Watkin-shauta-wartheim surgery

Watkin-shauta-wartheim surgery is used for surgical treatment of uterine prolapse. The external cervix descends below the plane of the ischial spine, which is called uterine prolapse. The cervix descended, but did not reach the vaginal opening, which was lighter than I; the cervix descended to the vaginal opening and was not exported, which was I degree. The cervix is removed from the vaginal opening, and the uterus is still in the vagina, which is lighter to the second degree; the cervix and part of the uterus are removed from the vaginal opening, which is II degree. The cervix and the uterus are all removed from the vaginal opening, which is called III degree uterine prolapse. Often accompanied by varying degrees of vaginal anterior and posterior wall bulging and cervical elongation. Cut the anterior wall of the vagina, separate the bladder from the cervix, and then cut the ventral pleats of the bladder uterus, pull the uterus out of the incision, and fix it between the bladder and the anterior wall of the vagina. It is called uterine vaginal and bladder interposition, referred to as Watkin- Shauta-wartheim surgery. It was Watkin's first application in 1898. In 1989, Wertheim reported the same surgical procedure, and then Shauta improved it, so it was called interuterine surgery. Treating diseases: uterine prolapse Indication Watkin-shauta-wartheim surgery is suitable for menopausal I, II or III degree uterine prolapse, with severe bladder bulging. Contraindications 1. Functional uterine bleeding, tubal effusion, fallopian tube ovarian cysts and uterine fibroids. 2. Preoperative routine diagnosis of segmental curettage, suspected cancer, forbidden to do this surgery. 3. The uterus should not be too large, but too small to support the bladder. Preoperative preparation 1. Eat eutrophic, digestible diet, 2d less slag diet before surgery, a small amount of pre-operative dinner, and breakfast on the day of surgery to avoid vomiting during surgery. 2. Start 3 days before surgery, gently scrub the vaginal wall with soapy liquid every day, then rinse with water, then rinse with 1:1000 Xinjieer liquid and dry the vaginal wall. 3. Clean the enema before the operation. 4. Prepare the skin 1 day before the operation. The preparation range includes the pubic symphysis, the genital area, the upper third of the upper thigh and the lower part of the thigh and the anus. It is estimated that the operation is difficult, and the abdominal surgery is required. Surgical procedure 1. Routine disinfection of the vulva and vagina, cover the disinfection towel. Guide the catheter with a metal catheter. Use the No. 4 silk thread to sew the labia minora on both sides of the labia majora to expose the vestibule. Use the vaginal retractor to open the vagina, expose the cervix, and then clamp the anterior lip of the cervix with double-jaw forceps or tissue forceps and pull it toward the vaginal opening. Note procaine or saline plus an appropriate amount of adrenaline (hypertensive disabled) into the vaginal mucosa, the sides of the bladder and so on. The anterior wall of the vagina is curved under the bladder groove, and the sides should reach the side. 2. Use curved scissors to extend from the incision between the vaginal wall and the bladder wall. The scissors tip should be placed against the vaginal wall. One by one, separate the vaginal wall from the bladder, and carefully approach the urethral opening to the urethral opening about 1 cm. Cut the anterior wall of the vagina after the longitudinal shape. The slit has an inverted T shape. 3. Hold the cut vaginal anterior wall with a rat tooth forceps and pull to both sides to expose the bladder under the incision. Bluntly separate, push the pubis cervix fascia to reach the inner edge of the puborectalis muscle. 4. Pull the cervix down and see that the bladder is attached to the cervix. A layer of fascia is placed at the junction of the bladder and the cervix, and the fascia is cut and extended to both sides. 5. Wrap the finger with gauze, separate the loose connective tissue between the bladder and the cervix, push up the pleats of the bladder uterus and free the bladder. 6. Retract the bladder with a small vaginal retractor, expose the bladder uterine peritoneal pleats, cut the peritoneum here, and extend slightly to both sides. A thread is sewn to the edge of the peritoneum and left as a marker. 7. In the midline of the anterior wall of the uterus, use the gut line for two or three 8-word sutures, leave the long line tail for traction, or use the rat tooth clamp to clamp the part, and gradually pull out the uterus from the peritoneal incision. 8. The edge of the bladder peritoneal incision was sutured to the posterior wall of the uterus with a gut to close the peritoneum. 9. The uterus is sutured to the tissue under the pubic arch with the gut, and the other gut is sutured to the bottom of the uterus, passing through the vaginal mucosa under the urethra to prevent the bladder from bulging again. Cut off excess vaginal mucosa. The anterior vaginal wall on both sides was sutured to the midline with a 2-0 chrome gut line. Pay attention to the suture and the uterine serosa underneath to avoid the formation of dead space. 10. The surgery is completed and the uterus is between the anterior wall of the vagina and the bladder complication Hemorrhage or hematoma Intraoperative vascular or stump ligation is not strong, a large amount of bleeding can occur in a short time after surgery, the vaginal wall suture should be disassembled, the bleeding blood vessels should be searched, and the suture should be re-sewn. If only a small amount of bleeding, gauze can be used to fill the vaginal pressure to stop bleeding, and use hemostasis drugs such as Yunnan Baiyao. 2. Wound infection There are many vaginal folds, so it is not easy to completely disinfect. The accumulation of small blood vessels in the surgical field is conducive to bacterial reproduction, and hematoma formation after surgery is more likely to occur. The vaginal purulent secretion in the vagina of the light is accompanied by a vaginal burning sensation; the body temperature fluctuates and rises, the vaginal wall suture is healed or necrotic, there is purulent secretion, antibiotics can be applied, drainage, And keep the vulva clean. 3. Urinary tract complications 1 less urine (<600ml / d), due to postoperative reluctance to drink water or hot days, should be supplemented with intravenous saline or 5% glucose solution; 2 urethritis, cystitis, mostly due to repeated catheterization Cause, there are frequent urination, urgency, hematuria and other symptoms, given antibiotics, diuretics and other treatment.