Interventional surgery for gynecological malignant tumors

Interventional operation is the use of ultrasound, computed tomography (CT), nuclear magnetic resonance (MRI), X-ray, laparoscopy and other modern medical imaging technology to perform targeted surgery on the organs and tissues of the lesion for diagnosis and treatment. purpose. The law has now become an indispensable part of comprehensive treatment. Due to its advantages of micro-trauma, accurate positioning, safety and effectiveness, and fewer complications, it has developed rapidly in the past 20 years. Generally divided into two major categories of vascular interventional surgery and non-vascular interventional surgery. Vascular interventional surgery was founded in 1953 by Seldinger. According to different placement positions, there are three types: subselectivity - insertion into the abdominal aorta; selective - insertion into the primary branch of the abdominal aorta; superselection - insertion into the abdominal aorta secondary or smaller Branch. The operation is small in trauma, easy to operate, and accurate in the intervention site, which makes some inoperable patients get treatment opportunities and simplifies surgery. Mainly include: angiography, vascular embolization, angioplasty, chemotherapy, drainage and biopsy. With the continuous advancement of medical biotechnology research, the treatment of gynecological malignant tumors has also been enriched. Tumor interventional surgery, due to its minimally invasive, accurate positioning, safe and effective, and fewer complications, the application of digital imaging subtraction angiography (DSA), B-ultrasound, CT, MRI and other modern imaging equipment and interventional instruments Under the premise of continuous research and development, in the past 20 years, the rapid development of interventional surgery has made it more convenient, safe and effective, not only improving the efficacy but also prolonging the survival time of patients. Treatment of diseases: uterine sarcoma, cervical cancer Indication Interventional surgery for gynecologic malignancies applies to: 1. Gynecological malignant tumors, such as vulvar cancer, cervical cancer, uterine sarcoma, ovarian cancer, malignant trophoblastic tumor and fallopian tube cancer in the middle and late stage. 2. Elderly patients are not qualified for surgical resection due to cardiovascular or other diseases. 3. Relieve the symptoms of advanced cancer, control ascites, and perform interventional chemotherapy to improve systemic conditions to prolong patient life and improve quality of life. 4. For patients with recurrence after surgery or radiotherapy, it is conducive to the elimination of residual tumor or pelvic metastatic lesions. 5. Patients who are unable to undergo radiotherapy or extensive surgery before surgery due to large tumors or late stage surgery can use the interventional surgery for chemotherapy, which can reduce the tumor, reduce the pressure on the organs, reduce the ascites, and create conditions for further surgery or radiotherapy. . Contraindications 1. Severe heart, liver and kidney dysfunction. 2. Leukocytes are low (less than 3 × 109 / L). 3. Iodine allergy test positive patients are relatively contraindications, and non-ionic contrast agents such as omnipaque have been used. Generally, it can be carried out smoothly. "Iodine allergy" is no absolute contraindication. Preoperative preparation 1. Routine blood, urine routine, liver and kidney function, chest X-ray, electrocardiogram, coagulation and blood type. 2. B-ultrasound, CT or MRI examination. 3. Blood tumor markers were examined for CA125, CA19.9, CEA, AFP, and the like. 4. Skin preparation in the vulva and groin area, for penicillin, procaine skin test and diarrhea glucan allergy test. 5. Oral administration of dipyridamole 25mg, 3/d 3 days before surgery, antibiotics were used 1 day before surgery. 6. Preoperative intramuscular injection of 10mg, pivoting 8mg (or Kangquan 3mg), for vomiting. 7. Suffering from acute and chronic genitourinary inflammation, and then undergo surgery after inflammation control. Surgical procedure 1. Place the catheter. 2. Take the groin area as the center, disinfect the drape, and perform DSA digital subtraction angiography. 3. Using the Selding's method, percutaneous femoral artery puncture, conventionally placed catheter sheath. 4. Invert the 5F "C" tube or the Simon catheter into the contralateral or ipsilateral internal iliac artery. 5. After routine angiography into the internal iliac artery, 40% to 60% ionic or non-ionic contrast agent was injected under pressure to visualize the iliac vessels, and the branching of the iliac vessels was observed. 6. Identify the main nutritional vessels of the lesion and the tumor, and select the perfusion artery. 7. Turn the catheter to the lower side, routinely avoid the gluteal artery and the iliac artery, and insert the tumor feeding artery through the anterior iliac artery (mostly the uterine artery, 40% of the ovarian cancer is from the uterine artery branch). 8. The tumor site is obviously thickened, curled, and the tumor staining area is specific under the contrast agent. 9. Pressurized injection of chemotherapy drugs, generally 2/3 of the total amount injected into the affected side. After injection, the tumor-supplying artery is embolized with gelatin sponge particles soaked with chemotherapy drugs. 10. Repeat the angiography after embolization, showing that the embolization is satisfactory and completed. complication 1. The hematoma at the puncture site is mainly oppressed, and can be absorbed without special treatment. Local hot compress and physiotherapy promote hematoma absorption. 2. The incidence of ulceration at the puncture site is about 5%. It can be changed every day and cured in about 1 month. 3. Chemotherapy-related complications, treated with chemotherapy complications.