Transvaginal tubal ligation

Transvaginal tubal ligation is a family planning operation. Family planning surgery includes birth control, sterilization and re-pregnancy surgery. Commonly used in birth control surgery are intrauterine device placement and removal, early pregnancy abortion and mid-term pregnancy termination. Sterilization is the use of surgical methods to block fertility to achieve permanent contraception, women commonly used tubal ligation. Re-pregnancy is a kind of surgery that belongs to the family planning category because of the infertility caused by obstruction of the fallopian tube or the need for re-fertility due to some reasons after tubal ligation. Surgery requires less pain, safety, reliability, side effects, and is easily accepted. Therefore, the indications must be strictly controlled. The operation requirements are based on the principle of quasi-light, thin and fine, to minimize tissue damage and reduce complications. Curing disease: Indication Transvaginal tubal ligation is applicable to: 1. A married woman is required to be a sterilization. 2. There is a infection in the abdominal wall or a serious skin disease is not suitable for abdominal incision. 3. Those who have concerns about abdominal surgery. 4. Those who are not suitable for childbirth due to systemic diseases or certain genetic diseases. Contraindications 1. Systemic diseases cannot be loaded on the operator. 2. There are infected lesions or severe skin diseases on the abdominal wall. 3. Within 2 hours, the body temperature is above 37.5 °C. 4. Patients with severe neurasthenia and neurosis, emotional instability, and serious concerns about surgery. 5. Pelvic tumors, inflammation, adhesion diseases and a history of pelvic surgery. 6. Vulvitis, vaginitis, severe cervical erosion. 7. puerperium. 8. The pelvic outlet is narrow or the vagina and perineum are too tight. Preoperative preparation 1. The choice of operation time for non-pregnancy women can be done at any time, usually 3 to 7 days after menstruation, if the menstrual period or the second half of menstruation should exclude pregnancy, and at the same time for curettage. Surgery can be performed simultaneously after abortion or removal of the IUD. After spontaneous abortion and expired abortion, you need to wait for the next menstrual period. After normal delivery or mid-term induction of labor, if there is no abnormality in the puerperium, the operation can be performed after 24 hours. After dystocia, it is necessary to observe the operation for 3 to 4 days. Cesarean section, small cesarean section and other gynecological operations can be performed at the same time. 2. Inquire about the history of the whole body and gynecological examination in detail, test blood, urine routine, clotting time, chest penetration if necessary. 3. Procaine allergy test. 4. The genitals are prepared for skin. 5. Soap water enema once a day before surgery. 6. Fasting a meal before surgery. 7. After menstruation, the surgeon washes the vagina 2 to 3 times before surgery. 8. Artificial abortion at the same time, the operator first, then do abortion and then re-sterilize the towel. Surgical procedure 1. Vulva, vagina routine disinfection, toweling. 2. The double-leaf vaginal speculum expands the vagina, and then disinfects the cervix, cervical canal and vaginal fistula with iodine and ethanol. 3. Incision. (1) anterior vagina incision: suitable for anterior and anterior flexion of the uterus, with a heavy hook or right angle hook to pull the posterior vaginal posterior wall, use a right angle vaginal pull hook to open the anterior wall of the vagina to the cervix Clamp the anterior lip of the cervix, pull it outward and downward, expose the anterior iliac crest, catheterize the catheter with a metal catheter, empty the bladder, determine the lowest point of the bladder at the cervix, and make a transverse incision about 1.5 cm below it. It is about 3cm long and reaches the submucosal loose connective tissue. It can also be injected subcutaneously with 5-10ml of normal saline containing 5-10U oxytocin or 1:1000 adrenaline before incision to reduce bleeding, submucosal tissue and cervix. The front fascia is also easily peeled off. Use the shank to push up along the cervix, separate the bladder from the cervix, and then use the pointing upwards to completely separate the bladder from the cervix and expose the peritoneum. At this time, the subject coughs, and the abdominal peritoneum can be seen with a slight abdominal pressure. Bulging, moving, clamping the peritoneum with 2 vascular clamps, and cutting the peritoneum between the two clamps, confirming that the peritoneum has been cut, clamping the anterior and posterior edges of the peritoneum, and then to the two The lateral extension of the incision was about 3 cm in length, and a 4th silk thread was used as a traction in the front and back of the peritoneum to prevent retraction. (2) vaginal posterior sacral incision method: suitable for uterine posterior tilting, posterior flexion, dilating the vagina, clamping the posterior lip of the cervix with cervical pliers, pulling the cervix forward and upward, pulling the vaginal posterior wall pull back to the lower, full After exposure, at the junction of the cervix and posterior sacral mucosa, the transverse incision is about 3 cm long, and the submucosal loose tissue is bluntly separated until the peritoneal reflex of the uterus rectal fossa is exposed. The peritoneum was cut about 3 cm between the two forceps. 4. Extract the fallopian tube and use a single-leaf hook or a right-angled hook to open the incision to expose the uterus, and take it out by direct tube or hook tube method. 1 direct tube removal method: the anterior ankle incision moves the uterus to the forward tilt position, and the posterior malleolus incision pushes the uterus body to the posterior tilt position, and clamps the uterus to the uterine horn with the non-toothed round forceps or the non-toothed long scorpion. Take the fallopian tube. 2 hook tube method: use the fallopian tube hook to stick to the anterior or posterior wall of the uterus to the end of the uterus and slide to the direction of the fallopian tube, which is equivalent to the middle part of the fallopian tube. The lower part of the fallopian tube can be used to refer to the fallopian tube. 5. Ligation of the fallopian tube due to the small field of surgery, the operation is a little difficult, mostly using folding, ligation, shearing or umbrella-end resection method, the end of the umbrella removal method has a high failure rate, can be stitched at the proximal end, the spacing between the two needles is not More than 0.3cm in case of effusion in the future. 6. Suture the peritoneum continuously or intermittently with a 2-0 gut or a 1st wire. 7. 2-0 gut sutured vaginal mucosa. complication 1. Bladder and rectal injury. 2. Pelvic infection.

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