Transabdominal tubal ligation

Curing disease: Indication Transabdominal tubal ligation is applicable to: 1. Both married couples and couples require sterilization. 2, due to systemic diseases or certain genetic diseases are not suitable for childbearing. 3, again cesarean section. Contraindications 1. Systemic diseases cannot tolerate surgery. 2, patients with severe neurological disorders, emotional instability, the majority of concerns about surgery. 3, the following conditions should be suspended surgery: 1 abdominal wall with infected lesions or internal and external genital inflammation. Two times in 224h, the body temperature is above 37.5 °C. Preoperative preparation 1, detailed medical history, do a whole body and gynecological examination, blood, urine routine examination, detection, clotting time, chest penetration if necessary. 2. Regular preparation for abdominal surgery. 3, soapy water enema 1 time before surgery. 4, fasting 1 meal before surgery. 5, sedatives before the operation, such as phenobarbital 0.1g or diazepam 10mg. Surgical procedure 1, take the head low hip high supine position, the abdomen according to routine disinfection, laying a sterile towel list. 2. Remove the median longitudinal or transverse incision of the abdomen. The size depends on the degree of obesity in the abdominal wall. The longitudinal incision after non-pregnancy or abortion is based on the pubic symphysis combined with 2 transverse fingers (about 3 cm). The straight incision after postpartum or mid-term induction is After massage the uterus to make it contract, the 2-3 cm below the bottom of the palace is the starting point along the abdominal white line, and the incision is about 2-3 cm long. The transverse incision is 2-3 cm below the pubic symphysis or under the uterine fundus. 3. Find the fallopian tube. The fallopian tube can be obtained by oval pliers, fallopian tube hook, fingerboard or endoscopic direct vision. 4. Ligation of the fallopian tubes. The ligation method is safe, simple, reliable, and has few side effects, and is conducive to future fallopian tube recanalization. There are several methods commonly used: (1) The proximal end of the core extraction method: use 2 tissue clamps to clamp the avascular part of the isthmus of the oviduct, the two clamps are about 1.5-2cm apart, and 0.5% procaine 1-2ml is injected into the serosa to make the slurry. The membrane is separated from the fallopian tube core. The serosal membrane is cut longitudinally about 2 cm in the dilatation of the dorsal injection of the fallopian tube. The mosquito-clamp is clamped to the edge of the serosa, and the serosa layer is gently separated. At both ends, the clamp distance is 1.0cm, and the fallopian tube core between the two clamps is cut about 1.0cm. The two ends are ligated with the 4th wire, the proximal end is embedded in the mesentery, and the serosa incision is sutured intermittently with the No. 1 silk thread. The end was fixed to the outside of the serosa with a No. 1 silk thread. (2) Sleeve ligation: In the isthmus of the fallopian tube, the serosa is lifted with a small mosquito clamp, and 1-2 ml of 0.5% procaine is injected under the serosa to separate the serosa layer from the die, near the isthmus. At the end, the serosa layer is cut together with the die. The cut can not be too deep. Only the die can be cut to prevent the film from tearing. The two ends are ligated with the No. 1 wire, and the proximal core is slightly sewed with the pattern clamp. Separate about 1 cm, retract it into the sleeve of the serosa, and suture the proximal septum with a No. 1 silk suture proximal serosa. The distal serosa was sutured with a No. 1 silk thread to expose the die to the serosa. (3) Double-folded frustration ligation and cutting method: Select the lessal part of the oviduct isthmus, use the tissue clamp to clamp the isthmus of the fallopian tube, and fold it. Use the vascular clamp to clamp the fallopian tube at a distance of about 1.5-2 cm from the tip of the clamp. Muscle and intima, remove the vascular clamp, use the 4th wire to sew through the frustrated mesangium, ligature the indentation, first ligature near the uterus, then return to the other end of the ligation, cut 1cm above the line The fallopian tube, the proximal end is then ligated with a thin wire. In order to prevent adhesion, the lumen of the fallopian tube can also be used to embed the lumen. 5, check the broken end without bleeding back to the abdominal cavity.