tubal pregnancy tubectomy

Tubal pregnancy resection and fallopian tube surgery for the surgical treatment of ectopic pregnancy. The implantation of pregnant eggs outside the uterine cavity is collectively referred to as ectopic pregnancy, also known as ectopic pregnancy, which is a common gynecological disease, and its incidence has increased in recent years. In terms of the implantation site of the pregnant egg, it can be divided into tubal pregnancy, ovarian pregnancy, abdominal pregnancy, residual uterine pregnancy, cervical pregnancy and the like. Among them, tubal pregnancy is more common, accounting for 95% to 97%. In tubal pregnancy, pregnant eggs can be implanted in any part of the fallopian tube, such as umbrella end, ampulla, isthmus, interstitial and so on. Among them, ampullary pregnancy is more common. Treatment of diseases: tubal pregnancy Indication 1, acute onset, accompanied by internal hemorrhagic shock, after examination of suspected tubal pregnancy, emergency surgery while saving shock. 2, the attachment block continues to increase, the urine pregnancy test continues to be positive, B-ultrasound confirmed tubal pregnancy, and the embryo continues to develop and has a tendency to destroy. Preoperative preparation 1, for patients with severe shock should be rapid blood transfusion, fluid replacement, oxygen, if necessary, do venous incision, rapid pressure transfusion, active rescue, while preparing for surgery. When the shock is improved, surgery is performed. If a large amount of bleeding in the abdominal cavity persists, although the rescue is not treated, the laparotomy should be immediately explored to gain time and stop the blood quickly, saving the patient's life. 2. Prepare for autologous blood transfusion. 3, mild patients to correct anemia, good preparation for intraoperative blood transfusion. 4, in remote areas, no blood bank and surgical facilities, the patient should be placed in a rectal, given morphine 10mg or 50-100mg cold, intravenous hypertonic sugar or intravenously balanced salt, dextran as a first aid, and then escorted to surgical conditions Hospital. Central stimulating drugs, booster drugs, laxatives or enema are prohibited before surgery to avoid exacerbating internal bleeding. Surgical procedure 1, cut the abdominal wall In the lower abdomen umbilical cord, the median longitudinal incision is made, and the abdominal wall is cut according to the layer. If there is blood in the abdominal cavity, the peritoneum is dark blue after separating the rectus abdominis. If there is no contraindication for autologous blood transfusion, the peritoneum is cut into a small mouth and placed in a straw. The blood in the abdominal cavity is collected in a sterile blood storage bottle with anticoagulant and ready for input. After the blood is sucked out, the peritoneal incision is enlarged. 2, control bleeding at the rupture The hand extends into the pelvic cavity, first touches the uterus as a sign, finds the diseased side fallopian tube, pulls it out by hand after separation, and quickly clamps the sides of the enlarged part with a vascular clamp or an oval clamp to cut off the bleeding source. To control bleeding at the rupture, be careful not to pinch the intestine. 3, check the uterus attachment, choose the surgical method After the blood in the abdominal cavity is aspirated, the examination determines the implantation site of the pregnant egg, the damage of the fallopian tube and the relationship with the surrounding tissue, whether the ovary is normal, which type of tubal pregnancy belongs to, and which operation is decided. If the fallopian tube isthmus, ampullary pregnancy rupture or miscarriage, fresh rupture, partial or complete fallopian tube resection, that is, starting from the end of the umbrella, use the hemostasis to gradually cut the fallopian tube mesenteric, such as partial resection, then in the fallopian tube isthmus Clamp, ligated with a 7-gauge thread. Sometimes the fallopian tube isthmus pregnancy rupture in the broad ligament, blood infiltration into the peritoneum, and even into the axillary to form a hematoma, can cut the peritoneum of the hematoma sidewall, carefully dig the hemorrhage, pay attention not to hurt the ureter. If the fallopian tube is severely damaged and it is impossible to retain all of them, the oviduct can be clamped until the uterine horn makes a wedge-shaped incision, and all the fallopian tubes are removed. Use the 7th silk thread or the 1-0 chrome gut for the 8th muscle layer suture, you can first pass through the suture at the uterine horn, then wedge-cut the interstitial part of the fallopian tube, and then tighten the suture, which can reduce blood loss. The fallopian tube interstitial pregnancy rupture, the lesion range is small, the rupture is not large, then the uterine angle wedge resection. The muscle layer was sutured with a 0 or 1-0 chrome gut, the first layer was sutured through the whole layer, and the second layer was sutured continuously. If the rupture was large, the uterine lesion was wide, and a total hysterectomy was required. If the diseased side of the ovary is severely damaged, or the fallopian tube ovary has adhesions, it is not easy to separate, while the contralateral ovary is normal, in order to gain time, the fallopian tube ovary can be removed at the same time. Use the tissue forceps to lift the tubal ovary intrinsic ligament, stretch the pelvic funnel ligament, clamp with 2 long curved hemostats, cut in the middle of the two vascular clamps, use the round needle 10 wire to ligature, and use the 7th wire near the heart. Ligation 1 time. After the fallopian tube is removed, the anterior and posterior ligaments of the wide ligament are sewed, and the round ligament is sewed behind the uterine horn to cover the rough surface of the incision to prevent adhesion. In an emergency, the last two steps may not be performed. 4, processing the contralateral attachment It is determined according to the patient's time and conditions. If the contralateral fallopian tube is normal, the patient has children, requires sterilization, and consent to the family members before surgery, can also perform sterilization surgery; if the contralateral fallopian tube has lesions, and does not wish to have another child, the patient is generally in good condition and should be removed. Prevention of secondary ectopic pregnancy after the day. 5, clear the pelvic blood Wash the abdominal cavity with normal saline, and exhaust the blood, especially the uterus rectal fossa and the axillary fossa on both sides. The area is low and the blood is more. Pay attention to clear it to prevent postoperative adhesion and infection. If the patient is not good, do not over-emphasize Do your best. 6. Suture the abdominal wall layer by layer. complication Intraoperative blood is not completely removed, the wound surface is rough, the bed is prolonged after surgery, the pelvic cavity is easy to adhere, and intestinal adhesions and intestinal obstruction can occur. Therefore, patients should pay attention to early bed-out activities.