Broad ligament myomectomy

Wide ligament myomectomy for the surgical treatment of uterine fibroids. Uterine fibroids are the most common benign tumors in the female genitalia and occur mostly in middle-aged women. According to the growth site of fibroids, it can be divided into uterine neck fibroids and uterine body fibroids. According to the relationship between fibroids and uterine muscle wall, it can be divided into intramural Myoma, Subserous Myoma and Submucous Myoma. The treatment method may be non-surgical treatment or surgical treatment, and the treatment should be determined according to the comprehensive judgment of the size, location, clinical symptoms, patient's age, fertility needs and the patient's general condition. Surgical treatment is currently the most commonly used treatment, and its indications are more than one month, irregular vaginal bleeding. 2 There are obvious symptoms of oppression. 3 fibroids over the size of 12 weeks of gestation. 4 fibroids grow rapidly and may be malignant. 5 There are pedicle fibroids under the mucosa, especially those who have protruded beyond the cervix. 6 cervical fibroids. 7 fibroids have complications, such as pedicle torsion, degeneration or infection. There are many surgical methods for uterine fibroids, including vaginal fibroids removal in the vagina. Pedicled subserosal myomectomy, abdominal uterine fibroids removal. Resection of broad ligament myoma. Cervical myomectomy. Subtotal uterus and total hysterectomy. The broad ligament fibroids can be divided into true and false. The true wide ligament intramuscular tumor can grow in the broad ligament, uterine ovary ligament and perivascular tissue of the ovary and uterus. This fibroid is not connected to the uterus. The pseudo-wide ligament internal fibroids are fibroids that extend outward from the uterus or cervix to the broad ligament and connect to the uterus. The relationship between true and pseudo-wide ligament fibroids and uterine arteries and veins and ureters is different. The former uterine arteries and veins are located in the lower part of the tumor, and the ureter often moves inward. In the pseudo-wide ligament intramuscular fibroids, the uterine arteries and veins move upwards and outwards, and the ureters are often displaced to the side wall of the pelvis. The displacement of these important organs often causes difficulty in surgery, and it is easy to accidentally injure if not paying attention. Wide ligament fibroids without uterine fibroids, feasible wide ligament myomectomy. If accompanied by uterine fibroids, the number is small, young patients without children, can also be treated with wide ligament myomectomy and uterine fibroids removal. If the fibroids are large and the patient does not need to retain fertility, the uterus can be removed at the same time. Treatment of diseases: pregnancy with uterine fibroids uterine fibroids Indication Wide ligament myomectomy for: 1. The fibroids are large, or produce compression symptoms. 2. The fibroids grow rapidly, and those suspected of degenerative changes are particularly suspected of malignant transformation. Remove the uterus at the same time if necessary. 3. Young patients, who need to retain fertility. Contraindications 1. Suspected that the fibroids are malignant. 2. Patients with endometrial lesions. 3. The cervix has severe lesions. 4. The fibroids are larger, or more numerous, and have children. 5. Although there are no children, but the fibroids are large and the number is large, the uterus can not be retained. 6. There is an acute infection. Preoperative preparation 1. With gynecological abdominal surgery. 2. Understand the requirements for fertility, both couples undergo infertility examinations, and talk to patients and their families about the possibility of uterine retention, and the possibility of recurrence of uterine fibroids. 3. Cervical scraping to check for cancer cells. 4. Preoperative diagnostic curettage, especially those with abnormal menstruation, to exclude endometrial lesions. 5. Large cervical fibroids, there will be certain difficulties during operation. If necessary, place a ureteral catheter before surgery to prepare for intestinal disinfection. Surgical procedure 1. Cut the abdominal wall. 2. Explore the relationship between the size and location of the fibroids, the uterus and the cervix, and whether there is a fibroid on the uterus. Identify the location of the ureter and round ligament. 3. Cut and sew the round ligament (if the round ligament does not affect the peeling of the fibroids, without cutting), open the anterior lobe of the broad ligament. The mid-bend vascular clamp clamps the edge of the broad ligament, extends into the finger, and slowly peels off, so that the fibroid is separated from the surrounding tissue. If the fibroids are too large, the posterior lobe of the broad ligament can be cut again and peeled off in the same way. Care is taken to distinguish the squeezed blood vessels and ureters during separation. Those who retain the uterus should be careful not to damage the ovaries and fallopian tubes and their blood vessels as well as the ascending branch of the uterine artery. The operation should be carried out under direct vision. 4. When the fibroids are in the downward direction, the bladder peritoneum should be folded back, the bladder should be pushed open, and the fingers should be inserted into the surrounding tissue of the tumor, at the bottom of the proximal broad ligament or near the uterus. It is difficult to peel off, and should be carefully identified. Clamp clamp, cut and sewed close to the fibroid side. Pay attention to the ureter at any time during the stripping. If there is a suspicious item, you should check it and then handle it. When the fibroids are large, the blood vessels should be correspondingly thickened, and should be clamped, cut, and sewed separately to avoid tearing the bleeding. If the uterine artery straddles the fibroid, it is more desirable to be able to perform complete dissociation without cutting. 5. After suturing the broad ligament cavity fibroids, check each important organ again, and after the exact hemostasis, cut off the anterior and posterior lobe of the excess broad ligament, suture with 2-0 gut or medium silk thread or purse Cavity, be careful not to hurt the blood vessels or ureters. 6. Suture the abdominal wall and see the abdominal wall suture and incision.