segmental curettage

Surgical treatment plays an important role in gynecological clinical medicine, and gynecological diagnosis and therapeutic minor surgery can not be ignored. Such as curettage, posterior malleolar puncture, vulva and cervical biopsy, etc., in the diagnosis and treatment of a wide range of applications. These procedures are often simple and significant. If it is negligent or improperly operated, it can cause a wrong diagnosis. Ineffective treatment will bring undue pain to the patient. Diagnostic curettage is a kind of important operation for diagnosing uterine cavity disease. Its purpose is to scrape the contents of the uterine cavity for pathological examination to assist diagnosis. If the cervical canal is suspected, the cervical canal and the uterine cavity should be cured in a stepwise manner. Treating diseases: hydatidiform mole Indication In order to determine the primary site of the disease, the correct staging of certain diseases was performed, and the tissues were taken from the cervix and uterine cavity for pathological examination. Contraindications 1. Vulvar and vaginal inflammation for various reasons. 2. Acute endometritis. 3. Acute exacerbation of chronic pelvic inflammatory disease. 4. Although trophoblastic tumors are not absolutely contraindicated, they should be used with caution. Preoperative preparation 1. Check blood routine, platelet, vaginal discharge routine, and measure body temperature. Blood pressure and pulse are measured in people over 45 years old. Those suspected of having a heart disease need to have an electrocardiogram. 2. Sex life is prohibited for 3 days before surgery. 3. Carefully understand the menstrual cycle. 4. The belt looper should be inspected or B-ultrasound before surgery. 5. Hydatidiform mole and choriocarcinoma before the operation of B-ultrasound and blood and blood, establish an infusion channel, ready to transfusion. If necessary, operate under B-monitoring. 6. Patients with inflammation and need emergency curettage, start using antibiotics before surgery, until 3 to 5 days after surgery. Surgical procedure 1. Empty the bladder, take the bladder lithotomy position, disinfect the vulva and vagina, and sterilize the surgical towel. 2. Double-checking to understand the size, azimuth, texture, activity, shape and relationship with the surrounding organs, and whether there are any abnormalities on both sides of the attachment. 3. Place the speculum, expose the cervix, disinfect the vagina and the cervix, clamp the front lip with a cervical clamp, and pull outward to make the uterus horizontal. 4. Before the probe is examined in the uterine cavity, first enter the 2.5~3cm with a small curette, and scrape the cervical canal tissue clockwise. If there is scraping, the hourly part should be recorded, and the scraped material should be sent for pathological examination or smear examination. 5. Gently probe the uterus with the uterus probe in the direction of the uterus, measure the depth and confirm whether the degree of flexion and size are consistent with the examination. If there is resistance, it is not possible to detect it. You can change the direction to find the position of the uterus without resistance and variation. It is clear whether there is a feeling of resistance to the probe caused by unevenness or adhesion of the inner wall and tumor compression. 6. Dilate the cervix and first arrange the dilators by number, expanding from small to large. The front end of the dilator is wiped with oil. With the right thumb, the middle finger and the middle finger, the dilator will follow the uterus direction and the degree of flexion, and it will be lightly, stably and slowly sent to the inner mouth of the cervix 1cm. If the resistance is not forcibly entered, the cause must be ascertained. If the inner mouth is too tight, it can be placed for 2 to 3 minutes, and gradually expands, generally expanding from 2 to 4 to 7 to 8. If you need to perform cervical or intrauterine surgery, you can expand to 10 to 16. 7. The curettage enters the uterine cavity with a small curette in the direction of the uterus, and the inner membrane is scraped from the bottom of the palace to the internal cervix. The front wall right side wall (or the left side wall) is clockwise or counterclockwise. ) back wall left side wall (or right side wall) double palace angle palace bottom, throughout the entire uterine cavity. 8. During surgery, pay attention to whether the uterine cavity is symmetrical, whether the surface is flat, the thickness of the intima, the presence or absence of submucosal fibroids, tissue adhesion, nodules. When the curettage is finished, the uterine cavity may be rough, and there is uterine contraction without bleeding. Always pay attention to the nature of the scraping and keep it for pathological examination. 9. Visually observe the scrapings, the normal endometrium is pink, bright and strip-like; suspicious endometrial adenocarcinoma, the scrapings are fish-like, white rotten meat-like; suspected endometrial tuberculosis, scraping The product is cheese-like; the moles of the moles are blister-like blocks of different sizes; the suspicious cells are suspicious, and the scrapings are denatured, necrotic irregular tissues. complication Bleeding Cancer cases may cause major bleeding during curettage. Such patients should not use uterine contractions, but should consider filling, and if necessary, arterial embolization can stop bleeding, and the effect is good. Uterine perforation Lactation, postmenopausal uterus and endometrial cancer patients can make the uterine wall weak, and it is easy to cause uterine perforation when diagnosed. For uterine perforation with less bleeding, it is feasible to treat conservatively with anti-inflammation and hemostasis; if the perforation is large and there is major bleeding, it is necessary to stop bleeding. 3. Infection Mainly seen in preoperative vaginal bleeding. Focus on prevention, strict aseptic operation during surgery, postoperative prophylactic antibiotic treatment can reduce the incidence of infection. For patients with existing infections, anti-infective treatment should be strengthened. 4. Uterine adhesions Such as the cleansing of the uterine cavity is not completely thorough, causing excessive sputum scraping, causing intrauterine adhesions, the consequences of which are infertility, miscarriage, amenorrhea, dysmenorrhea and so on. Adhesion can be separated under hysteroscopy.