Ovarian Tumor Resection (Adnexectomy)

Surgery is the main method for the treatment of ovarian tumors. For children and young patients, the patient has a partial attachment or a simple ovarian tumor removal procedure. Before and after menopause and postmenopausal patients, multiple uterus and bilateral accessory resection are performed. Attachment resection is a fallopian tube oophorectomy. Mostly used for the removal of the fallopian tube ovary with lesions. Treatment of diseases: ovarian tumors Indication 1. The ovarian cyst is too large, there is no normal ovarian tissue, and the contralateral ovary is normal. 2. The age is more than 40 years old, the contralateral ovary is normal, and the affected side is chocolate cyst, teratoma or epithelial ovarian cyst. 3. Inflammatory adhesion mass, abdominal pain caused by adhesion before surgery is ineffective by conservative treatment. 4. Patients with ovarian cancer in their relatives, older than 35 years old, should be removed from the affected side of the ovaries. 5. Menopausal women, with ovarian tumors on one side, even if they are small cysts less than 5 cm, it is also recommended to remove the affected side or bilateral attachments. Contraindications 1. Severe cardiovascular disease, pulmonary insufficiency. 2. Diffuse peritonitis. 3. Umbilical hernia, hernia, abdominal wall hernia, inguinal hernia or femoral hernia. 4. Coagulation is abnormal. 5. Due to the history of surgery, extensive scarring of the abdominal wall or extensive adhesions in the abdominal cavity. 6. Excessive obesity. Preoperative preparation 1. Preparation of the skin of the abdomen and vulva (including the cleaning of the umbilicus). 2. Intestine preparation 0.1% soapy water enema before the night before surgery. If it is possible to involve the operation of the intestine, 3 days of bowel preparation is performed before surgery. 3. Preoperative medication, such as a large range of surgery, may involve the intestines, antibiotics should be used to prevent infection 3 days before surgery. Sedative, atropine or scopolamine was injected 30 min before surgery. 4. Indwell the catheter. 5. Prepare blood or prepare for autologous blood transfusion. Surgical procedure 1. Head low-foot high supine position, routine three-point puncture, mirroring and exploration, pay attention to the affected side of the ovary with or without adhesion and contralateral ovary, uterus. Routine collection of peritoneal fluid or irrigation fluid for cytology. Expose the ovary in front of the uterus. It is usually necessary to use the probe rod along the inner side of the ovary, and the ovaries and cysts are carefully placed outwardly from the posterior lobe of the broad ligament, so that the uterus naturally sinks to the rear, so that the ovary is located in front of the uterus for easy operation. If the cyst is larger than 10cm, it is usually necessary to first place a set of rings on the puncture site, and then use a long needle to connect the suction tube. After piercing, the liquid is sucked out. After the needle is pulled out, the puncture hole is clamped to lift the wall. , tighten the ferrule to prevent leakage of the remaining cyst fluid. 2. The following three methods are introduced to describe the attachment removal: (1) ferrule ligation method: put the ferrule, place the ferrule on the side of the affected side attachment, and then use the clamp to slide the other side of the coil to the cystic surface. When the maximum diameter is exceeded, the fallopian tube is absent. In the circle, you can clamp the fallopian tube into the ring with a forceps in the circle. Pay attention to the clamp and fix it. The assistant carefully tightens the ferrule until it is entangled in the pedicle of the affected side (including the ovary intrinsic ligament, funnel ligament and fallopian tube). Isthmus). Three sets of the same method, use scissors to carefully cut the pedicle at 0.5~1cm above the ligation line, pay attention to the pedicle is not too short, and do not cut the cyst. (2) Sewing or bipolar coagulation: The ovarian intrinsic ligament, funnel ligament and fallopian tube are treated with fractional suture or bipolar coagulation, and then cut. (3) Electrocoagulation plus ferrule ligation: firstly treat the pelvic funnel ligament with bipolar coagulation, and then cut the ovarian intrinsic ligament and fallopian tube with ferrule method and cut it. 3. Take out the specimen: first put into the ferrule, clamp the ovary with the forceps and fix it, puncture the cyst through the long needle of the abdominal wall, draw the cyst fluid, and after the emptying, lift the capsule wall, tighten the ferrule, and then puncture Remove the specimen from the hole. 4. Other steps are the same as before.