Radical Surgery for Pelvic Endometriosis

Radical surgery refers to the operation of removing the uterus, attachments and all lesions. Treating diseases: endometriosis Indication 1. Nearly menopause. 2. Because the lesions are extensive, involving important organs can not be removed, the ovaries must be removed to atrophy the lesions, to achieve pain relief and to protect organs. 3. The ovary is severely damaged, unable to retain normal ovarian tissue, or the blood vessels of the ovary are damaged, unable to maintain blood donors. 4. Those with other ovarian lesions, or malignant tumors, must be removed. If the patient is still young, the benign tumor can still be stripped. 5. Patients with uterine adenomyosis. Contraindications No special contraindications. Preoperative preparation 1. Make a comprehensive assessment of the patient's fertility, including related endocrine tests, diagnostic curettage, etc. 2. Do laparoscopic examination as much as possible to determine the stage of the disease, and have a preliminary understanding of the distribution and adhesion of the lesion. 3. If necessary, perform cystoscopy or fiber colonoscopy to rule out the invasion of the lesion. 4. 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. 5. 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. Surgical procedure 1. The incision takes the midline incision of the umbilical cord, which is about 12-15 cm long. To fully expose the surgical field, the lower end of the incision should reach the upper edge of the pubic symphysis. 2. Explore the pelvic cavity to understand the distribution of all lesions, separate the adhesion of the uterus, fallopian tubes, ovaries and surrounding tissues, and restore their natural anatomical position as much as possible. 3. Separate the adhesion between the posterior uterus and the rectum until the uterus rectal fossa exposes the lesion. 4. Same as the hysterectomy attachment removal section. 5. Careful examination and removal of endometriotic lesions, as with conservative or semi-conservative surgery. complication 1. Postoperative prone to symptoms of climacteric syndrome, can be given medication, with caution in the use of estrogen to prevent recurrence. 2. Due to the severity of the disease, the peeling surface is wider. In the 2 to 3 months after surgery, some intestinal obstruction symptoms may occur due to intestinal adhesions. Symptomatic therapy should be used. If the complete intestinal obstruction is ineffective, the conservative treatment is invalid. Open laparotomy is required.

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