Revert surgery

Revert surgery is used for surgical treatment of uterine prolapse. The external cervix descends below the plane of the ischial spine, which is called uterine prolapse. The cervix descended and did not reach the vaginal opening, which was lighter than I. The cervix descends to the vaginal opening and is not exported. It is I degree. The cervix is removed from the vaginal opening, and the uterus is still in the vagina, which is lighter than II. The cervix and part of the uterus are removed from the vaginal opening and are heavy to the second degree. The cervix and the uterus are all removed from the vaginal opening, which is called III degree uterine prolapse. Often accompanied by varying degrees of vaginal anterior and posterior wall bulging and cervical elongation. Neugebauer In 1867, LeFort introduced the same operation in 1877 to treat uterine prolapse, which is to suspend the majority of the anterior and posterior wall of the vagina, forming a vaginal mediastinum, so that the vagina is basically closed (left side of each hole) to block the bladder. , rectal bulging and uterine prolapse, known as Neugebauer-LeFort surgery, generally referred to as LeFort surgery. The advantages of surgery are simple operation, less tissue invasion, and less bleeding. High safety and good results. But there are also shortcomings, that is, not sexual life, a small number of stress urinary incontinence may occur, and it is difficult to treat once there is a malignant lesion. The Revert surgery is divided into complete closure and partial closure. Complete vaginal closure is to completely close the vagina without leaving a hole in both sides. Only used for 1 uterus removal, bladder or (and) rectal bulging. 2 vaginal wall repair failed, invalid. 3 uterus atrophy, no drainage. Therefore, there are very few people who apply this procedure. Although there are many surgical procedures for some of the Redft surgery, LeFort surgery is still used. Treating diseases: uterine prolapse Indication Revert surgery is suitable for women with uterine prolapse, old and frail, and without sex. Contraindications 1. Have a normal sex life. 2. Vaginitis, vaginal ulcer, moderate and severe cervical erosion, cervical ulcer. 3. Cervical precancerous lesions, cervical cancer, endometrial adenocarcinoma. Preoperative preparation 1. Check vaginal discharge to eliminate trichomoniasis, fungi, and pus. 2. Cervical scraping cytology to rule out cancer. 3. Segment curettage, send cervical tissue, endometrial tissue biopsy, exclude malignant lesions, precancerous lesions. Surgical procedure 1. Use the cervical rat tooth forceps to clamp the cervix to the outside and make a rectangular (about 6cm × 2cm) incision on the anterior and posterior wall of the vagina as a mark boundary. The lower boundary of the anterior wall is about 2 cm below the urethra, the upper boundary is about 2 to 3 cm from the cervix, the upper boundary of the posterior wall is about 2 to 3 cm from the cervix, and the lower boundary is about 1 cm from the vaginal opening. A mucosal surface with a width of 0.5 to 1 cm should be left on both sides of the boundary. The two rectangles of the front and rear walls should be able to meet each other. 2. Cut the mucosa within the boundary of the anterior wall from the lower edge, separate it from the bladder with a curved scissors, and cut the tip toward the vaginal wall; or bluntly separate until the entire rectangular anterior wall of the vagina is peeled off and removed. The pad is pressed with moist hot saline gauze to stop bleeding. 3. Pull the cervix forward and upward, fully expose the posterior wall of the vagina, and cut, peel and remove the rectangular posterior wall of the vagina according to the above method. 4. Using the 0-chrome gut suture to suture the mucosal edge of the proximal cervix, the needle is inserted into the mucosal surface of the anterior wall of the vagina, over the fresh wound of the anterior and posterior wall, and the mucosal surface of the posterior wall is needled and ligated. The mucosal surface outside the new wound. 5. For fresh wounds, from the inside to the outside, 2-0 chrome gut is made into a row of intermittent sutures, so that the front and rear wall wounds are close to each other, leaving no dead space. 6. Intermittently suture the mucosal edges of the anterior and posterior vaginal walls on both sides with a 0-chrome gut. Finally, the mucosal margin under the urethra and in the vaginal opening is sutured. After the operation is completed, there are mucosal holes on both sides of the vagina to insert the catheter. complication Hemorrhage or hematoma Intraoperative vascular or stump ligation is not strong, a large amount of bleeding can occur in a short time after surgery, the vaginal wall suture should be disassembled, the bleeding blood vessels should be searched, and the suture should be re-sewn. If only a small amount of bleeding, gauze can be used to fill the vaginal pressure to stop bleeding, and use hemostasis drugs such as Yunnan Baiyao. 2. Wound infection There are many vaginal folds, so it is not easy to completely disinfect. The accumulation of small blood vessels in the surgical field is conducive to bacterial reproduction, and hematoma formation after surgery is more likely to occur. In the light of the vagina, there is a smelly purulent secretion, accompanied by a vaginal burning sensation. In severe cases, the body temperature fluctuates and rises, the vaginal wall sutures are poorly healed or necrotic, and there is purulent secretion. Antibiotics can be applied, drainage can be performed, and the vulva can be kept clean. 3. Urinary tract complications 1 less urine (<600ml / d), due to postoperative reluctance to drink water or hot days and sweat, should be supplemented with intravenous saline or 5% glucose solution. 2 urethritis, cystitis, mostly due to repeated catheterization, urinary frequency, urgency, hematuria and other symptoms, given antibiotics, diuretics and other treatment.