Conservative surgery for tubal pregnancy

Conservative surgery for tubal pregnancy is used for surgical treatment of ectopic pregnancy. The implantation of pregnant eggs outside the uterine cavity is collectively referred to as ectopic pregnancy, also known as ectopic pregnancy, which is a common gynecological disease, and its incidence has increased in recent years. In terms of the implantation site of the pregnant egg, it can be divided into tubal pregnancy, ovarian pregnancy, abdominal pregnancy, residual uterine pregnancy, cervical pregnancy and the like. Among them, tubal pregnancy is more common, accounting for 95% to 97%. In tubal pregnancy, pregnant eggs can be implanted in any part of the fallopian tube, such as umbrella end, ampulla, isthmus, interstitial and so on. Among them, ampullary pregnancy is more common. Treatment of diseases: tubal pregnancy Indication 1, tubal pregnancy, fetal sac is not large, not ruptured, or broken or abortion type no active bleeding or less bleeding. 2, the contralateral fallopian tube has been removed, no healthy children, hope to have children. 3. The embryo implantation site is at least 2 cm away from the uterine horn. 4. It is estimated that the fallopian tubes retained after surgery are at least 4 cm long. Contraindications 1, the fallopian tube pregnancy rupture, severe damage, there are signs of shock. 2, the pelvic and fallopian tubes have obvious inflammation and adhesions, and the function of the fallopian tubes is poor. Preoperative preparation 1. Determine the diagnosis by medical history, physical examination, B-ultrasound, laboratory tests, etc. 2. Prepare the operating microscope, electrocautery and non-invasive suture. Surgical procedure 1. Cut the abdominal wall: Make a median longitudinal incision between the umbilicus and cut the abdominal wall according to the layer. 2. Use the tissue forceps to lift the muscular layer of the fallopian tube at both ends of the lesion, and cut it along the longitudinal wall of the tube to reach both ends of the lesion. 3, the tube endodermal sac or blood clots are squeezed out, sometimes using a knife handle to help strip, and some still need to gently scrape. Use fine head electrocoagulation to stop bleeding or pressure to stop bleeding. 4, the muscle wall of the wall, serosal layer, with 4-0 ~ 7-0 without damage to the intestinal line suture. Do not suture the mucosal layer. It can also be sutured without II suture. 5, fully wash the pelvic cavity to prevent infection and adhesion. If the tubal isthmus is narrow, the wall is thin, or the fallopian tube has been ruptured, a segment of the fallopian tube of the ectopic pregnancy or a segment of the fallopian tube that has been ruptured can be removed, and then the end-to-end anastomosis is performed. Generally, the proximal and distal ends of the fallopian tube must be confirmed. It is advisable for the end section to perform this operation. The end-to-end anastomosis can be performed with an 8-0 nylon thread and sutured 4 needles at 3, 6, 9, and 12 points, passing through the serosa and muscle layers without passing through the mucosal layer. complication Postoperative tubal stenosis, adhesion or blockage, resulting in secondary ectopic pregnancy or infertility.

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