abdominal subtotal hysterectomy

The operation is simple, it is not necessary to cut the vagina, reduce the chance of infection; does not affect the support of the pelvic floor, can prevent vaginal bulging and prolapse; preserve the normal length of the vagina, does not affect the postoperative sexual life. Treatment of diseases: pregnancy with uterine fibroids uterine fibroids Indication Patients with uterine fibroids younger than 35 to 40 years old with no lesions of the cervix and indications for surgery; patients with abnormally difficult hysterectomy; severe systemic complications such as heart, liver, kidney, etc. Damage, poor tolerance to surgery, or emergency removal of the uterus. Contraindications Contraindications: pelvic malignant lesions (except early onset carcinoma in situ), endometriosis with extensive pelvic adhesions and pelvic inflammatory disease, larger and lower position cervical fibroids, broad ligament fibroids, with larger sum There are adhesive attachment blocks (>6cm diameter), the height of the fundus is higher than the umbilicus, and the vagina is extremely narrow. Preoperative preparation Cervical smear and diagnostic curettage were performed before surgery to exclude cervical and uterine malignant tumors. Surgical procedure For the inferior median incision; after exploring the pelvic and abdominal cavity, use 2 curved vascular clamps to lift the uterus from the uterine horn; if the side attachment is to be removed, lift the resection side fallopian tube, open the anterior and posterior lobe of the broad ligament, expose the ovarian arteriovenous, use 3 The vascular clamp is clamped in turn, and the end is double-slited or ligated. Continue to expose the round ligament forward and cut it in the middle, and the stump is ligated with a 7-gauge thread. Open the bladder to reverse the peritoneum, if you need to remove one side of the fallopian tube and retain the side of the ovary, you need to treat the mesentery in several stages, and cut the ligation of the ovary intrinsic ligament. If the attachment is retained, use the 2 curved vascular clamps close to the uterine horn to clamp the isthmus of the fallopian tube and the ovarian intrinsic ligament, and then cut it with a 7-gauge thread. Separate and slightly push the bladder to about 1cm below the uterine isthmus, do not need to free the bladder; treat the uterine blood vessels: reduce the loose tissue around the uterus, and then use the three curved vascular clamps to clamp the uterine vessels vertically at the level of the uterine isthmus, then cut off. The suture was cut 2 times with the 7th thread; the uterus was removed along the uterine isthmus, and the uterine stump was sutured intermittently with the 0-series line; the pelvic peritoneum was sutured; the peritoneum was sutured. complication 1. Bleeding: When dealing with uterine round ligament, ovarian intrinsic ligament, and fallopian tube, the end of the suture is not tight or the knot is slippery and causes bleeding, so double ligation is appropriate. When cutting the uterine arteries and veins, the tissue surrounding the uterine arteries and veins should be separated as much as possible, the blood vessels should be recognized, and the uterus should be clamped tightly and firmly ligated. When pushing down the bladder, it is necessary to distinguish the levels, too shallow or too deep will cause bleeding. 2. Adjacent organ injury: Because subtotal hysterectomy is often used for adhesion between uterus and pelvic organs, especially when the bladder, rectum and cervical adhesions are dense, the anatomical level is not clear, and bladder, rectum and ureteral damage are prone to occur. Once it appears, it should be patched immediately.