Transabdominal hemiextraperitoneal hysterectomy

Transabdominal semi-peritoneal hysterectomy for surgical treatment of uterine fibroids. Treatment of diseases: uterine fibroids Indication Transabdominal semi-peritoneal hysterectomy applies to: 1. Factor uterine fibroids or other benign uterine diseases require removal of the uterus, and severe adhesion around the cervix, routine removal of uterine difficulties. 2. Young women with benign uterine diseases need to remove the uterus. Contraindications 1. Same as intraperitoneal hysterectomy. 2. The uterus is over 12 weeks pregnant. 3. The pelvic adhesions are severe. Preoperative preparation 1. Prepare with the general gynecological abdominal surgery. 2. Cervical scraping to check cancer cells. 3. Menstrual disorders and patients under the age of 50, should be diagnosed curettage before surgery, a comprehensive understanding of the uterus, except for endometrial lesions to determine the ovarian retention. 4. On the 3rd day before surgery, the vagina was perfused with disinfectant (1:1000 benzalkonium chloride or 1:5000 furancillin solution) daily. Make a vaginal swab culture if necessary. Surgical procedure 1. Abdominal wall incision A midline incision or a transverse incision was made in the lower abdomen, and the skin, subcutaneous fat, and rectus abdominis anterior sheath were incised, and the preperitoneal space was exposed. 2. Isolation of the peritoneal bladder space With extraperitoneal cesarean section, side entry or insertion can be used. The bladder fascia was cut transversely 1 to 2 cm below the top of the bladder, deep into the bladder muscle layer, and the incision was extended to both sides. The upper edge of the bladder fascia is lifted with forceps, and the bladder is separated and pushed down, first separated upward to reach the top of the bladder, and then separated downward to reach the peritoneal reflex of the bladder. Here, the umbilical ligament and the umbilical ligament are seen, and the thickness of the tissue is cut and sewn. 3. Incision of the peritoneum The incision was made at the midpoint of the bladder peritoneal reflex, and the incision was enlarged to both sides to the size of the uterus. 4. Remove the uterus and accessories The finger enters the abdominal cavity to remove the uterus from the peritoneal reflex incision, and the peritoneal incision is moved to the posterior uterus. 5. Treatment of ligaments and uterine blood vessels According to the condition, the ligaments, pelvic funnel ligaments, uterine arteries and veins were cut and sutured, and the ligature was pulled. 6. Cut the posterior lobe of the broad ligament After cutting the broad ligament at the level of the uterine fibular ligament, the rectum is pushed down to the external uterus. 7. Close the abdominal cavity The peritoneum was closed before and after the cervix was sutured continuously with a 4th wire. The stumps of each accessory were placed outside the peritoneum. 8. Treatment of uterine fibular ligament, main ligament, and removal of the uterus. 9. Guan abdomen The bladder was repositioned and the layers of the abdominal wall were routinely sutured.

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