tubal pregnancy abdominal dissection

Treatment of diseases: tubal pregnancy Indication 1. Local hemorrhage in the tubal pregnancy is inactive, the wall is not broken or the rupture is small, and the patient's general condition is stable. 2. The patient has the requirement to retain fertility and is easy to follow up after surgery. 3. Exclude intrauterine pregnancy. Contraindications 1. Severe cardiovascular disease and pulmonary insufficiency. 2, diffuse peritonitis. 3, umbilical hernia, hernia, abdominal wall hernia, inguinal hernia or femoral hernia. 4, middle and late pregnancy. 5, abnormal blood coagulation. 6, due to a history of surgery, extensive scarring of the abdominal wall or extensive adhesions in the abdominal cavity. 7, obese. 8, ectopic pregnancy hemorrhagic shock. Preoperative preparation 1. Preparation of the skin of the abdomen and vulva (including the cleaning of the umbilicus). 2, before the preparation of the bowel surgery, 0, 1% soapy water enema. 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 intestinal tract, should be used 3 days before surgery to prevent infection. Sedative, atropine or scopolamine was injected 30 min before surgery. 4, indwelling catheter. 5, prepare blood or prepare for autologous blood transfusion. Surgical procedure 1, supine position, routine disinfection, drape and cover sheet, umbilical cord gas needle puncture filling CO2 gas into pneumoperitoneum. 2, the first hole of the 10mm casing sheath puncture, set the mirror. 3, under the microscope to detect the situation in the abdominal cavity, to understand the pregnancy side of the fallopian tube and uterus, contralateral attachments. 4, the second side of the lower abdominal wall of the lower abdominal wall 10mm, 5mm casing sheath puncture. 5, sucking up the blood in the abdominal cavity and blood clots, take the head low foot high (about 10 ° ~ 15 °). 6. Separate the adhesions and blood clots around the oviduct on the affected side, and move the oviduct on the side of the lesion to the front of the uterus, and fix it with a clamp or a probe. 7. Use electrocoagulation or needle electrode to cut along the longitudinal axis (edge and cut) the wall of the fallopian tube, usually 1cm. 8. Use the bending separation clamp to clamp the embryonic tissue and clot in the fallopian tube, or use the suction tube to suck out. Be careful not to damage the wall of the fallopian tube, but try to take the net pregnancy tissue. 9. Use bipolar coagulation, monopolar coagulation or internal coagulation to control the bleeding of the inner wall of the tube. 10. If the incision is less than 5mm, it may not be sutured. If it is larger than 5mm, it is necessary to suture one needle. 11. Rinse the abdominal cavity and check for active bleeding. Aspirate the effusion, vent, take the cannula sheath and suture each puncture hole.