriate part of the unligated end, the vas deferens was gently pressed with a vascular clamp, and the spermatic fascia lifted by the medium wire at the press site and the opposite end was indeed ligated, and the long tail was retained, and the excess vas deferens was cut out by about 1 cm. In this way, the contralateral vas deferens are embedded in the fascia, so that the two ends are isolated to prevent recanalization. Temporarily place the vas deferens in the scrotum. 10, the same method of ligation of the contralateral vas deferens. 11, also the vas deferens Lightly lift the long tail line of the first vasectomy tube, reveal the vasectomy tube, carefully check that there is no bleeding, cut the short tail, gently pull the testicle down, return the vas deferens to the scrotum, and reset it. The same method also returns the contralateral vas deferens. 12, closed the incision Stitch 1 stitch at the rupture, or use a forceps to press the rifle clamp closed, or use your fingers to squeeze the rupture. complication Post-operative complications of female ligation: 1. Incision infection: Surgical vision is not adequately prepared for the skin. Most of the subjects are from rural areas. There are few bathing opportunities, poor personal hygiene, and many skin dirt. Simple disinfection often fails to achieve the purpose of sterilization. difference. 2, postoperative hematoma: the surgeon only pursues the speed, the osmotic blood of the tight muscle layer is not treated with hemostasis, and the extravasation of the muscle layer after the operation causes blood in the incision and affects the healing of the knife edge. Complications after male ligation: 1. Bleeding after ligation. 2. Incision infection and inflammation of the reproductive system. 3, painful nodules. 4, epididymal deposition disease.

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