Broad ligament cyst surgery

Wide ligament cyst surgery for the surgical treatment of ovarian tumors. Surgery is the main method for the treatment of ovarian tumors. For children and young patients, patients with partial or partial ovarian tumor resection are excluded. Before and after menopause and postmenopausal patients, multiple uterus and bilateral accessory resection are performed. The cyst is located in the broad ligament along the fallopian tube and ovary and the vaginal side of the uterus (Figure 11.1.4.1.2.4-1 to 11.1.4.2.2.4-3). Mainly from the remains of the secondary kidney or middle kidney tube. The cyst in the broad ligament is a cyst that occurs between the two lobe of the broad ligament, so it is extranasally pelvic, mostly serous. This cyst is characterized by unilaterality, single cyst, slow growth, and rarely develops to large. The anterior wall of the cyst is covered with the anterior lobe of the broad ligament, the round ligament, the fallopian tube, and the pelvic funnel ligament. The posterior wall of the cyst often has a uterine artery running in between, and the outer wall of the tumor abuts against the side wall of the pelvis. The ureter often passes between the two or attached to the side wall of the cyst and can be displaced. Larger cysts can be placed close to the ankle. The inner side wall of the cyst pushes the uterus aside, sometimes the bladder changes. The lower wall of the cyst can reach the rectal fossa and even the small pelvic cavity, compressing the rectum or sigmoid colon. The upper wall of the cyst is the posterior lobe of the broad ligament. Sometimes the intestine and the omentum adhere to it. Some cysts are thin and easy to rupture when peeled off. These conditions will increase the difficulty of surgery and the possibility of organ damage. Wide ligament cysts have true and false points, the two must be identified, and the surgical treatment of the two is also different, the cysts between the two lobe of the broad ligament called the true broad ligament cyst, the pseudo-wide ligament cyst is the tubal hydrops communicating with the ovary Form a fallopian tube ovarian cyst. More often due to inflammation and wide ligament peritoneal adhesions fixed. Treatment of diseases: ovarian tumors in children with ovarian tumors Indication The wide ligament cyst surgery is suitable for pelvic cysts confirmed by gynecology or B-ultrasound, and the diameter is more than 6cm. Contraindications 1. Pregnant women with early pregnancy can be prevented from developing after 4 months of pregnancy in order to avoid miscarriage. 2. The patient has serious medical complications, such as metabolic disorders (diabetes, etc.) or heart, liver, and kidney dysfunction. Should be considered after the condition of treatment is stable under treatment control. Surgical procedure 1. Cut the abdominal wall and probe The median longitudinal incision of the lower abdomen should be slightly higher than the upper boundary of the cyst. After laparotomy, the size, location and relationship with the surrounding organs should be examined in detail, and the ovarian cysts in the false broad ligament should be distinguished. 2. Cut the suture basin funnel ligament Cut the pelvic funnel ligament in the lateral side of the cyst. If the pelvic funnel ligament is not visible in the cyst, the curved anterior lobe cyst or the anterior lobe of the broad ligament and the fallopian tube can be cut into a curved incision. Open the ligament peritoneum until the pelvic funnel ligament, use the vascular clamp to pick out the ovarian arteriovenous, remove the ureter, clamp the blood vessel, cut it, ligation with the 10th wire, and then ligation at the proximal end. 3. Cut off the fallopian tube and ovarian intrinsic ligament From the end of the fallopian tube of the pelvic funnel ligament, the posterior lobe of the broad ligament is cut open to the uterine horn, and the fallopian tube is sutured at the uterine horn. Then the finger is slightly peeled off to fully expose the ovarian intrinsic ligament, and then clamped. Cut, suture, ligation, so as not to cut the cyst wall. 4. Peel the cyst Through the above operation, the blood flow to the cyst has been completely cut off, the edge of the cyst can be cut along the broad ligament, the wall of the cyst is removed, and the gap between the cyst and the broad ligament is separated until the cyst is completely peeled off. Pay attention to the ureter during the stripping process. The separation of the bottom of the cyst is performed under direct vision as much as possible. In the case of a large fibrous band, it must be cut under direct vision. In addition to not damaging the ureter, care should be taken not to damage the uterine arteries and veins below. 5. Stitching the wound cavity of the broad ligament After the cyst was exfoliated, a large wound cavity was formed between the anterior and posterior lobe of the broad ligament, and there was no bleeding or oozing of the ureter in the wound cavity. If there is damage or bleeding, it must be disposed of. Then, cut off the excess wide ligament peritoneum, use the 4th silk thread or 2-0, 3-0 gut line, intermittent or continuous suture of the broad ligament peritoneal incision, pay attention to not leave a cavity when suturing, to prevent intracavitary Form a hematoma, and pay attention to prevent suture injury to the uterine artery and ureter. 6. Suture the abdominal wall The abdominal cavity was cleaned and the abdominal wall was sutured layer by layer. complication The main complications of exfoliation of the wide-ligament cyst are resection of the hematoma and ureteral injury. Causes and prevention are as described above.