Spaulding-Richardson surgery

Spaulding-Richardson surgery for surgical treatment of uterine prolapse. The external cervix descends below the plane of the ischial spine, which is called uterine prolapse. The cervix descended, but did not reach the vaginal opening, which was lighter than I; the cervix descended to the vaginal opening and was not exported, which was I degree. The cervix is removed from the vaginal opening, and the uterus is still in the vagina, which is lighter to the second degree; the cervix and part of the uterus are removed from the vaginal opening, which is II degree. The cervix and the uterus are all removed from the vaginal opening, which is called III degree uterine prolapse. Often accompanied by varying degrees of vaginal anterior and posterior wall bulging and cervical elongation. Curing disease: Indication Spaulding-Richardson surgery is suitable for II, III degree uterine prolapse, no longer fertility, but is willing to maintain normal vaginal function; with cervical hypertrophy, prolongation, or combined with functional uterine bleeding or small and medium uterine fibroids. Contraindications 1, poor general condition, such as severe heart disease, hypertension, nephritis, diabetes, cirrhosis, liver damage, active tuberculosis, pulmonary insufficiency, long-term cough, mental disorders, malignant tumors, bleeding disorders and severe anemia It is not suitable for surgery, and then consider it after improvement. 2, vulvitis, vaginitis (trichomoniasis, fungus or senile), severe cervical erosion or pelvic inflammatory disease, etc., should be controlled after surgery. 3, the cervix and / or vaginal ulcers, it is not suitable for surgery when not healed; if the ulcer is superficial and located within the scope of resection, surgery can also be performed. 4. Patients with malignant lesions in the cervix or uterus. It is not suitable for uterine prolapse surgery. Cervical carcinoma in situ or very early uterine body cancer, may be considered for vaginal removal of the uterus, repair the anterior and posterior wall of the vagina. 5, menstrual period, pregnancy and lactation are not suitable for surgery. After 3 to 7 days of menstruation, the incision will be healed before the next menstrual cramp. If surgery is performed during pregnancy, the possibility of recurrence of uterine prolapse is high. The tissue is weak during lactation, the suture is easy to cut, easy to bleed, and the infection is easy to spread. Preoperative preparation 1, a few days before surgery to eat eutrophic, easy to digest diet, 2d less slag diet before surgery, a small amount of pre-operative dinner is appropriate, breakfast is prohibited on the day of surgery, in order to avoid vomiting during surgery. 2, 3d before surgery, gently scrub the vaginal wall with soapy liquid every day, then rinse with water, then rinse with 1:1000 Xinjieer liquid, dry the vaginal wall. 3. Clean the enema before the operation. 4, skin preparation 1 day before surgery, skin preparation range includes pubic symphysis, genital area, upper thigh 1/3 inner side of the buttocks and around the anus; it is estimated that surgery is difficult, need to undergo abdominal surgery, while cleaning the abdominal skin. 5, due to surgery through the vagina into the abdominal cavity, disinfection should be more rigorous. Preparation for blood transfusion should be done. Surgical procedure 1, routine disinfection of the vulva and vagina, cover the disinfection towel. Guide the catheter with a metal catheter. Use the No. 4 silk thread to sew the labia minora on both sides of the labia majora to expose the vestibule. Use the vaginal retractor to open the vagina, expose the cervix, and then clamp the anterior lip of the cervix with double-jaw forceps or tissue forceps and pull it toward the vaginal opening. Note procaine or saline plus an appropriate amount of adrenaline (hypertensive disabled) into the vaginal mucosa, the sides of the bladder and so on. The anterior wall of the vagina is curved under the bladder groove, and the sides should reach the side. 2, using curved scissors from the incision into the vaginal wall and the bladder wall, the scissors tip should rely on the vaginal wall, one by one, separate the vaginal wall from the bladder, carefully to the direction of the urethra, directly to the urethra below about 1cm. Cut the anterior wall of the vagina after the longitudinal shape. The slit has an inverted T shape. 3. Hold the cut vaginal anterior wall with a rat tooth forceps and pull to both sides to expose the bladder under the incision. Bluntly separate, push the pubis cervix fascia to reach the inner edge of the puborectalis muscle. 4, traction the cervix down, visible bladder attached to the cervix. A layer of fascia is placed at the junction of the bladder and the cervix, and the fascia is cut and extended to both sides. 5, wrap the fingers with gauze, separate the loose connective tissue between the bladder and the cervix, push up the bladder uterus peritoneal deflation, free bladder. 6. Pull the uterus forward and upward, expose the posterior wall of the vagina, cross the incision along the cervix, extend backwards, and cut around the cervix for 1 week. The posterior wall of the vagina and the posterior part of the cervix are separated to reveal the main ligaments on both sides of the cervix. The curved hemostatic forceps clamped the main ligament close to the cervix, cut it, and sewed the end with a 2-0 chrome gut. The contralateral main ligament is treated in the same way. 7. Cut off the prolonged cervix. The cut surface is slightly conical with the cervix or slightly inward. 8. Use a triangular curved needle with a 1-0 chrome gut, pass through the left and right horns of the cervical tissue, and sew the descending branch of the uterine artery to reduce bleeding from the cervical section. One end of the gut is treated with a triangular curved needle with a No. 1 chrome gut, passing through the midpoint of the posterior lip of the cervix, and then pierced into the posterior wall of the cervix through the cervical canal, and out of the cervix to the outside of the mucosa; the other end is treated the same way. The two needles are separated by a distance of about 0.5cm, and the mucosa is covered by the posterior lip wound. 9. Cut the peritoneum at the pleats of the bladder uterus and extend the incision to both sides. 10. Pull the uterus out of the incision. If the uterus is too large, a part of the anterior wall of the uterus may be removed first, and the uterus is reduced and then pulled out of the incision. 11. Clamp the oviduct, ovarian ligament and round ligament on the right side with 3 long curved forceps, cut between the inner and the 1st clamps, double suture with 10th thread, and the first line is reserved for traction. The left fallopian tube, ovarian ligament and round ligament were treated by the same method. 12, with 2 bending pliers close to the left edge of the uterus to clamp the broad ligament and other uterine artery ascending branch, cut off from it, double suture ligation with a 10 wire. The same method is used to treat the right broad ligament. The uterus was removed laterally at the upper edge of the uterine isthmus. 13, the cervical end of the end with a No. 1 chrome gut line relatively interrupted suture. The ends of the round ligament, fallopian tube and ovarian ligament were sutured to the cervical stump. 14. The upper edge of the bladder uterine peritoneal bleed is sutured on the peritoneum behind the cervical stump with a 0-chrome gut line to close the abdominal cavity. 15. The sutures of the main ligaments on both sides are sutured to the anterior midline of the cervix, so that the preserved cervix is up and back to strengthen the support function of the pelvic floor. The 4th silk thread or the 2-0 chrome gut is used to suture the anterior vesicle of the bladder relative to the bladder. 16. The top of both sides of the anterior wall of the vagina is sutured to the stump of the cervix and covered in front of the cervix to form a new anterior lip of the cervix. The anterior and posterior vaginal walls on both sides of the cervix were sutured with a 2-0 chrome gut. 17. Cut off the excess anterior wall of the vagina and suture it with a 2-0 chrome gut. Repair of the posterior wall of the vagina with the aforementioned posterior vaginal wall repair. complication 1, hemorrhage or hematoma Intraoperative vascular or stump ligation is not strong, a large amount of bleeding can occur in a short time after surgery, the vaginal wall suture should be disassembled, the bleeding blood vessels should be searched, and the suture should be re-sewn. If only a small amount of bleeding, gauze can be used to fill the vaginal pressure to stop bleeding, and use hemostasis drugs such as Yunnan Baiyao. 2, wound infection There are many vaginal folds, so it is not easy to completely disinfect. The accumulation of small blood vessels in the surgical field is conducive to bacterial reproduction, and hematoma formation after surgery is more likely to occur. The vaginal purulent secretion in the vagina of the light is accompanied by a vaginal burning sensation; the body temperature fluctuates and rises, the vaginal wall suture is healed or necrotic, there is purulent secretion, antibiotics can be applied, drainage, And keep the vulva clean. 3, urinary tract complications 1 less urine (<600ml / d), due to postoperative reluctance to drink water or hot days, should be supplemented with intravenous saline or 5% glucose solution; 2 urethritis, cystitis, mostly due to repeated catheterization Cause, there are frequent urination, urgency, hematuria and other symptoms, given antibiotics, diuretics and other treatment.