Abdominal extensive hysterectomy, total vaginal and total urethrectomy plus bladder flap replacement of urethral abdominal wall transplantation

All vulvar, vagina, cervix and other cancers are committed to the bladder, the urethra and the whole vagina, but the main ligament, uterine ligament and vagina are not infiltrated into the pelvic wall. Treatment of diseases: cervical cancer bladder cancer Indication All vulvar, vagina, cervix and other cancers are committed to the bladder, the urethra and the whole vagina, but the main ligament, uterine ligament and vagina are not infiltrated into the pelvic wall. Preoperative preparation 1. The corresponding examination should be carried out to understand the entire urinary system. 2. Oral antibiotics for 3 to 5 days before surgery. Surgical procedure Surgical sequence: extensive uterus total vaginal, total urethral resection bladder flap urethral abdominal wall transplantation. 1. Abdominal incision: mid-lower incision in the middle and lower abdomen, from the upper edge of the pubic symphysis, up to 2 ~ 3cm around the umbilicus. 2. Extensive total uterine resection: See extensive hysterectomy and extensive uterine total vaginal resection. 3. Expose the anterior wall of the bladder: pull the uterus backwards and upwards, and cut the pelvic peritoneum at the bottom of the bladder. The peritoneum is separated to the pubis and the anterior wall of the bladder is free. 4. Expose the upper part of the anterior wall of the urethra: under the pubic symphysis, separate the loose connective tissue between the pubis and the bladder and the urethra, reveal the lower part of the bladder and the upper part of the urethra, continue to free the urethra under the shame, and release the upper and middle urethra. 5. Cut the upper urethra: cut the urethra along the lower edge of the pubis at the urethra. The urethral stump was continuously locked and sutured. 6. Perineal incision: an arc-shaped incision is made about 1 cm above the outer urethra, and the vaginal mucosa is formed along the left and right vestibules to form an elliptical incision. 7. Separation of the anterior segment of the anterior wall of the urethra: along the incision above the urethra, the connective tissue around the anterior wall of the urethra and the urogenital muscles are separated from the lower edge of the pubic symphysis, deep to the anterior wall of the lower bladder, and the entire urethra is free. 8. Separation of the vagina: separation of the posterior wall and lateral wall of the vagina, the method is the same as extensive uterine resection of the whole uterus (see extensive uterus plus total vaginal resection). At this point, the surgical specimen can be removed from the vaginal incision. In the abdominal surgery group, two hoses were placed for drainage Vaseline gauze applied to the wound surface all the iodoform yarn was clogged and then fixed by the vagina. Methods See extensive uterine total vaginal resection. 9. Close the pelvic peritoneum: The abdominal group surgery cooperated with the vaginal surgery group to close the pelvic peritoneum. 10. Bladder valve artificial urethra formation: a 9 cm × 5 cm bladder flap with a nearly trapezoidal shape on the anterior wall of the bladder. From the neck of the bladder, the base is at the base of the bladder. The bladder wall incision was sutured continuously with a 3-0 absorbable line and made into an artificial urethra. 11. Bladder valve artificial urethral abdominal wall transplantation: a 1.5-2 cm diameter circular incision was made in one side of the lower abdomen skin, and then the peritoneal surgical fascia was cut in a cross shape, and the end of the artificial urethra was taken out of the abdomen. , with no tension. 12. Fix the base of the artificial urethra: The artificial urethral adventitia and the external oblique muscle fascia are sutured for 4 to 5 needles at about 3 to 4 cm below the bladder fistula. 13. Stitching the artificial urethral opening: suture the artificial urethral opening and suture the skin. The suturing method is to take a needle from the muscular layer at the lower edge of the bladder fistula, and then the entire layer penetrates the bladder fistula and is ligated with the skin. 14. Fix the artificial urethral opening: make the bladder fistula nipple-like, retaining the suture. Place a small iodine imitation yarn around the mouth and fix it with the original suture. 15. Acupuncture: The abdominal wall is sutured in layers, and the right lower abdomen is the location of the bladder fistula. complication The common cause of poor drainage of the artificial urethra of the abdominal wall is clot blockage. It should be removed as soon as possible. If necessary, replace the mushroom tube to avoid leakage of the bladder wall due to water injection into the bladder. 1. Vaginal bleeding: postoperative vaginal drainage, color bright red, may have active bleeding, should use hemostatic drugs, if necessary, re-clogging the vaginal yarn. When conservative treatment is ineffective, it should be stopped in time to stop bleeding. 2. Postoperative infection: This operation has a large wound surface and is easy to be contaminated. Strong antibacterial drugs should be used after surgery. If the body temperature continues to be above 39 °C, vaginal secretions and blood samples should be taken for bacterial culture and drug susceptibility test in time, and the drug should be used under the guidance of drug susceptibility results.