Surgery for chronic pelvic inflammatory disease

Acute pelvic inflammatory disease, surgery is forbidden, and traditional Chinese medicine treatment with antibiotics, physiotherapy, detoxification, and qi and blood treatment can limit, dissipate and heal the inflammation. However, if a pelvic abscess is formed, surgery should still be performed. According to the location and extent of the inflammatory foci, the corresponding surgery is selected, such as: 1 adhesion lysis, suitable for adhesion around the fallopian tube, although the lumen is unobstructed, but the adhesion of the adhesion zone can cause the egg tube to be twisted, causing infertility. When found by laparoscopy, the adhesion can be separated by laparoscopic micro-shearing to separate the adhesion tissue. 2 fallopian tube resection, one or both sides, because the lesion is limited to the fallopian tube. 3 fallopian tube oophorectomy, one or both sides, suitable for lesion invasion of the fallopian tube and ovary. 4 total or total hysterectomy, including one or bilateral fallopian tube resection, or fallopian tube oophorectomy. Treatment of diseases: chronic pelvic inflammatory disease Indication Fallopian tube abscess or stagnant water, salpingectomy. Fallopian tube ovarian abscess or stagnant water (also known as fallopian tube ovarian cyst), go fallopian tube oophorectomy. Due to tubal ovarian abscess caused by extensive pelvic adhesions, uterine incision can be used for fallopian tube oophorectomy. Contraindications Acute salpingitis, the onset of chronic inflammation. Preoperative preparation 1. Intravenous infusion of a sufficient amount of effective antibiotics. 2. Support therapy to maintain water and electrolyte balance. Surgical procedure 1. Salpingectomy and Salpingo-oophorectomy (Salpingectomy and Salpingo-oophorectomy) (1) Fallopian tube resection: 1 The median longitudinal incision of the lower abdomen, 8 to 10 cm long, cut the abdominal wall layer by layer. 2 to explore the relationship between fallopian tube lesions and the uterus, ovary, and adhesions of surrounding tissues. Separate the adhesion, cut the adhesion zone, and completely dissipate the fallopian tube. 3 Use the rat tooth forceps to lift the umbrella end of the fallopian tube, close the fallopian tube with 2 curved vascular clamps, double clamp the oviduct mesangium, cut between the two clamps, and suture with a 4th thread. Clamp, cut, and sew inward in the same way until the uterine horn. 4 From the uterine horn, clamp the proximal end of the fallopian tube, cut off, remove the fallopian tube, use the No. 7 silk thread to sew, make a purse-string suture around the root of the broken end, and wear a round ligament to cover the broken end. The ligament peritoneum was sutured with a No. 1 silk thread to cover the mesangial stump. Or suture the uterine horn, round ligament and ovarian ligament relatively intermittently. To cover the stump of the egg tube and the stump of the mesentery. 5 suture the abdominal wall layer by layer. (2) Fallopian tube oophorectomy: 1 cut the abdominal wall layer by layer. 2 probe the pelvic cavity, separate adhesions, cut the adhesion zone, and completely free the fallopian tube ovarian mass. Hold the lumps with a large gauze pad and hold it in one hand. 3 with 3 curved vascular clamps, close to the wall of the lump, clamp the pelvic funnel ligament, cut between the first and second pliers of the near lump, and use the round needle with the 7th silk thread to suture and ligature. Clamp, cut, and sew the pelvic funnel ligament inward with the same method. 4 In the uterine horn, clamp the proximal end of the fallopian tube and the ovarian ligament with three curved vascular clamps, cut off between the first and second clamps of the proximal mass, and remove the fallopian tube ovarian mass. Use a needle with a 7-gauge thread to double suture and ligature the broken end. 5 Sew the stumps together and suture the round ligament with the 4th silk thread to the posterior lobe of the broad ligament to embed the stump. 6 suture the abdominal wall layer by layer. 2. Uterine half-cut ovarian resection (Salpingo-oophorectomy with Bisection of the Uterus) (1) Cut the abdominal wall layer by layer. (2) Identify the uterus and attachments, and separate the adherent omentum and intestines. (3) Clamping and cutting the round ligament, and sewing the two broken ends respectively. The peritoneum of the uterine bladder reflex is cut transversely, and the bladder is separated and pushed down to the cervix. (4) Clamping the two uterine horns with the claw clamp, and cutting the uterus from the midline of the uterus to the lower longitudinal section, reaching the cervix orally, the uterus is in two halves, and the uterine artery is clamped. The cervix was cut transversely and the uterine artery was double-slited. (5) After disposing half of the uterus, use two fingers to lift the accessory mass of the lesion from below. Adhesive organs are easier to separate. A half of the uterus and the lesions were attached to the pelvis, and the upper part of the broad ligament was stretched. The three long curved jaws were clamped, cut off, and half of the uterus and mass were removed. The suture was ligated and ligated with a 7-gauge thread. (6) The same side handles the opposite side. (7) suture the abdominal wall layer by layer. complication Adhesion of the pelvic and abdominal organs, dextran (32% Dextran-70) in the abdominal cavity, postoperative physiotherapy and traditional Chinese medicine treatment, have a certain preventive effect.