giant cervical tumor hysterectomy

Cervical fibroids are a special type of uterine fibroids. Due to the lack of clinical symptoms, they are difficult to diagnose when they are small. When they are found, the fibroids are often large, and the diameter is more than 10 cm. The incarceration is in the pelvic cavity or the vagina, which brings difficulties to the operation. Due to the complex anatomical relationship around the cervix, it is easy to cause bladder, ureter or rectal injury during surgery. Treatment of diseases: uterine malignant mesodermal mixed tumor uterine fibroids Indication Uterine fibroids with a diameter of more than 10 cm and incarcerated in the pelvis or vagina. Contraindications Combined with other organ diseases, such as severe cardiovascular disease, respiratory disease, hemorrhagic disease, etc., can not tolerate anesthesia. Preoperative preparation Cervical smear and diagnostic curettage were performed before surgery to exclude cervical and uterine malignant tumors. Surgical procedure Open and round ligament treatment: same as general abdominal hysterectomy, but the giant cervical fibroids are displaced upwards, and care should be taken to avoid damage to the bladder when opening the peritoneum. The round ligament should be sought in front of the attachment between the uterine horn and the inguinal canal. Treatment of ovarian blood vessels: As the cervical fibroids push up the uterus, the pelvic funnel ligaments become shorter. The ovaries, veins and ureters are distorted and close to each other. Therefore, when treating ovarian veins and veins, the pelvic funnel ligament should be opened. The lateral side should be separated from the lateral peritoneum to separate the ovaries, veins and free ureters, fully exposing the ovarian blood vessels, direct vision. Lower the clamp and carefully check the tissue that was lifted to confirm that there is no ureter, then cut and sew. If the ovary should be preserved, the anterior and posterior lobe of the broad ligament should be opened. The ovarian blood vessels should be separated by fingers. Open the bladder uterus reflexed subperitoneal push the bladder: the anterior lip of the cervix is often in a higher position, but it is easy to separate from the intercervical tissue. Pushing the bladder away exposes the tumor, pushing the surrounding tissue along the tumor to the lower pole of the tumor. The fibroids located in the posterior lip of the cervix should be pushed away from the rectum to free the fibroids and surrounding tissues. Treatment of uterine blood vessels: Under normal circumstances, the uterine blood vessels are located 2 cm outside the uterine isthmus and the ureter. Cervical fibroids move up the ureter, especially the uterine fibroids protruding to the sides of the ureter often attached to the surface of the fibroids, multiple fibroids when the ureter or even through the fibroids, the ureter and uterine vessels are significantly displaced, due to uterine movement The vein is also easily displaced, so when the uterine blood vessels are treated, the exposed ureter should be dissociated downwards, and the bladder should be fully pushed down, especially the bladder foot must be completely free, which can expose a weak area of triangular tissue. The inner side of the lower triangle is the uterine wall, the lower side is the main ligament, the outer side is the uterine artery and vein, and the ureter passes through it. It is separated by the small right angle clamp along the ureter. It is easy to separate the uterus, vein and ureter. Clamp, cut the uterine blood vessels, double suture. Treatment of the main ligament: At this time, the ureter should continue to descend from the ureter and uterine artery to the bladder entrance. The ureter often adheres to the surface of the tumor, and the tissue is loose. The bladder and ureter are pulled to the side below with a hook, and the main ligament is cut by clamping on the inside. Sometimes the main ligament is weakened and loosened by the fibroids. It is easy to be pushed open. The main ligament is not treated, that is, the uterus is removed from the iliac crest. The main ligament stops bleeding if there is bleeding. complication Urinary system damage: including bladder damage and ureteral injury. Bladder injury is the most common urinary tract injury, which occurs in the adhesion of the separation of the bladder, separation of the cervical bladder space or electrocoagulation near the bladder. In patients with pelvic surgery, pelvic inflammatory disease, cervical fibroids, care should be taken. Once a bladder injury occurs, it should be promptly discovered and treated. This is an important guarantee for avoiding secondary laparoscopic surgery or secondary laparotomy. Once bladder injury is found, it should be repaired under laparoscopy in time. Open surgery should be performed for those who have difficulty repairing. For patients with mild lesions and small extent, conservative treatment of Fo-1ey catheters can be performed after surgery. Intestinal tube injury: Once the injury is found, it should be repaired in time, and if necessary, converted to open surgery.

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