porro surgery

The cesarean section and the removal of the uterus were first created in 1876 by the Italian doctor Eduardo Porro. At that time, there was no antibiotics after suturing the uterus after cesarean section, and the maternal mortality rate was close to 100%. After the simultaneous removal of the uterus, the bleeding and postoperative infections are greatly reduced, and the maternal survival rate is increased to 44%, which is a major contribution to obstetrics. At present, the safety of cesarean section is very high, but in order to solve some critical cases, this procedure still has a certain significance. The original cesarean section hysterectomy was a major uterine resection, but in recent years there was a total uterine resection. The latter technical operation is more complicated, but can avoid the diseases caused by the cervix. Excessive hemorrhage of the placenta previa requires hysterectomy, and general hysterectomy should also be performed. In practice, the choice of surgical procedure should be based on the local part of the uterus and the general condition of the patient and the skill level of the surgeon. Treatment of diseases: pregnancy with uterine fibroids Indication Porro surgery is suitable for: 1. Uterine bleeding: due to early placenta stripping and placenta previa, uterine contraction flaccid, uterine rupture or aura rupture, intraoperative uterine incision laceration and uterine blood vessels and bleeding. 2. Infection at birth: The uterine cavity has been seriously infected during operation, and the incision does not heal after the uterus remains; it can cause late bleeding or become a infected spot that threatens the mother's life. 3. Implantable placenta: All or most of the placenta is implanted in the uterine wall, although there is no major bleeding but the placenta cannot be delivered. 4. Pregnancy with uterine fibroids: no longer have fertility requirements, larger or more fibroids. 5. Requires sterilization: Haynes believes that hysterectomy should be performed at the same time as cesarean section. This will not only provide reliable sterilization, but also prevent re-operations that may be needed in future uterine conditions. 6. At the time of cesarean section, the presence of the uterus is found, and the patient will be born to the mother in the near or long term. Contraindications It is desirable to retain fertility while retaining the uterus without a patient. Preoperative preparation 1. Preoperative preparation for elective surgery 1 Advance admission is required. There are clear indications for surgery during antenatal examination, or women who are likely to have cesarean section should be admitted before the expected date of delivery. 2 active treatment of complications, for those with complications, should be actively treated first, such as pregnancy-induced hypertension syndrome, should be treated when the treatment is not yet fully control when choosing a favorable time for surgery. Pregnant women with anemia should check the cause and correct anemia. Pregnant women with heart disease should have heart failure before heart failure. Active infection prevention, etc., when co-infection. 3 Actively promote the maturity of the fetus, and promote the fetal lung maturation in time if the fetus is immature and must be delivered. The elective surgery can be done under all preparations, after the start of labor, or at the time of pre-production. 2. Preoperative preparation for emergency surgery Most of the emergency cesarean section encounter difficulties in the labor process, or the pregnancy must be terminated immediately due to sudden changes in pregnancy complications, accounting for more than half of all cesarean section, some of which were admitted earlier, and more have been treated accordingly. . If you are admitted to the emergency department, the doctor should pay close attention to review the medical history, do a physical examination and necessary auxiliary examinations, fully estimate the mother and baby, and identify the surgical indications. 3. Specific preparations 1 Correct the general condition, according to different conditions to deal with, especially pay attention to correct maternal dehydration, electrolyte imbalance, and actively deal with fetal distress. If there is hemorrhagic shock, the blood volume should be supplemented in time. 2 blood preparation, obstetric hemorrhage is often very urgent and large, you should always be ready for blood transfusion. Those who have had bleeding before delivery should be operated at the same time as blood transfusion. Because of the need for surgery before the bleeding, they can effectively stop bleeding, so they can not wait for a long time and delay the rescue. 3 preparation of skin, according to the scope of gynecological abdominal surgery. 4 catheter. 5 Preoperative medication, for pregnant women with infection or possible infection, antibiotics should be given before surgery. For immature fetuses. Preoperative medication to promote fetal lung maturation. 6 to prepare for the rescue of infants, including tracheal intubation, umbilical vascular injection. It is best to have a neonatologist to participate in the rescue. Surgical procedure Cut the abdominal wall The location of the incision in the abdominal wall should be higher than that in the lower cesarean section. It is often necessary to exceed the umbilicus. The midline incision can be used to bypass the umbilicus to reach the umbilicus, but it is better to take the midline incision. The full length is 1, 3 on the umbilicus. 3 under the umbilicus. It is beneficial to expose the uterus and avoid the adhesion of the abdominal wall incision to the uterine incision. The method of operation is the same as the cesarean section of the lower uterus. 2. Reveal the uterus and protect the abdominal cavity After the operator rinses the gloves, the abdominal cavity is probed, the uterus is corrected, and a gauze pad is filled between the abdominal wall and the uterine wall, thereby pushing the intestine and fixing the uterus for easy operation, and completely obstructing the abdominal cavity to prevent the contents of the uterine cavity from overflowing into the abdominal cavity. 3. Cut the uterus The median longitudinal incision of the uterine wall is taken between the bilateral ligaments on both sides, and the lower end of the uterus is more than the reflex of the peritoneum. It can be extended upwards as needed, and the total length is about 12 to 13 cm. First cut a small mouth about 4 ~ 5cm in the middle of the palace, pay attention to keep the fetal sac intact, with the left hand and the middle finger into the wall between the wall and the fetal sac, and the right hand holding the blunt scissors to extend the incision upwards and downwards. When you puncture the membrane, you should promptly absorb the overflowing amniotic fluid. In addition to the median longitudinal incision in the body, there are some special cases where the transverse incision of the uterus, the incision of the uterus, the incision of the posterior wall of the uterus, and the incision of the uterine wall. 4. Delivery of the fetus Regardless of the fetal position, after the expansion of the membrane, the surgeon's right hand extends into the uterine cavity, holding the fetal foot (single foot or both feet), and the fetus is delivered by the hip traction. If it is a single hip, the surgeon uses the finger to hook the groin of the fetus to the outside, and delivers the buttocks to deliver the delivery. 5. Delivery of placenta Because most of the placenta is attached to the uterine body, there are many chances of encountering the placenta under the incision. The placenta should be pushed to the side to deliver the fetus quickly. Generally, there is no difficulty. If there is no placenta under the incision and there is no major bleeding, wait for the contraction, and deliver the placenta after it is naturally stripped. The traditional operation system uses the oval clamp to clamp the wound to stop bleeding, but the muscle wall of the uterine wall is thick, and the clamp hemostasis has a great trauma to the tissue, which makes the anatomical relationship break and makes it difficult to meet and affect the healing of the incision. It is now proposed to use a small hook or an assistant to hook the upper end of the incision with the finger to tighten the entire incision, or to tighten a needle in the suture at each end of the incision to force the blood vessel and blood sinus to close to stop bleeding. 6. Remove the uterus The procedure is seen in the whole uterus and total hysterectomy. 7. Clean the abdominal cavity Absorb the amniotic fluid and blood that overflow into the abdominal cavity. If there is fecal stool or infectious uterine contents spilling into the abdominal cavity, flush with saline and check the accessories on both sides. Count gauze and dressings. The abdominal wall is sutured layer by layer. complication 2 days after hysterectomy, there may be a small amount of vaginal bleeding, mostly residual vaginal blood in the operation, no need to deal with. About 7 days after surgery, due to suture absorption and shedding, local small amount of oozing may occur, mostly reddish or serous exudation, which gradually decreases and disappears after 2 to 3 weeks. If the bleeding lasts for a long time, you should pay attention to whether there is any infection, check it, and handle it according to the situation. If vaginal bleeding occurs within a short period of time after surgery, it should be checked immediately to find out the cause. If the bleeding is broken, gauze can be used for compression. If it is active bleeding, it should be immediately localized or clamped to stop bleeding or electrocoagulation to stop bleeding. Many should reopen the abdominal cavity to stop bleeding. Sudden massive hemorrhage 2 weeks after the operation, mostly due to detachment or infection of the knot, and the infection of the broken end can be suppressed by iodoform gauze, such as pelvic hematoma, if necessary, open bleeding to stop bleeding.