Transvaginal myomectomy

The advantage is that the uterus is retained, the ovarian function is not affected, and there is a chance of pregnancy for those who have fertility requirements. The disadvantage is the risk of uterine rupture during pregnancy and childbirth. Treatment of diseases: uterine sarcoma uterine fibroids Indication Patients under the age of 35 who are eager to have uterine fibroids; those who are 40 years of age or older are strongly urged to retain the uterus; those who need to correct menstrual disorders and pain caused by fibroids. It is suitable for submucosal fibroids with pedicle of the cervix or pedicle of the uterus and the lower pedicle attachment. Contraindications Pelvic malignant lesions (except early onset carcinoma in situ), endometriosis and pelvic inflammatory disease with extensive pelvic adhesions, larger and lower cervical fibroids, broad ligament fibroids, with larger and cohesive Attachment mass (>6cm diameter), the height of the fundus is higher than the umbilicus, and the vagina is extremely narrow. Preoperative preparation Cervical smear and diagnostic curettage were performed before surgery to exclude cervical and uterine malignant tumors. Surgical procedure Surgical procedure: bladder lithotomy position, vulva and vagina routine disinfection, catheterization; single-leaf hook to dilate the vagina, expose the tumor; use hand to rub the tumor pedicle, clamp the tumor with the uterus double-claw clamp, gently pull outward; If the tumor pedicle is thinner, the tumor can be reversed until the tumor pedicle naturally falls off; if the tumor pedicle is thicker, the toothed hemostat can be used, the tumor pedicle is clamped at the root of the tumor pedicle, the fibroid is removed, and the gut is sutured with No. 0. Tie the tumor. The hemostatic forceps can also be left for 24 hours and then released. Note that the catheter is indwelled at the same time until the hemostat is removed. complication Treatment of fibroids and treatment of residual cavities: Large intermuscular fibroids should be carefully treated during the stripping operation. When approaching the uterine mucosa, try not to break into the uterine cavity. When suturing the residual cavity, the suture should be close to the mucosa. Lower layer, avoid entering the uterine cavity. To prevent postoperative infection or endometriosis. Bleeding: There is a blood vessel that nourishes the fibroids in the connective tissue in the pseudocapsular of the fibroid. After the fibroids are removed, the bleeding points in the pseudocapsule are carefully sewed. If the wound surface oozes, you can use the hot saline gauze to stop bleeding, or the muscle wall to inject oxytocin (oxytocin) 10U to reduce bleeding.

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